Using Chest Vibration Nursing Intervention to Improve Expectoration of Airway Secretions and Prevent Lung Collapse in Ventilated ICU Patients:FA Randomized Controlled Trial

Tuesday, 13 July 2010

Yu-chih Chen, PhD
Nursing Department, Taipei Veterans General Hospital, Taipei, Taiwan
Li F. Wu, MS, RN
Department of Nursing, Taipei,Veterans General Hospital Medical Center, Taipei, Taiwan
Pei-Fan Mu, PhD, RN
Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan
Li H. Lin, MS, RN
Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
Shin-shang Chou, RN, MSN, MBA
Intensive Care Unit, Taipei Veterans General Hospital, Taipei, Taiwan

Learning Objective 1: to discuss the care of complications of ventilated critical ill patients

Learning Objective 2: to explore the effectiveness of care protocol for ventilated assocaited pneumonia of critical ill patients

Purpose: The purpose of this study is to evaluate the effect of a chest vibration nursing intervention on the expectoration of airway secretions and thus preventing lung collapse among ventilated critically illness patients.

Methods:  This was a randomized, single-blind experimental design. In total, 95 patients enrolled were from two ICUs and were randomly assigned into the experimental group (n=50) and 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 experimental group received routine positioning care plus the use of chest vibration nursing intervention for 72 hours.  The chest vibration intervention tool places six times per day. Outcome variables were dry sputum weight (DSW) per 24 hours and lung collapse index (LCI); these were measured at 24 hours, 48 hours and 72 hours.

Results:  The patients who received the chest virbration nursing intervention had a greater DSW and a lower lung collapse index score after 24 hours. The pre-test DSW and group could explain 48.2% of the variance of the DSW at 24 hours. The LCI at the 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 lung collapse index after vibration, when monitored by the generalized estimating equation in time sequence.

Conclusion:

The results suggest that the chest virbration 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 with ventilators in ICUs.