Research question Among mechanically ventilated adult ICU patients, can chest physiotherapy (CPT) prevent the onset of ventilator-associated pneumonia (VAP) compared with standard care?
Introduction VAP is a common nosocomial infection with various known strategies for prevention, including CPT. Conflicting evidence regarding CPT for VAP prevention exist since CPT may cause desaturation and respiratory muscle fatigue.
Objectives To determine the efficacy of CPT, compared with standard care, in preventing the onset of VAP among mechanically ventilated adult ICU patients, its effect on ICU mortality, length of ICU stay, and duration of mechanical ventilation.
Inclusion criteria Controlled trials on adult mechanically ventilated ICU patients, given CPT for VAP prevention, compared with standard care.
Search strategy An electronic search in PubMed, EMBASE, CENTRAL, BioMedCentral, Elsevier Health, and Herdin was done. Reference lists were checked manually.
Study manoeuvres The authors arrived at a consensus and the Cochrane risk of bias tool was used for evaluation.
Statistical analysis Mantel-Haenszel method using the Review manager 5.3.
Results Twenty studies were found, and 10 were retrieved for review. Five studies were included, representing 595 patients. Evaluation of the included studies found 1 study with low risk of bias, 2 studies with high risk, and 2 studies with unclear risk. Overall combined meta-analysis of all 5 studies found no difference in VAP incidence between the 2 groups (RR 0.80, 95% CI 0.52 to 1.23, P = 0.05). A subgroup analysis done excluding the studies with high risk of bias still showed no difference in VAP incidence (RR 0.96, 95% CI 0.62 to 1.50, P = 0.86). CPT made no significant difference on ICU mortality (RR 0.97, 95% CI 0.57 to 1.97, P = 0.07), duration of ICU stay (RR 0.36, 95% CI -1.83 to 2.55, P = 0.10), and duration of mechanical ventilation (RR 0.23, 95% CI -0.74 to 1.21, P = 0.14).
Conclusions It is not recommended to perform routine CPT on mechanically ventilated adult ICU patients to prevent the onset of VAP, as this is associated with potential harm and unnecessary costs. The authors recommend that more trials with low risk of bias be conducted on CPT for VAP prevention.