Using chest vibration nursing intervention to improve expectoration of airway secretions and prevent lung collapse in ventilated ICU patients: a randomized controlled trial.
BACKGROUND
Almost 80% of patients in the intensive care unit are intubated and on mechanical ventilation. Thus, their airway clearance ability is compromised and their risk of lung collapse increased. A variety of interventions are used to enhance airway clearance with the goal of preventing atelectasis and infection. The purpose of this study was to evaluate the effect of a chest vibration nursing intervention on the expectoration of airway secretions and in preventing lung collapse among ventilated critically ill patients.


METHODS
This was a randomized, single-blind experimental study. A total of 95 patients were enrolled from 2 ICUs and randomly assigned into either the experimental group (n = 50) or control group (n = 45). Patients in the control group received routine positioning care, which consisted of a change in body position every 2 hours. Patients in the experimental group received routine positioning care plus the use of chest vibration nursing intervention for 72 hours. This intervention consisted of placing a mechanical chest wall vibration pad on the patients back for 60 minutes when the patient was in a supine position. The chest vibration intervention was performed 6 times a day. Outcome variables were dry sputum weight (DSW) per 24 hours and lung collapse index (LCI); these were measured at 24, 48 and 72 hours.


RESULTS
Patients who received the chest vibration nursing intervention had greater DSW and lower LCI after 24 hours. Pre-test DSW and group could explain 48.2% of the variance in DSW at 24 hours. The LCI at 24, 48 and 72 hours were all significantly improved in the intervention group compared to the control group. The previous LCI measured was the most significant predictor of the next LCI measured. A significant difference was found between the control and experimental groups in their 24-, 48- and 72-hour DSW and LCI after vibration, when monitored by the generalized estimating equation in time sequence.


CONCLUSIONS
The results suggest that chest vibration may contribute to expectoration and thus improve lung collapse among ventilated patients in an ICU. Chest vibration nursing intervention is a safe and effective alternative pulmonary clearance method and can be used on patients who are on ventilators in ICUs.
Chen
Yu-Chih
YC
Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. ycchen@vghtpe.gov.tw
Wu
Li-Fen
LF
Mu
Pei-Fan
PF
Lin
Li-Hwa
LH
Chou
Shin-Shang
SS
Shie
Huei-Guan
HG
D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000451:nursing*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D001261:Pulmonary Atelectasis / Q000517:prevention & control*; D012044:Regression Analysis; D012121:Respiration, Artificial / Q000451:nursing*; D016037:Single-Blind Method; D013909:Thorax; D014732:Vibration