Efficacy of instilled saline in conjunction with chest physiotherapy on secretion clearance in adults diagnosed with a ventilator acquired pneumonia: a randomised crossover feasibility trial
Abstract
INTRODUCTION
Chest physiotherapy is routinely provided to mechanically ventilated (MV) patients in intensive care units (ICUs) to aid secretion clearance. Physiotherapists may instil saline down the endotracheal tube to aid secretion clearance. However, there is limited evidence and no UK guidelines on the use of saline instillation (SI).
OBJECTIVE
To evaluate the feasibility of a definitive trial examining the efficacy of SI during chest physiotherapy on secretion yield in patients with ventilator-acquired pneumonia (VAP).
METHODS
A randomised crossover feasibility trial was performed on patients with VAP at a large UK ICU. Patients underwent twice daily chest physiotherapy sessions, alternating between SI vs. Non-SI for three days or until extubation. Primary outcomes were feasibility measures: recruitment, retention, and protocol fidelity. Secondary outcomes included safety outcomes and secretion yield, assessed using two approaches: "adjusted wet sputum weight" and "sputum pellet weight".
RESULTS
Of 32 eligible patients, 94% (N = 30) were recruited, of whom 7% (N = 2) were subsequently withdrawn; 21 (70%) completed all six sessions. No adverse events occurred in SI sessions. The adjusted wet sputum weight appeared to underestimate secretion yield in SI sessions, resulting in a negative median value (-0.49 g; IQR: -2.39, 1.11), which was significantly lower than Non-SI sessions (median: 0.99 g; IQR: 0.26, 2.11; p < 0.001). Analysis using sputum pellet weight reversed the…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 32 participants or records.
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