Ms. SHINY THOMAS STAFF NURSE NEUROSURGERY ICU JPNATC, AIIMS New Delhi

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Presentation transcript:

Ms. SHINY THOMAS STAFF NURSE NEUROSURGERY ICU JPNATC, AIIMS New Delhi   EFFECTIVENESS OF MECHANICAL VIBRATOR FOR CHEST PHYSIOTHERAPY IN VENTILATED HEAD & SPINAL INJURED PATIENTS Ms. SHINY THOMAS STAFF NURSE NEUROSURGERY ICU JPNATC, AIIMS New Delhi

BACKGROUND Chest infection is one of the major factor in morbidity & mortality in ventilated head & spinal injured patients. Chest physiotherapy (CPT) has been used to improve airway clearance and treat lung collapse; however, the evidence to support its use has been conflicting. It is hypothesized that mechanical vibrators may help in improving the quality & frequency of chest physiotherapy in these groups of patients.

AIMS & OBJECTIVES To assess the effects of active CPT techniques, such as percussion and vibration along with mechanical vibrator. To assess the decrease (if any) in chest infection rates & mortality in ventilated patients with head & spinal cord injury who received mechanical vibrator chest physiotherapy.

MATERIALS & METHODS This retro-prospective study was carried out in all ventilated head & spinal injured patients over 6 months in Neurosurgery ICU. The clinical (demographics, admission GCS & in hospital mortality) & microbiological data (Modified tracheal culture) was collected over the two time periods.

The ‘Control’ group MATERIALS & METHODS Patients in whom data was retrospectively collected from January 2011 to March 2011 (before the introduction of Vibrators).

The ‘Test’ group MATERIALS & METHODS Patients in whom data was prospectively collected from April 2011 to June 2011 (following introduction of Vibrators).

MATERIALS & METHODS All chest physiotherapy using mechanical vibrators was done by bedside nurses every 2 hourly.

MODIFIED TRACHEAL CULTURE

RESULTS A total of 575 numbers of patients were evaluated in the study. Both Control & test groups were well matched with respect to the: CONTROL GROUP TEST GROUP Number Of Head Injuries 234 206 Number of Spinal Injuries 74 64 Mean Age 30.75 years 31.9 years Male: Female Ratio 89:13 77:13 Mean Admission GCS 9.6 9.9 Average Ventilator Days 7.46 days 7.9 days Tracheal culture positivity (On surveillance)* 9.83% 15.18% *p>0.05

VENTILATOR DAYS CONTROL GROUP TEST GROUP

PERCENTAGE OF TRACHEAL CULTURE POSITIVE PATIENTS 15.84% 10.63% 8.3% PERCENTAGE OF TRACHEAL CULTURE POSITIVE PATIENTS CONTROL GROUP TEST GROUP

RESULTS The mortality was significantly lower in the test group 17.4% as compared to the control groups 27.21%.

MORTALITY RATE IN PERCENTAGE 31.48% 15.84% MORTALITY RATE IN PERCENTAGE CONTROL GROUP TEST GROUP

CONCLUSIONS: Use of mechanical vibrators by nurses for chest physiotherapy can improve outcomes & chest infection rates in ventilated head & spinal injury patients. We recommend their use as standard of care for ventilated patients.

THANK YOU