1. 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

2. 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.

3. 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.

4. 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.

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

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

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

9. MODIFIED TRACHEAL CULTURE

11. 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

12. VENTILATOR DAYS
CONTROL GROUP
TEST GROUP

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

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

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

16. 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.

17. THANK YOU