Intrapulmonary percussive ventilation in critical care and acute care settings

Abstract

Patients in critical care are at risk of pulmonary complications, which may result in impaired respiratory function and poor patient outcomes. Respiratory physiotherapy interventions are routinely employed to treat these respiratory complications. However, the current body of evidence does not support the routine application of respiratory physiotherapy interventions in critically ill populations. Intrapulmonary percussive ventilation (IPV) is a modality that is used to promote airway clearance, prevent, or treat pulmonary atelectasis and improve gas exchange. Despite its wide use, the research evidence to support its effectiveness remains unclear in the critical care population.

The studies included in this thesis explore the evidence of IPV use and evaluate the effectiveness of IPV intervention in adults with critical illness.

The systematic review in Chapter 2 assesses and summarises the effectiveness of IPV intervention on ICU length of stay (ICU-LOS), gas exchange, and pulmonary complications. The review findings showed weak evidence to support IPV intervention, highlighting the need for more studies.

The study in Chapter 3 explored the feasibility and safety of IPV in non-intubated ICU patients. The study included 35 patients (IPV = 22, CPT = 13), which showed that IPV was feasible and safe in patients with critical illness.

Chapter 4 is a scoping review that assesses and summarises the clinical application of IPV intervention in critical care, acute care (non-ICU), and outpatient settings.

The final study (chapter 5) included a randomised controlled trial evaluating the effectiveness of IPV in adults with critical illness compared to CPT. The study included 106 non-ventilated patients allocated to the IPV or CPT group. The study showed that the IPV intervention reduced ICU-LOS, improved oxygenation and RR compared to the CPT group.

Overall, the findings of this thesis demonstrate that IPV intervention improves outcomes in patients with critical illness.