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Santos E.1,2, Silva J.2, Assis Filho M.T.2, Vidal M.2, Montes M.3, Lunardi A.1,4
1Universidade Cidade de Sao Paulo, Master and Doctoral Program in Physical Therapy, Sao Paulo, Brazil, 2Universidade Federal do Amapá, Physical Therapy, Macapá, Brazil, 3Faculdade de Macapá, Physical Therapy, Macapá, Brazil, 4Universidade de São Paulo, Physical Therapy, Sao Paulo, Brazil
Background: Pleural effusion of different etiology are treated with chest drainage. The thoracic drainage can lead to severe complications with a 20% mortality rate. Techniques for lung expansion as deep breathing and incentive spirometry seem to decrease the drain length of stay. However, the effects of techinques more optimized as noninvasive positive pressure in these patients remain poorly known.
Purpose: To test the effects of positive airway pressure added to usual respiratory care on resolution of pleural effusions after drainage.
Methods: This trial enrolled 150 patients with pleural effusion and chest drainage in situ for 24h randomly assigned into 3 groups: G1= Usual respiratory care (G1=Incentive spirometry, toilet bronchial, walking; n=50) (G2= Positive Pressure (Usual care as G1 + Positive pressure at 15cmH2O; n=51), G3= Control (Sham intervention; n=49). All patients received 3 daily interventions until the drain was removed for a maximum of 7 days. Chest drainage output and X-ray (criteria for removal of drain) were assessed daily. Days of chest tube drainage, length of hospital stay, pulmonary complications (pneumonia, atelectasis, or lung entrapment) and side effect of positive pressure (aerophagia or pleural fistula) were recorded until hospital discharge. Outcome assessors and statisticians were blinded to the random allocation. Costs in each group were also estimated. ANOVA, Kaplan-Meier and chi-square tests were used.
Results: G2 presented shorter chest tube drain (4±2 vs 6±6 vs 6±3 days; p 0.0001) and hospital length stay (5±4 vs 7±7 vs 7±6 days; p 0.0001) compared to G1 and G3. In addition, G2 had decreased need for antibiotics (15% vs 36% vs 47%; p 0.0001) and a lower rate of pneumonia (0% vs 16% vs 20%; p=0.004) compared to G1 and G3. All groups has the same rate of side effect (9% vs 2% vs 6%; p>0.05). Total treatment costs were lower in G2 (R$ 2000 ± 500 vs 2500 ± 500 vs 3500 ± 1500; p 0.04), compared with G1 and G3, even with the addition of positive pressure cost.
Conclusion(s): The addition of positive pressure in the usual respiratory care decreases the thoracic drainage and hospitalization length stay, the rate of pulmonary complications, the antibiotic use and the total treatment costs in patients with pleural effusion.
Implications: Our main goal was to provide information that could help physiotherapists in their clinical practice. We believe that our results should guide the treatment of patients with pleural effusion drained because it provides information on clinical aspects and costs of adding the positive pressure to the usual care of this population. This is the first clinical trial in this field and can initiate further research with this population. On the basis of this study, we consider fairly consistent add positive pressure to the respiratory care of patients with pleural effusion drained.
Funding acknowledgements: Grant # 442709/2014-5, National Council for Scientific and Technological Development (CNPQ)
Topic: Cardiorespiratory
Ethics approval: Trial approved by the Ethics Committee of the Universidade Cidade de São Paulo, registered prospectively at clinicaltrials.gov (NCT02246946)
All authors, affiliations and abstracts have been published as submitted.
