Pre- and Postoperative Chest Therapy With Positive Expiratory Pressure (PEP) to Prevent Hospital-acquired Pneumonia

University Hospital Bispebjerg and Frederiksberg566 enrolled

Overview

The goal of this clinical trial is to investigate whether pre- and postoperative treatment with systematic PEP therapy can prevent hospital-acquired pneumonia in patients with hip frac-ture. It will also learn about the barriers regarding PEP therapy in this group of patients. * Does pre- and postoperative treatment with systematic PEP therapy prevent hospital-acquired pneumonia in patients with hip fracture? * Which barriers do participants have regarding PEP therapy in this group of patients? Researchers will compare systematic PEP therapy to no intervention besides standard treat-ment to see if systematic therapy with PEP can prevent hospital-acquired pneumonia. Participants will: * Receive systematic PEP therapy during hospitalization or no intervention besides standard treatment * Register the PEP therapy four times daily on a paper checklist. Failure to perform the treatment and the reason must also be documented on the checklist.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

566

Conditions

Hip Fractures (ICD-10 72.01-72.2)

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Hip fracture regardless of age * Cognitively well-functioning * Able to understand the study and give informed consent * Able to speak and understand Danish * Resident of Region Hovedstaden or Region Sjælland Exclusion Criteria: * Cognitively impaired * Unable to understand the study and give informed consent * Pneumonia upon admission * Delirium upon admission * Pneumothorax For patients with e.g. dementia or brain injury, the ability to give informed consent will be assessed individually.

Outcomes

Primary Outcomes

The incidence of hospital-acquired pneumonia

Primary Outcome is the incidence of hospital-acquired pneumonia in the control and intervention group. Documented in the Sundhedsplatformen and diagnosed with one ore more of the following: * Thoracic x-ray * Sputum culture * Auscultation * Infection markers

Time frame: During hospitalization, from intervention start to discharge, which is on average one week

Secondary Outcomes

Number of participants dead within 30-days after discharge

Number of participants dead within 30 days after discharge

Time frame: 30-day mortality, assessed 30 days after discharge from the orthopedic ward

Number of participants readmitted within 30-days after discharge

Number of participants readmitted within 30 days after discharge

Time frame: 30-day readmission post-discharge, assessed 30 days after discharge from the orthopedic ward

Incidence of delirium during hospitalization (journal entry, CAM-screening, diagnosis), up to 4 weeks.

Time frame: During hospitalization, from intervention start to discharge, which is on average one week

Degree of regained basic mobility (Cumulated Ambulation Score - CAS) on the the day of discharge compared to the assement made at admission.

Degree of regained basic mobility (Cumulated Ambulation Score - CAS) on the the day of discharge compared to the assement made at admission. CAS values ranges from 0 to 6. A score of 6 represents an independant patient in regards to getting in and out of bed, sit-to-stand from a chair, and walking. A score of 0 represents a patient completely dependant on help getting in and out of bed, sit-to-stand from a chair, and walking.

Time frame: CAS the weeks up to hip fracture and CAS at discharge, which is on average one week after admission

Discharge destination (home, nursing home, care facility, rehab, another ward/hospital, etc.). Number of participants discharged to home, care facility, rehab, another hospital/ward or ot he discharge destination.

Time frame: Assessed at discharge from the orthopedic department, which is on average one week efter admission