Intrapulmonary percussive ventilation in tracheostomized patients: A randomized controlled trial

Objective: To investigate whether the addition of intrapulmonary percussive ventilation to the usual chest physiotherapy improves gas exchange and lung mechanics in tracheostomized patients. Design and setting: Randomized multicenter trial in two weaning centers in northern Italy. Patients and participants: 46 tracheostomized patients (age 70 ± 7 years, 28 men, arterial blood pH 7.436 ± 0.06, PaO₂/FIO₂ 238 ± 46) weaned from mechanical ventilation. Interventions: Patients were assigned to two treatment groups performing chest physiotherapy (control), or percussive ventilation (IMP2 Breas, Sweden) 10 min twice/day in addition to chest physiotherapy (intervention). Measurements and results: Arterial blood gases, PaO₂/FIO₂ ratio, and maximal expiratory pressure were assessed every 5th day for 15 day. Treatment complications that showed up in 1 month of follow-up were recorded. At 15 days the intervention group had a significantly better PaO₂/FIO₂ ratio and higher maximal expiratory pressure; after follow-up this group also had a lower incidence of pneumonia. Conclusions: The addition of percussive ventilation to the usual chest physiotherapy regimen in tracheostomized patients improves gas exchange and expiratory muscle performance and reduces the incidence of pneumonia.