الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Intensive Care Units (ICUs) are special units used to provide care for critically ill patients who are admitted to the ICU for many reasons either related to pulmonary diseases such as acute respiratory failure and massive pneumonia or other causes such as neuromuscular diseases, after major surgeries, shock, or post-arrest.
Invasive mechanical ventilation (MV) is a lifesaving intervention which used as a cornerstone in the treatment plan for these critically ill patients, but the presence of tracheal intubation indeed seriously impairs cough reflex and mucociliary escalator function leading to accumulation and impaction of secretions in the lower airways. This exposes MV patients to severe lung complications including pneumothorax, lung injury, alveolar damage, ventilator-associated pneumonia, secretion retention, and atelectasis, prolongs the weaning process, and may increase mortality as a result of significantly impaired bronchial mucociliary transport velocity.
Chest physiotherapy (CPT) is one of preventive strategy acclaimed as an important constituent of respiratory care in all mechanically ventilated patients, even in the absence of primary or significant lung disease, CPT facilitate removal of retained or profuse airway secretions aiming to reduce airway resistance, optimize lung compliance, improve tidal volume, decrease the work of breathing, improve oxygenation, prevent pulmonary complications, and therefore potentially reduce the length of ICU stay.
Chest physiotherapy has several techniques as chest percussion and squeezing which are the most frequently techniques recommended for mechanically ventilated patients who have impaired cognition or poor coughing ability. Chest percussion and squeezing are used to enhance mucociliary clearance from both central and peripheral airway, and both techniques are more effective in mobilizing secretions that are adherent to the bronchial walls. Therefor this study carried out to determine the effect of chest percussion and squeezing on respiratory status in mechanically ventilated patients in Alexandria main university hospital.
A convenience sample of 60 adult mechanically ventilated patients who were admitted to casualty care unit (unit I) and the general ICU (unit III) and required continuous invasive mechanical ventilation for more than 48 hours were included in the study.
Two tools were used to collect the data of this study namely. “Respiratory Status Monitoring for Mechanically Ventilated Patients ”, and “Chest Percussion and Squeezing Effects Assessment”. Tool one ”Respiratory status monitoring for mechanically ventilated patients” it includes two parts :Part I:patients demographics and clinical data such as sex, age and clinical data such as current diagnosis, medical history, prescribed medications, length of ICU stay, RASS and hemodynamic parameters such as central venous pressure, mean arterial pressure, heart rate. Part II: respiratory assessment for mechanically ventilated patients.
Tool two “Chest percussion and squeezing effects assessment” it include secretion volume and oxygenation parameters such as arterial blood gases values and SpO2 monitoring using pulse oximeter.
The main finding of the current study was that:
In relation to demographic and clinical characteristics of the studied critically ill patients, the majority of the studied group were lied in age ranging from 40-60 years. 50% and 63.3% of the control and intervention group respectively were male, while 50% and 36.7% of the control and intervention group respectively were female. No statistical significant difference was found between the two groups.
As regarding effectiveness of chest percussion and squeezing, it can be concluded from the present study that, the chest percussion and squeezing was highly effective and improve the oxygenation parameter for intervention group as FiO2, SpO2, PaO2, pulmonary oxygen capacity index (PaO2/ FiO2),VT, and RR.Additionally there is highly statistical significant differences between two groups regarding PaO2 ,VT ,respiratory inspection and auscultation , RR , the amount and viscosity of excreted secretions in favor to intervention group.
Finally, it can be recommended that:
- Chest percussion and squeezing should be initiated for mechanically ventilated patients to prevent several complications and help the patients to gain independence and return to an active life style, conduct a periodic workshop for knowledge of CCNs about chest squeezing technique or expiratory rib cage compression technique.
- Further studies are needed to assess the effect of chest squeezing and expiratory rib cage compression (ERCC) on longer term outcomes, such as duration of mechanical ventilation and length of hospitalization in intensive care unit.