Effectiveness of Passive Chest Physiotherapy in Prevention of Ventilator Associated Pneumonia in Sepsis

Author(s): Nida Rizvi, Syed Muhammad Fahad, Syed Hasan Abbas Rizvi, Faizan Saeed Syed, Syed Ali Farooq Zaidi, Adnan Anwar, Muhammad Ali

Background: Around 19 million cases of sepsis are reported annually, with 5 million deaths are estimated to be recorded in middle and low income countries due to sepsis. Ventilator Associated Pneumonia is most common risk factor associated with sepsis. Passive chest physiotherapy involves various techniques including Percussions, Compression and Manual Hyperinflation Technique for external manipulation; they basically dislodge chest secretions by applying kinetic energy to chest wall.

Objective: To evaluate effectiveness of passive chest physiotherapy in prevention of ventilator associated pneumonia in sepsis.

Methodology: This was a Quasi Experimental Study conducted in Liaquat National Hospital from February October with non probability convenient based sampling. Total 60 intubated patients diagnosed with sepsis on the basis of American college of chest physicians and society of critical care principle or conditions that could lead to sepsis like impaired immune system, infection, renal failure, burn, Urinary Tract Infection,exposure to invasive devices were included in this study. Excluded were those with pulmonary embolism, pulmonary edema, clotting disorders, osteoporosis of ribs, lung contusion,emphysema, Intracranial pressure greater than 20mmHg, hemodynamically unstable patients, cardiac problems, skin infections . Ethical Approval was taken from Institutional Review Board of Liaquat National School Of Physiotherapy. Passive chest physiotherapy was administered to patient twice daily (11:00 am and 3:30 pm) in 10 days. Patients were given standard care as per ICU protocol in the form of nursing, pharmacology as prescribed by physician/Surgeon throughout intervention period. Acute Physiology, Age, Chronic Health Evaluation II (APACHE II) and Clinical Pulmonary Infection Scoring (CPIS) were used as assessment tools. Data was analyzed using spss 22.0.

Result: APACHE II was used for predicting mortality of patients diagnosed with sepsis during first 24 hours of Intensive Care Unit stay (1. 38 ± 0. 49); on 10th day after passive chest physiotherapy mortality rate was significantly decreased (0. 05 ± 0. 22). The CPIS Scoring used for predicting chances of Ventilator Associated Pneumonia showed that before initiation of passive chest physiotherapy chances of ventilator associated pneumonia was 53. 3% (1. 53 ± 0. 50) while CPIS Scoring at 10th day showed significant decrease i. e. 3. 3% (1. 28 ± 0. 78) (0. 03).

Conclusion: It was observed that passive chest physiotherapy twice daily leads to significant decrease in CPIS scoring suggesting decrease in occurrence of Ventilator associated pneumonia in sepsis and Passive Chest physiotherapy was significant in decreasing mortality rate of patients.

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