The Science Journal of the American Association for Respiratory Care
Background: A large number of papers have been reported that conventional chest physical therapy failed to improve in critically ill patients. Particularly, Trendelenburg position and chest wall percussion were the cause of hypoxia, arrhythmia, bronchospasm, increase in intracranial pressure and pain. I have already reported the results of meta-analysis in cardiopulmonary physical therapy, which chest wall percussion is ineffective, combined aerosol therapy and chest PT was more effective than chest PT. The purpose of this study was to compare the effect of squeezing and percussion in critically ill patients. Method: I instructed registered nurses in two hospitals about chest PT before this study. However, the effect of percussion and squeezing were blinded. STUDY 1: Sixty one patients undergoing thoracic or abdominal surgery were randomized into two groups. The first group (n=32) received modified drainage position with squeezing and the second group (n=29) treated drainage position with percussion. I compared the number and duration of atelectasis or pneumonia and length of ICU stay. STUDY 2: One hundred sixty one patients admitted by trauma or cerebral vascular accident were randomized into two groups, which were squeezing group (n=80) and percussion group (n=81). I compared the same parameters as study I. STUDY 3: I determined the effect was based on examination of the effect size (ES) or Odds ratio of study 1 and 2. Results: The duration of atelectasis or pneumonia was significantly shorter in squeezing group (2.4 ± 3.4 days) than percussion group (3.6 ± 3.0 days) in STUDY 1 (p<0.05). The length of ICU stay significantly reduced in squeezing (3.3 ± 2.5 days) compared with percussion (4.6±2.4 days) in STUDY 1 (p<0.05). In the STUDY 2, the duration of atelectasis or pneumonia was also significantly shorter in squeezing (7.4 ± 3.7 days) than percussion (13.4±3.6 days) (p<0.001). The length of ICU stay significantly reduced in squeezing (9.7±2.2 days) compared to percussion (16.5±3.4 days) (p<0.001). Odds ratio of atelectasis and pneumonia in study 1 and 2 was as follows. Conelusions: 1) Squeezing technique significantly reduced the number of pulmonary complications more than chest wall percussion in critically ill patients. 2) Squeezing technique reduced the duration of atelectasis more than chest wall percussion in critically ill patients. 3) Squeezing technique reduced the length of ICU stay more than chest wall percussion in critically ill patients.
|study 1||32||29||0.21||0.06 |
|study 2||80||81||0.62||0.33 |