THE EFFECT OF MANUAL LUNG HYPERINFLATION AND POSTURAL DRAINAGE ON PULMONARY COMPLICATIONS IN MECHANICALLY VENTILATED TRAUMA PATIENTS

This study questioned whether manual lung hyperinflation (MHI) and pos tural drainage reduced the incidence of nosocomial pneumonia or improv ed other outcome variables in mechanically ventilated trauma patients. Patients were withdrawn from the study if they, developed nosocomial pneumonia according to a predetermined definition or on the clinical s uspicion of nosocomial pneumonia by the attending intensivist. Of the 46 patients who fulfilled all the inclusion criteria and were enrolled into the study 22 patients were randomized to group A (physiotherapy) and 24 patients to group B (control group). Twice as many patients we re withdrawn in group B (8/24) compared with group A (4/22), although the differences were not statistically significant, [X-2(1, 1) =1.36, P=0.24], The length of time receiving mechanical ventilation and in ri te ICU was similar between the two groups and there were no difference s in pulmonary dysfunction (''worst'' daily PaO2/FiO(2) ratio) between the two groups. There were no ICU deaths in either group, Physiothera py as used in this study was not associated with a reduced incidence o f nosocomial pneumonia based on standard clinical criteria. Neverthele ss the trend to mole frequent nosocomial pneumonia irt the control pat ients suggests that a larger study in more severely injured patients w ith stricter clinical criteria for the definition of nosocomial pneumo nia is indicated.