Efficacy of instilled saline in conjunction with chest physiotherapy on secretion clearance in adults diagnosed with a ventilator acquired pneumonia: a feasibility study

Weblin, Jonathan ORCID: 0000-0002-0788-8431 (2024). Efficacy of instilled saline in conjunction with chest physiotherapy on secretion clearance in adults diagnosed with a ventilator acquired pneumonia: a feasibility study. University of Birmingham. M.Res.

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Abstract

Introduction

Chest physiotherapy is routinely provided to intubated and mechanically ventilated patients in intensive care units (ICUs) to aid secretion clearance. If pulmonary secretions are thick, physiotherapists will often use normal saline instillation (NSI) as part of a multimodal intervention. However, evidence on the benefits of NSI during chest physiotherapy is limited. This trial aimed to evaluate the feasibility of delivering a definitive trial to examine the efficacy of NSI during chest physiotherapy on secretion yield for patients with ventilator acquired pneumonia (VAP).

Methods

Patients admitted to a large West Midlands ICU and diagnosed with VAP were included in the trial. A randomised crossover feasibility design was employed for the intervention (twice daily chest physiotherapy). On day one patients were randomised to receive either chest physiotherapy with NSI or without NSI during the morning treatment session. Physiotherapy treatment then alternated between NSI and non-saline sessions for three days or until extubated, whichever sooner. Primary outcomes were feasibility measures: patient recruitment, retention, and protocol fidelity. Secondary outcomes included physiological parameters, sputum weight and safety of NSI.

Results

Of 32 eligible patients, 94% (n=30) consented to participate. Of these, 28 (93%) completed the study intervention with only two (7%) patients’ next of kin withdrawing consent during the intervention. Of patients surviving to hospital discharge who regained capacity (n=9), 100% provided consent for ongoing participation. Protocol fidelity was at 100% with no missing data or adverse events related to NSI. NSI was associated with a significant drop in SpO2 two minutes post intervention (p<0.05) and higher sputum pellet weight (p<0.001). Adjusted wet sputum weight is not a reliable outcome measure for measuring secretion clearance when NSI is used.

Conclusion

A trial looking at the effect of NSI during chest physiotherapy on secretion yield for mechanically ventilated patients with VAP is feasible to conduct and acceptable to participants. However, validation of the methodology for processing sputum samples and determining sputum pellet weight is required before proceeding to a definitive trial.

Type of Work:

Thesis (Masters by Research > M.Res.)

Award Type:

Masters by Research > M.Res.

Supervisor(s):