Nurse-performed POCUS-guided targeted chest physiotherapy in term neonates with severe pneumonia: protocol for a stepped-wedge cluster randomised trial
Abstract
Introduction: Severe pneumonia in term neonates frequently leads to acute respiratory failure requiring invasive mechanical ventilation. Point-of-care ultrasound (POCUS) can identify pulmonary consolidation at the bedside without ionising radiation, while chest physiotherapy (CPT) may help mobilise secretions and improve aeration. We aim to evaluate whether a nurse-performed POCUS-guided targeted CPT care pathway shortens the duration of invasive mechanical ventilation in term neonates with severe pneumonia.
Methods and analysis: This multicentre stepped-wedge cluster randomised trial will be conducted across three tertiary neonatal intensive care units (NICUs) over eight 3-month periods. All NICUs will begin in the control condition and then cross over sequentially to the intervention according to a randomised schedule. We plan to enrol 240 infants (approximately 80 per NICU). Eligible participants are term neonates with severe pneumonia, imaging-confirmed pulmonary consolidation and objectively defined respiratory failure requiring invasive mechanical ventilation. During intervention periods, trained bedside nurses will perform standardised lung POCUS every 8 hours and deliver targeted positioning and gentle percussion based on the ultrasound-determined location of consolidation. Control periods will involve standard care without routine nurse-performed lung POCUS; all CPT exposure will be recorded. The primary outcome is the duration of invasive mechanical ventilation…
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: 240 participants or records.
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