Chest physiotherapy for the prevention of ventilator-associated pneumonia: A meta-analysis.

Abstract

BACKGROUND\nVentilator-associated pneumonia (VAP) remains a frequent and severe complication in mechanically ventilated patients. We undertook a meta-analysis to evaluate the efficacy of chest physiotherapy (CPT) for the prevention of VAP.\n\n\nMETHODS\nA systematic literature search of PubMed and Embase databases were searched up until November 25, 2018 for published studies of mechanically ventilated patients comparing CPT with controls and reporting on the occurrence of VAP. Two authors independently selected studies and abstracted data on study quality and outcomes. We pooled data using random-effects models.\n\n\nRESULTS\nA total of 6 randomized (n\u202f=\u202f704) controlled trials were identified. CPT did not significantly reduce the incidence of VAP (risk ratio\u202f=\u202f1.02; 95% confidence interval, 0.82-1.26; P\u202f=\u202f.87), but reduced hospital mortality (risk ratio\u202f=\u202f0.68; 95% confidence interval, 0.48-0.95; P\u202f=\u202f.02). No significant differences were observed regarding intensive care unit mortality, length of intensive care unit stay, and duration of mechanical ventilation.\n\n\nCONCLUSIONS\nCPT may not significantly reduce the incidence of VAP and alter other important clinical outcomes in adult patients receiving mechanical ventilation. However, the results should be interpreted cautiously owing to the heterogeneity and the limited trials. Further large-scale, well-designed randomized controlled trials are needed.