A pilot study of extubation from mechanical ventilation and the effect of chest physiotherapy intervention
Date
2009-05-15T09:55:21Z
Authors
Ngubeni, Winnifred Keabecoe
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Abstract
It is a common practice for physiotherapists working in Intensive Care Unit (ICU) to treat
patients who are intubated and mechanically ventilated and assist with extubation. The role
of chest physiotherapy treatment (CPT) with extubation hasn’t been scientifically proven to
be effective.
Purpose of the Study
The purpose of this pilot study was to determine whether the omission of one CPT prior to
extubation influences the outcome of patients four-hours after extubation.
Methods
A randomized-controlled trial (RCT) was conducted in an academic hospital with 20-
cardiothoracic and general ICU beds. Patients consented to participate in the study after
ethical clearance was obtained from University of Witwatersrand Committee for Research on
Human Subjects. Twenty-two patients were randomly assigned to a control group to receive
CPT and suctioning prior to extubation (n=12) or to an experimental group to receive
suctioning only prior to extubation (n=10). All patients were then re-assessed four-hours
after extubation to assess the difference in outcome measures in arterial blood gases (ABG),
breathing pattern, peak expiratory flow rate (PEFR), respiratory rate (RR), cough
effectiveness and re-intubation rate. Groups were compared with respect to the categorical
parameters using the Fischer’s exact test. A two-sample t-test with unequal variances and a
non-parametric Mann-Whitney test were used to compare the ABG and RR results between
the groups.
Results and Discussion
The ABG, breathing pattern, RR, and cough effectiveness were not statistically significant
between the groups. PEFR could not be measured due to the inability to follow instruction by
the majority of patients. None of the patients required re-intubation within 24-hours. Eight
patients in each group received CPT after four-hours due to clinical findings of an ineffective
cough, added sounds and abnormal breathing patterns.
Conclusion:
Patients in the control group had a significant shorter period of mechanical ventilation (MV)
than those allocated in the experimental group. However eight patients in both groups
required CPT treatment when assessed four hours after extubation.
Description
Keywords
extubation, chest, physiotherapy