Critical Care Research and Practice

Volume 2012 (2012), Article ID 329843, 1 page

doi:10.1155/2012/329843

Letter to the Editor

Comment on “Effectiveness of Physiotherapy for Ventilator-Associated Pneumonia”

George Ntoumenopoulos

Physiotherapy Department, Guy's and St Thomas' NHS Foundation Trust, Kings Health Partners, London SE1 7EH, UK

Received 14 May 2012; Accepted 22 May 2012

Copyright © 2012 George Ntoumenopoulos. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 (). After adjustment was made by logistic regression for other important variables, chest physiotherapy was independently associated with a reduced occurrence of VAP (). 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

S. Hellweg, “Effectiveness of physiotherapy and occupational therapy after traumatic brian injury in the intensive care unit,” Critical Care Research and Practice, vol. 2012, Article ID 768456, 5 pages, 2012.

G. Ntoumenopoulos, J. Presneill, M. McElholum, and J. Cade, “Chest physiotherapy for the prevention of ventilator-associated pneumonia,” Intensive Care Medicine, vol. 28, no. 7, pp. 850–856, 2002.

R. B. Pattanshetty and G. S. Gaude, “Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: a randomized clinical trial,” Indian Journal of Critical Care Medicine, vol. 14, no. 2, pp. 70–76, 2010.

S. Blot, J. Rello, and D. Vogelaers, “What is new in the prevention of ventilator-associated pneumonia?” Current Opinion in Pulmonary Medicine, vol. 17, no. 3, pp. 155–159, 2011.