What place for intrapulmonary percussive ventilation in the intensive care unit: a systematic review.

ABSTRACT: In the intensive care units, airway clearance and lung mobilization techniques have an early important role on respiratory complications and its consequences such as decreased saturation, ventilated time increased, more lung infections, higher mortality rate and length of stay (LOS). From those points came out the question: how efficient is the IPV for the ICUs patients? This systematic review aims to synthetize the immediate and prolonged physiological (gas exchange, cardiorespiratory, lung and mechanical functions ) and clinical effects (symptoms, LOS, infections) with the use of IPV as an airway clearance and as a lung recruitment technique in order to determine if IPV can be recommended or not in routine use in ICUs or not and in what conditions. METHODS: Prisma guidelines were respected during all stages of the systematic review. 5 databases were screened to extract, review and analyze all the randomized control trials, cohort, comparative or observational studies investigating the effects of the IPV in the ICUs. RESULTS: 7 studies involving a total of 276 patients were analyzed in which 5 diseases were investigated and a sample size >50 patients was obtained by 1 study only. IPV appears to improve gas exchange for AECOPD and tracheostomized patients, reduce the risk of lung infections for post-intubated and tracheostomized patients and reduce the length of stay for AECOPD and indicated to IPV patients. CONCLUSIONS: Insufficient evidences about the effectiveness of the IPV in the ICUs as an airway clearance technique and/or lung recruitment technique does not allow to recommend its routine use.