Chest

Chest

Volume 115, Issue 6, June 1999, Pages 1658-1666
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Clinical Investigations in Critical Care
Effect of Combined Kinetic Therapy and Percussion Therapy on the Resolution of Atelectasis in Critically Ill Patients

https://doi.org/10.1378/chest.115.6.1658Get rights and content

Background

Some critically ill patients have difficulty in mobilizing their respiratory secretions. These patients can develop pulmonary atelectasis that may result in hypoxemia. There are some data to show that atelectasis may be prevented by turning a patient from side to side utilizing special beds.

Study objectives

To determine the role of kinetic therapy (KT) combined with mechanical percussion (P) in the resolution of established atelectasis of the lungs and hypoxemia in critically ill, hospitalized patients. (KT was defined as rotation of a patient along the longitudinal axis of ≥ 40° to each side continuously.)

Design

Prospective and randomized study (2:1 test to control group).

Patients

Twenty-four patients with respiratory failure, either mechanically ventilated or spontaneously breathing, who demonstrated segmental, lobar, or unilateral entire lung atelectasis were studied.

Setting

Medical ICU and adult respiratory ward in a county hospital in New York.

Interventions

Seventeen patients were treated with KT combined with mechanical P using a KT system (Triadyne Kinetic Therapy System; KCI; San Antonio, TX). Seven patients received manual repositioning and manual P every 2 h. Both groups received similar conventional therapy with inhaled bronchodilators and suctioning.

Results

Partial or complete resolution of atelectasis was seen in 14 of 17 patients (82.3%) in the test group as compared with 1 of 7 patient (14.3%) in the control group. The median duration to resolution of atelectasis was 4 days in the test group. Bronchoscopy was performed in 3 of 7 patients in the control group, but in none of the patients in the test group. A cost of $720 was incurred per patient for utilizing the specialty beds for a mean duration of 4 days. An improvement in oxygenation index occurred in the test group (change in baseline Pao2/fraction of inspired oxygen from 207.4 ± 106.7 mm Hg to 318 ± 100.7 mm Hg) at the end of therapy, while the control group showed a reduction over a similar duration of time (181.3 ± 96.3 mm Hg to 112 ± 21.2 mm Hg).

Conclusions

KT and mechanical P therapy resulted in significantly greater partial or complete resolution of atelectasis as compared with conventional therapy. There was a generalized trend toward statistical significance in the improvement of oxygenation and a reduced need for bronchoscopy in the group receiving KT and P therapy.

Section snippets

Materials and Methods

The protocol was approved by the Institutional Review Board of Nassau County Medical Center, East Meadow, NY. New or previously admitted patients to the MICU or VW of Nassau County Medical Center between 1995 and 1997 were considered eligible if they had respiratory failure and evidence of atelectasis on chest radiographs. Patients could be breathing spontaneously or mechanically ventilated. Patients or their designees who gave written consent were randomized to either KT with P (test) or

Results

A total of 32 patients were offered enrollment in the protocol. Two patients died before consent could be obtained, while three patients’ relatives refused to give consent for the study (expressing concern at the degree of rotation). The remaining two patients upon intubation, at the time of enrollment in the study, demonstrated radiographic resolution of atelectasis. Twenty-five patients were considered eligible for the study. Of these, 17 were randomized to the test group and 8 to the control

Discussion

This study suggests that a significantly higher rate of partial or complete resolution of atelectasis may be achieved in critically ill patients who receive both KT and mechanical P. An improvement in oxygenation that was maintained over the study duration of 2 weeks and a reduced need for bronchoscopy were also seen. To our knowledge, this is the first study looking at KT and P as a treatment modality for radiographically evident atelectasis.

The critically ill patient who is unable to move or

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    Supported by an unrestricted financial grant from Kinetic Concepts Inc, San Antonio, TX. None of the authors have any financial interest in Kinetic Concepts, Inc.

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    Copyright © 1999 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.