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Volume 2, No 3, September, 2001
CHEST PHYSICAL THERAPY AND ITS EFFECTS ON LUNG FUNCTIONS IN MECHANICALLY VENTILATED CRITICALLY ILL INFANTS
Saadia Abd El-Fattah MD.*, Mahmoud Tarek Abd El-Monim MD.*, Ehab Abd El-Aziz Ph.D.**, Ahmed M. El-Kahky Ph.D.**, Hala Ahmed El-Sayed PT.D.***, Faten H. Abd El-Aziem PT.D.**** and Abeer E.M.Salem* Pediatric department, Faculty of Medicine, Ain Shams University *; Institute of Post-Graduate Childhood Studies (medical dept.), Ain Shams University **; Faculty of Physical Therapy, Misr University for Science and Technology ***; Faculty Of Physical Therapy, Cairo University ****.
Abstract
BACKGROUND: Mechanical ventilation is the principal mode of respiratory support for critically ill patients with respiratory failure. Chest physiotherapy (CPT) in mechanically ventilated infants is needed since intubated patients are unable to cough effectively and may retain bronchial secretions.
OBJECTIVES: To evaluate the effects of applying chest physiotherapy (CPT) to mechanically ventilated critically ill infants in relation to their pulmonary mechanics, blood gases, ventilator settings and outcome.
SUBJECTS & METHODS: The study included 30 mechanically ventilated critically ill infants who were subjected to CPT (percussion, vibration, and postural drainage) [group I] in comparison to 20 mechanically ventilated infants who were not subjected to CPT [group II]. Radiological findings, ventilator settings, capillary blood gases (CBG), pulmonary mechanics and final outcome were evaluated in both groups. Evaluation was done at time of their admission and repeated 48 hours later as well as just before extubation in those who survived. Studied pulmonary mechanics included: minute ventilation total (MVT), tidal volume spontaneous (TVS), tidal volume mechanical (TVM), dynamic compliance (CD), mean airway pressure (MAP), peak expiratory flow (PEF), airway resistance (RAW) and work of breathing (WOB).
RESULTS: Initial evaluation showed no significant differences between both groups as regards CBG and pulmonary function parameters. PCO2 was significantly lower in group I compared to group II after 48 hours of CPT (p<0.05). PEF was significantly higher while RAW and WOB were significantly decreased in group I compared to group II after 48 Hours and before extubation. Group I had less days of mechanical ventilation and higher % of survivors (7.7 + 2.3 days & 43%) compared to group II (9.1 + 2.1 days & 40 %) but the differences were insignificant.
CONCLUSIONS: chest physiotherapy has a positive effect on blood gases and respiratory functions. Although this positive effect did not lead to a decrease in mortality rate, yet CPT is recommended to be a standard treatment modality in critically ill patients as it helps in clearing secretions and reinflating atelectatic areas with subsequent improvement in both pulmonary functions and blood gases. This may be of value in reducing the need for assisted ventilation and its complications.
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