EFFECT OF MULTIMODAL PHYSIOTHERAPY ON OUTCOME OF MECHANICALLY VENTILATED PATIENTS AT ZAGAZIG UNIVERSITY RESPIRATORY INTENSIVE CARE UNIT IN (2014-2015)

Abstract

Background: In critically ill patients,physiotherapy and inspiratory muscle training are considered important
components of pulmonary rehabilitation;as they enhance the weaning process and help patients to return to
their optimal functional capacities. The aim of this work was to compare the possible benefits and risks of
delivering multimodal physiotherapy (PT) to mechanically ventilated patients to improve patients’ outcome.
Patients and Methods: Forty mechanically ventilated patients with acute or acute on top of chronic
respiratory failure from ZUH (RICU) were enrolled in a randomized controlled clinical trial. The patients
were classified equally into test group and control group, control group patients were subjected to
conventional PT, while test group patients were subjected to inspiratory muscle training in addition to
conventional PT. Pre and post assessment of SAPSII and Barthel index scores, PImax, RSBI and weaning
outcomes were done for both studied groups.
Results: Both patients’ groups were matched together as regards age, sex, ABG, diagnosis and
comorbidities. The test group had a high significant lower frequency of conventional PT sessions in relation
to control group 8 and 12 sessions respectively (P<0.01). Barthel index was improved post physiotherapy in
the test group better than control group but without statistical significant difference (P>0.05).There was high
significant improvement in PImax post-PT in the test group when compared to control group (-34.36.02
cmH2O) versus (-24.62.45 cmH2O) respectively (P<0.001).The indices of weaning were significantly
improved in test group than control group as regards PaO2/FIO2, PImax and RSBI (P<0.05).The incidence of
complications (VAP, Bed sore and Electrolyte imbalance) increased among the control group than the test
group but without statistical significance differences (P>0.05).The weaning success was (90% &70%) in test
group versus control group, while the duration of MV, duration of weaning and length of ICU stay were
significantly reduced in test group (5, 4.5 and 8.8 ± 2.22 days) versus control group (6, 6 and 11.95 ± 3.4.2
days), (P<0.05, P<0.01 and P<0.001), respectively.
Conclusion: Conventional chest physiotherapy is safe ICU intervention with few complications. Adding
inspiratory muscle training (using a threshold pressure device) to the conventional physiotherapy can
improve maximum inspiratory pressure,functional capacity and RSBI, with potential reductions in length of
ICU stay and the duration of invasive mechanical ventilation.
Keywords: Physiotherapy, Inspiratory muscle training, Mechanical ventilation, Intensive Care Unit.