Efektivitas chest physiotherapy pada pasien ventilasi invasif dan NIV terhadap outcome klinis serta durasi rawat
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https://doi.org/10.31101/jitu.4610Abstract views 151 times
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chest physiotherapy, ICU, length of stay, outcome klinis, ventilasi mekanikAbstract
Pasien di Unit Perawatan Intensif (ICU) dengan ventilasi mekanik sering mengalami kegagalan pembersihan jalan napas akibat retensi sekret, yang dapat menyebabkan komplikasi seperti atelektasis dan memperpanjang durasi ventilasi serta lama rawat inap (LOS). Chest Physiotherapy (CPT) atau teknik pembersihan jalan napas (ACT) diperlukan untuk memperbaiki mekanika paru dan memfasilitasi penyapihan (weaning). Penelitian ini merupakan systematic review yang menggunakan metode PRISMA. Pencarian literatur dilakukan melalui database Google Scholar dengan rentang tahun 2015–2025, kriteria inklusi artikel berbahasa inggris dan merupakan artikel peneltian serta menggunakan salah satu jenis dari CPT dan memiliki outcome klinis. Menghasilkan 20 artikel yang memenuhi kriteria inklusi untuk dianalisis. Analisis artikel dilakukan dengan menggunakan pendekatan PICO, yang meliputi populasi pasien dengan ventilasi invasif maupun non-invasif yang menerima intervensi chest physiotherapy serta airway clearance technique. Pada pasien ventilasi invasif, CPT multimodal yang dikombinasikan dengan rehabilitasi dini terbukti meningkatkan keberhasilan ekstubasi dan menurunkan durasi penggunaan ventilator. Pada pasien Non-Invasif (NIV), CPT lebih berdampak pada perbaikan luaran fungsional dan kelelahan dibandingkan mortalitas. Teknik berbasis alat seperti Mechanical Insufflation-Exsufflation (MI-E) efektif dalam mobilisasi sekret, namun dampaknya terhadap LOS bersifat heterogen. Penurunan LOS yang signifikan lebih terlihat ketika intervensi dilakukan secara komprehensif dan intensif. CPT dan ACT memberikan kontribusi kuat terhadap perbaikan outcome klinis respirasi, khususnya oksigenasi dan mobilisasi sekret. Meskipun efek terhadap durasi rawat bervariasi, pemilihan teknik yang tepat berdasarkan kondisi fisiologis pasien dapat mendukung percepatan penyapihan ventilator.
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References
Ahmed Sayed, Z., & Galal Sayed, I. (2020). Effect of Multimodality Chest Physiotherapy on Extubation and Critically Ill Mechanically Ventilated Patients Outcomes. In Original Article Egyptian Journal of Health Care (Vol. 11, Issue 2).
Akella, P., Voigt, L. P., & Chawla, S. (2022). To Wean or Not to Wean: A Practical Patient Focused Guide to Ventilator Weaning. Journal of Intensive Care Medicine, 37(11), 1417–1425. https://doi.org/10.1177/08850666221095436
Akselim, S., Dandinoğlu, T., Topal, S., & Çalışkan, G. (2022). The Effects of Early Pulmonary Rehabilitation and Diaphragm Kinesiotaping on Diaphragm Muscle Thickness in Patients with Severe COVID-19 Pneumonia in the Intensive Care Unit. https://doi.org/10.21203/rs.3.rs-1742436/v1
Alnefaie, Y. M., Alsaadoon, S. M., & Alotaibi, M. M. (2024). The Role of Physiotherapy in Reducing ICU- Acquired Weakness : A Comparative Study of Early vs . Delayed Rehabilitation in Critically Ill Patients. 12(5), 1–9.
