Dear Editor
I read with interest the review from Hellweg [1]. However the findings of Ntoumenopoulos et al. [2] were in-accurately reported.
Ntoumenopoulos et al. [2] investigated the effect of chest physiotherapy in sixty adult patients intubated and mechanically ventilated for at least 48-hours. There were no differences in the duration of mechanical ventilation, length of stay in ICU or mortality. Ventilator-associated pneumonia (VAP) as assessed by combined clinical assessment and the clinical pulmonary infection score (CPIS) occurred in 39% of the control group and 8% of the intervention group (P = 0.02). After adjustment was made by logistic regression for other important variables, chest physiotherapy was independently associated with a reduced occurrence of VAP (P = 0.02). Therefore, contrary to the conclusions by Hellwegg [1] the work of Ntoumenopoulos et al. [2] provides preliminary evidence that chest physiotherapy in ventilated patients was independently associated with a reduction in VAP.
A randomised controlled trial by Pattanshetty and Gaude [3] reported that twice-daily chest physiotherapy was associated with a significant decrease in the clinical pulmonary infection scores (surrogate measure of VAP) and with a significant reduction in mortality. Blot et al. [4] therefore recommend the further investigation of chest physiotherapy for the prevention of VAP.
References
- 1.Hellweg S. Effectiveness of physiotherapy and occupational therapy after traumatic brian injury in the intensive care unit. Critical Care Research and Practice. 2012;2012:5 pages. doi: 10.1155/2012/768456.768456 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ntoumenopoulos G, Presneill J, McElholum M, Cade J. Chest physiotherapy for the prevention of ventilator-associated pneumonia. Intensive Care Medicine. 2002;28(7):850–856. doi: 10.1007/s00134-002-1342-2. [DOI] [PubMed] [Google Scholar]
- 3.Pattanshetty RB, Gaude GS. Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: a randomized clinical trial. Indian Journal of Critical Care Medicine. 2010;14(2):70–76. doi: 10.4103/0972-5229.68218. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Blot S, Rello J, Vogelaers D. What is new in the prevention of ventilator-associated pneumonia? Current Opinion in Pulmonary Medicine. 2011;17(3):155–159. doi: 10.1097/MCP.0b013e328344db65. [DOI] [PubMed] [Google Scholar]