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Journal of Physiotherapy Oct 2018In intubated adult patients receiving mechanical ventilation, does multimodality respiratory physiotherapy prevent ventilator-associated pneumonia, shorten length of... (Meta-Analysis)
Meta-Analysis
Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review.
QUESTION
In intubated adult patients receiving mechanical ventilation, does multimodality respiratory physiotherapy prevent ventilator-associated pneumonia, shorten length of intensive care unit (ICU) stay, and reduce mortality?
DESIGN
A systematic review with meta-analysis of randomised controlled trials.
PARTICIPANTS
Intubated adult patients undergoing mechanical ventilation who were admitted to an intensive care unit.
INTERVENTION
More than two respiratory physiotherapy techniques such as positioning or postural drainage, manual hyperinflation, vibration, rib springing, and suctioning.
OUTCOMES MEASURES
Incidence of ventilator-associated pneumonia (VAP), duration of ICU stay, and mortality.
RESULTS
Five trials were included in the meta-analysis. Random-effects models were used to calculate pooled weighted mean difference (WMD) for length of ICU stay and pooled risk ratio (RR) for incidence of VAP, and fixed-effects model was used to calculate pooled RR for mortality. The effect on the incidence of VAP was unclear (RR 0.73 in favour of multimodality respiratory physiotherapy, 95% CI 0.38 to 1.07). The effect on length of stay was also unclear (WMD -0.33days shorter with multimodality respiratory physiotherapy, 95% CI -2.31 to 1.66). However, multimodality respiratory physiotherapy significantly reduced mortality (RR 0.75, 95% CI 0.58 to 0.92).
CONCLUSION
Multimodality respiratory physiotherapy appeared to reduce mortality in ICU patients. It was unclear whether this occurred via a reduction in the incidence of VAP and/or length of stay because the available data provided very imprecise estimates of the effect of multimodality respiratory physiotherapy on these outcomes. These very imprecise estimates include the possibility of very worthwhile effects on VAP incidence and length of ICU stay; therefore, these outcomes should be the focus of further investigation in rigorous trials.
REGISTRATION
PROSPERO CRD42018094202. [Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, Cavero-Redondo I, López Muñoz P, Martínez-Vizcaíno V (2018) Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. Journal of Physiotherapy 64: 222-228].
Topics: Adult; Hospital Mortality; Humans; Intensive Care Units; Length of Stay; Physical Therapy Modalities; Pneumonia, Ventilator-Associated
PubMed: 30220625
DOI: 10.1016/j.jphys.2018.08.005 -
Journal of Thoracic Disease Oct 2017Chondroblastoma is an uncommon benign bone tumour arising typically in the epiphysis. Few cases of chondroblastoma of the rib have been reported in the literature. We...
Chondroblastoma is an uncommon benign bone tumour arising typically in the epiphysis. Few cases of chondroblastoma of the rib have been reported in the literature. We describe a case of chondroblastoma of a 47-year-old man located in the body of the IX right rib. The patient presented a moderate right thoracic pain with an apparently palpable mass. Computed tomography (CT) scan showed a well-defined oval 49 mm × 43 mm lesion with the lytic bone destruction of the rib. A surgical resection was performed with an excellent outcome and no recurrence after 4-year follow-up. We also conducted a systematic review of literature where we evidenced that chondroblastoma could affect people of all age, but it's most common in children and young adult. Surgical resection constitutes the treatment of choice.
PubMed: 29268433
DOI: 10.21037/jtd.2017.08.137