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Physiotherapy effectiveness in ICU patients: Chest physiotherapy may not be the only explanation
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MODEL
Respiratory Medicine (2015) xx, 1e1
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/rmed
LETTER TO THE EDITOR
Physiotherapy effectiveness in ICU patients: Chest physiotherapy may not be the only explanation
Conflict of interest None.
References To the Editor Castro et al. [1] concluded that chest physiotherapy delivered 4 times a day (group A) was the main factor associated with the reduction in mechanical ventilation (MV) length of stay (LOS), ICU LOS, respiratory infection and mortality when compared to a single session per day (group B). The conclusion of Castro’s et al. study may be methodologically compromised by the large heterogeneity between the study groups. Nearly half (48%) of the patients in group B were hospitalized with neurological diseases (cerebral infarction and brain trauma). Though the authors believed this fact did not influence their results, previous studies showed that ventilator-associated pneumonia (VAP) prevalence in neurological patients is higher in comparison to medical/surgical ICU patients [2,3], which might be responsible for the increase in MV and ICU LOS and, consequently, mortality rate. In addition, Ramsay score was higher in group B and sedation level is an independent risk factor for VAP [4]. Another reason for concern is the description of physical therapy treatment. In the Materials and Methods section, it was characterized by endotracheal suctioning, manual thorax percussion and general mobilization. However, the authors affirmed in the Discussion section that weaning and early mobilization were also employed as part of the physiotherapy treatment. Since assembling and adjusting ventilator settings and weaning were part of the treatment, the authors should have emphasized these aspects in the manuscript, rather than just “chest physiotherapy”.
[1] Castro AA, Calil SR, Freitas SA, Oliveira AB, Porto EF. Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients. Respir Med 2013;107(1):68e74. [2] Maeshima S, Osawa A, Hayashi T, Tanahashi N. Elderly age, bilateral lesions, and severe neurological deficit are correlated with stroke-associated pneumonia. J Stroke Cerebrovasc Dis 2014;23(3):484e9. [3] Cook A, Norwood S, Berne J. Ventilator-associated pneumonia is more common and of less consequence in trauma patients compared with other critically ill patients. J Trauma 2010; 69(5):1083e91. [4] Rello J, Diaz E, Roque M, Valles J. Risk factors for developing pneumonia within 48 hours of intubation. Am J Respir Crit Care Med 1999;159:1742e6.
Raquel Annoni* Monique Buttignol Ruy de Camargo Pires Neto Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil *Corresponding author. Sa ˜o Paulo University Medical School, Av. Dr. Arnaldo, 455, room 1155, Sa ˜o Paulo, SP, Zip Code: 01246-903, Brazil. Tel./fax: þ55 11 30618521. E-mail address: [email protected] (R. Annoni) 1 July 2013
http://dx.doi.org/10.1016/j.rmed.2013.08.047 0954-6111/ª 2015 Elsevier Ltd. All rights reserved. Please cite this article in press as: Annoni R, et al., Physiotherapy effectiveness in ICU patients: Chest physiotherapy may not be the only explanation, Respiratory Medicine (2015), http://dx.doi.org/10.1016/j.rmed.2013.08.047
MODEL
Respiratory Medicine (2015) xx, 1e1
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/rmed
LETTER TO THE EDITOR
Physiotherapy effectiveness in ICU patients: Chest physiotherapy may not be the only explanation
Conflict of interest None.
References To the Editor Castro et al. [1] concluded that chest physiotherapy delivered 4 times a day (group A) was the main factor associated with the reduction in mechanical ventilation (MV) length of stay (LOS), ICU LOS, respiratory infection and mortality when compared to a single session per day (group B). The conclusion of Castro’s et al. study may be methodologically compromised by the large heterogeneity between the study groups. Nearly half (48%) of the patients in group B were hospitalized with neurological diseases (cerebral infarction and brain trauma). Though the authors believed this fact did not influence their results, previous studies showed that ventilator-associated pneumonia (VAP) prevalence in neurological patients is higher in comparison to medical/surgical ICU patients [2,3], which might be responsible for the increase in MV and ICU LOS and, consequently, mortality rate. In addition, Ramsay score was higher in group B and sedation level is an independent risk factor for VAP [4]. Another reason for concern is the description of physical therapy treatment. In the Materials and Methods section, it was characterized by endotracheal suctioning, manual thorax percussion and general mobilization. However, the authors affirmed in the Discussion section that weaning and early mobilization were also employed as part of the physiotherapy treatment. Since assembling and adjusting ventilator settings and weaning were part of the treatment, the authors should have emphasized these aspects in the manuscript, rather than just “chest physiotherapy”.
[1] Castro AA, Calil SR, Freitas SA, Oliveira AB, Porto EF. Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients. Respir Med 2013;107(1):68e74. [2] Maeshima S, Osawa A, Hayashi T, Tanahashi N. Elderly age, bilateral lesions, and severe neurological deficit are correlated with stroke-associated pneumonia. J Stroke Cerebrovasc Dis 2014;23(3):484e9. [3] Cook A, Norwood S, Berne J. Ventilator-associated pneumonia is more common and of less consequence in trauma patients compared with other critically ill patients. J Trauma 2010; 69(5):1083e91. [4] Rello J, Diaz E, Roque M, Valles J. Risk factors for developing pneumonia within 48 hours of intubation. Am J Respir Crit Care Med 1999;159:1742e6.
Raquel Annoni* Monique Buttignol Ruy de Camargo Pires Neto Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil *Corresponding author. Sa ˜o Paulo University Medical School, Av. Dr. Arnaldo, 455, room 1155, Sa ˜o Paulo, SP, Zip Code: 01246-903, Brazil. Tel./fax: þ55 11 30618521. E-mail address: [email protected] (R. Annoni) 1 July 2013
http://dx.doi.org/10.1016/j.rmed.2013.08.047 0954-6111/ª 2015 Elsevier Ltd. All rights reserved. Please cite this article in press as: Annoni R, et al., Physiotherapy effectiveness in ICU patients: Chest physiotherapy may not be the only explanation, Respiratory Medicine (2015), http://dx.doi.org/10.1016/j.rmed.2013.08.047