Adding positive airway pressure to mobilisation and respiratory techniques hastens pleural drainage: a randomised trial

Abstract

Questions: In patients with a collection of fluid in the pleural space, do mobilisation and respiratory techniques: shorten the drainage period and length of hospital stay; improve respiratory function and oxygenation; and prevent pulmonary complications? Does the addition of positive airway pressure to this regimen further improve the effects? Design: Randomised controlled trial with three intervention arms, concealed allocation, intention-to-treat analysis and blinded assessment. Participants: One hundred and fifty-six inpatients with a fluid collection in the pleural space and with chest drainage in situ. Intervention: Participants received usual care and were randomly assigned to: a control group that also received sham positive airway pressure (4 cmH(2)O) only (Con); an experimental group that received incentive spirometry, airway clearance, mobilisation and the same sham positive pressure (Exp1); or an experimental group that received the Exp1 regimen except that the positive airway pressure was 15 cmH(2)O (Exp2). Treatments were provided three times per day for 7 days. Outcome measures: Days of chest tube drainage, length of hospital stay, pulmonary complications and adverse events were recorded until hospital discharge. Costs in each group were estimated. Results: The Exp2 group had shorter duration of chest tube drainage and length of hospital stay compared with the Exp1 and Con groups. In addition, the Exp2 group had less antibiotic use (18% versus 43% versus 55%) and pneumonia incidence (0% versus 16% versus 20%) compared with the Exp1 and Con groups (all p < 0.01). The groups had similar rates of adverse events (10% versus 2% versus 6%, p > 0.05). Total treatment costs were lower in the Exp2 group than in the Exp1 and Con groups. Conclusions: In patients with a fluid collection in the pleural space, the addition of positive pressure to mobilisation and respiratory techniques decreased the duration of thoracic drainage, length of hospital stay, pulmonary complications, antibiotic use and treatment costs. (C) 2019 Australian Physiotherapy Association.