The Effect of Chest Physiotherapy Methods Applied Before Aspiration on Respiratory Characteristics

Physiotherapy is one of the most frequently used supportive treatments in intensive care units due to its positive effects on critically ill patients. Chest physiotherapy (GF), which constitutes the most effective part of the physiotherapy programs applied to intensive care patients under mechanical ventilation (MV) support, consists of a series of techniques aimed at clearing airway secretions, facilitating appropriate lung ventilation by increasing lung volume and respiratory muscle strength, and improving the respiratory system and gas exchange. . Of these techniques, manually applied percussion vibration and expiratory rib cage compression (EGCC) are some of the most commonly applied GF techniques in patients on MV support. This study was conducted to evaluate the effect of chest physiotherapy techniques applied before aspiration on vital signs, blood gas values and amount of secretion in patients on mechanical ventilation support.

This study was carried out to determine the effect of chest physiotherapy techniques applied before aspiration on the vital signs, blood gas values and amount of secretion in patients on mechanical ventilation support.This randomized, controlled and experimental study was conducted between May 2021 and October 2022 in Tunceli State Hospital intensive care units with patients on mechanical ventilation support. The study was completed with a total of 78 patients, including the percussion vibration group (n=26), the expiratory rib cage compression group (n=26), and the control group (n=26). Data were collected with the "Patient Identification Form", "Vital Signs Recording Form", "Blood Gas Values Recording Form" and "Secretion Amount Recording Form". Two aspirations were performed in each of the three groups with an interval of three hours. Three hours after the first aspiration, chest physiotherapy techniques were applied to the two experimental groups, but not to the control group. A second aspiration was then performed. Vital signs and blood gases were measured before and after both aspiration procedures, and the amount of secretion collected during the two aspiration procedures was weighed.In the comparison between groups according to time; Statistically significant changes were found in heart rate during the first aspiration period, and diastolic blood pressure and respiratory rate during the second aspiration period (p\<0.05). In the independent comparison between groups; statistically significant difference was found in diastolic blood pressure, respiratory rate and peripheral SpO2 values (p\<0.05). In group comparisons; while the averages of secretion weight and amount did not show a significant change in all three groups (p\>0.05), it was found that it tended to increase in the percussion-vibration and expiratory rib cage compression groups, while it tended to decrease in the control group.In this study, it was concluded that chest physiotherapy techniques had a beneficial effect on some vital signs in patients on mechanical ventilation support, did not make any difference in other parameters. Further studies are needed to determine the positive effects of these techniques on vital signs, blood gases and secretion.

Eligibility Criteria:
Inclusion Criteria:

* 18 years and older
* Intubated in the intensive care unit for more than 48 hours
* Followed in synchronized intermittent mechanical ventilation (SIMV) mode
* with arterial catheter
* with hemodynamic stability
* PEEP \<10
* Patients with Glasgow Coma Scale \>3 were included.

Exclusion Criteria:

* Rib fracture, chest trauma
* with pneumothorax
* with hemoptysis
* with increased intracranial pressure
* Having a history of spine surgery
* with chest drainage tube
* Those with skin infection and subcutaneous emphysema in the back and chest area
* The mechanical ventilation setting to be changed during the study
* with life-threatening cardiac arrhythmia
* pregnant
* Obese (Body Mass Index \>30)
* Patients who had to be aspirated outside of the specified periods during the study were excluded from the study