this study will be conducted to distinguish between effect of rib mobilization and routine chest physiotherapy on weaning parameters from mechanical ventilator in patients with pneumonia • HYPOTHESES: It will be hypothesized that there may be significant effect of rib mobilization on weaning parameters from mechanical ventilator in patients with pneumonia. RESEARCH QUESTION: Does rib mobilization have an effect on weaning parameters from mechanical ventilator in patients with pneumonia? measuring weaning parameters: on screen of mechanical ventilator : measuring respiratory rate, Tidal volume (TV), FiO2. * Arterial blood gases (ABG) analyzer machine ABG is recorded daily (PH- PaO2 - PaCO2) * Length of ICU stay: calculated by (admission date - discharge date * Weaning success rate
Ventilator-associated pneumonia (VAP) represents a significant sub-set of (HAP) remains the most frequent intensive care unit (ICU)-acquired infection its incidence ranges from 9% to 27% of ventilated patients ,VAP is associated with an increased length of stay, mortality and health care costs, Pneumonia can result in chest wall stiffness, decreased mobility, limiting the range of motion during breathing and decreased lung compliance and impaired respiratory function , Rib mobilization: is an articular , non-invasive, passive technique that can be useful with acutely ill, hospitalized patients emphasizes the placement of a repetitive force to increase the range of motion of the posterior rib articulations and chest wall , lessening somatic dysfunction of the spine, stretches myofascial structures and improve respiratory mechanics So, this study will be conducted to distinguish between effect of rib mobilization and routine chest physiotherapy on weaning parameters among intubated pneumonic patients on mechanical vent.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
60
rib mobilization technique The patient in experimental group will be relaxed in semi- fowler position while connected to mechanical ventilator, therapist will seat at the patient "side, his fingers pads are placed at the position of the patient's rib angles , pulling upward and the lateral position the position is held while wait for the soft tissues to release this take from 15 seconds .Release of the diaphragm through manual contact with hypothenar region of therapist thumb inferior laterally xiphoid process and rest along Antero lateral costal margin below rib7 during exhalation the therapist thumb give pressure posteriorly repeat this steps for 3 to5 respiratory cycle • routine chest physiotherapy percussion on chest wall its frequency should be 3-7 beats per sec. vibration applying a light pressure with hand on affected segment for about 5 min modified postural drainage R. and L. side. U\&L limb passive ex. for R.10 x3 set .this program for 30 minutes once daily for ten days
routine chest physiotherapy the patient will be laid in half supine position connected to a ventilator applying * percussion on chest wall its frequency should be 3-7 beats per second or 180-420 beats per minute * vibration applying a light pressure with flattened hand on affected segment for about 5 minutes * modified postural drainage (right and left sidling 10 min for each side * upper and lower limb exercise for 4 limbs (3 sets and each set has 10 repetition * this program for 30 minutes once daily * for 10 consecutive days
El Galaa Military Hospital
Cairo, Egypt
RECRUITINGArterial blood gases
• Arterial blood gases (ABG): (PH -PaO2 - PaCO2) • PaO2/FiO2 ratio (P/F): One element of predicting successful weaning from mechanical ventilation is PaO2/FiO2 \> 200
Time frame: at least 10 consecutive days
Respiratory rate (RR)
It will be measured using a mechanical ventilator.
Time frame: at least 10 consecutive days
Tidal volume (TV)
It will be measured using a mechanical ventilator.
Time frame: at least 10 consecutive days
Length of hospital stay
;• Length of stay in intensive care unite can be defined as the number of days that an in-patient will remain in ICU during a single admission event, is calculated by subtracting the admission date (ADATE) from the discharge date (DDATE)
Time frame: at least 10 consecutive days
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