Ariawan, D., Abdillah, H., Hamidah, E., & Hadiyanto, H. (2025). The Relationship Between Patient Length of Stay and Family Anxiety Levels in the ICU. Jurnal Keperawatan Priority, 8(2), 112–121. https://jurnal.unprimdn.ac.id/index.php/jukep/article/view/7011/4224
Ashary, A. A. A., Shoukry, K. E. S., Hassan, N., & Ibrahim, A. F. (2024). Effects of the thoracic block technique on vital signs, blood gases, and lung compliance in children with atelectasis. Journal of Taibah University Medical Sciences, 19(4), 739–745. https://doi.org/10.1016/j.jtumed.2024.06.006
Belli, S., Prince, I., Savio, G., Paracchini, E., Cattaneo, D., Bianchi, M., Masocco, F., Bellanti, M. T., & Balbi, B. (2021). Airway Clearance Techniques: The Right Choice for the Right Patient. In Frontiers in Medicine (Vol. 8). Frontiers Media S.A. https://doi.org/10.3389/fmed.2021.544826
Chambers, R. (2021). Clinical usage of non-invasive ventilation by physical therapists in cystic fibrosis centres across Australia: A cross-sectional survey study Authors 1.
da Silva, K., Carneiro Oliveira, C., Ferracini Cabral, L., Malaguti, C., & José, A. (2023). Pulmonary expansion manoeuvres compared to usual care on ventilatory mechanics, oxygenation, length of mechanical ventilation and hospital stay, extubation, atelectasis, and mortality of patients in mechanical ventilation: A randomized clinical trial. PLoS ONE, 18(12 December). https://doi.org/10.1371/journal.pone.0295775
Davidson, A. C., Banham, S., Elliott, M., Kennedy, D., Gelder, C., Glossop, A., Church, A. C., Creagh-Brown, B., Dodd, J. W., Felton, T., Foëx, B., Mansfield, L., McDonnell, L., Parker, R., Patterson, C. M., Sovani, M., & Thomas, L. (2016). BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax, 71, ii1–ii35. https://doi.org/10.1136/thoraxjnl-2015-208209
de Camillis, M. L. F., Savi, A., Rosa, R. G., Figueiredo, M., Wickert, R., Borges, L. G. A., Galant, L., & Teixeira, C. (2018). Effects of mechanical insufflation-exsufflation on airway mucus clearance among mechanically ventilated icu subjects. Respiratory Care, 63(12), 1471–1477. https://doi.org/10.4187/respcare.06253
El-Bably, M. M., Galal, A. M. M., Rafat, R. H., & El Rehem, S. M. A. (2023). Effect of physiotherapy and its frequency on the outcome of COVID-19 patients regarding acute care setting at isolation unit of Ain Shams University. The Egyptian Journal of Chest Diseases and Tuberculosis, 72(3), 433–442. https://doi.org/10.4103/ecdt.ecdt_82_22
Fereydounnia, S., Shadmehr, A., Tahmasbi, A., & Salehi, R. S. (2022). The Comparison of the Effectiveness of Respiratory Physiotherapy Plus Myofascial Release Therapy Versus Respiratory Physiotherapy Alone on Cardiorespiratory Parameters in Patients With COVID-19. International Journal of Therapeutic Massage and Bodywork: Research, Education, and Practice, 15(1), 4–14. https://doi.org/10.3822/ijtmb.v14i4.691
Giovannetti, P., Morin, L., & Reynaud-gaubert, M. (2020). Safety and Efficacy of an Innovative Airway Clearance Device Versus Manual Chest Physiotherapy Techniques For Airway Secretion Clearance: a Feasibility Study. European Journal of Respiratory Medicine, 2(1), 132–137. https://doi.org/10.31488/ejrm.107
Goetz, R. L., Vijaykumar, K., & Solomon, G. M. (2022). Mucus Clearance Strategies in Mechanically Ventilated Patients. Frontiers in Physiology, 13(March), 1–9. https://doi.org/10.3389/fphys.2022.834716
Hassan, A., Milross, M., Lai, W., Shetty, D., Alison, J., & Huang, S. (2021). Feasibility and safety of intrapulmonary percussive ventilation in spontaneously breathing, non-ventilated patients in critical care: A retrospective pilot study. Journal of the Intensive Care Society, 22(2), 111–119. https://doi.org/10.1177/1751143720909704
Hoo, Z. H., Daniels, T., Wildman, M. J., Teare, M. D., & Bradley, J. M. (2015). Airway clearance techniques used by people with cystic fibrosis in the UK. Physiotherapy (United Kingdom), 101(4), 340–348. https://doi.org/10.1016/j.physio.2015.01.008
Javaherian, M., Shadmehr, A., Keshtkar, A., Beigmohammadi, M. T., Dabbaghipour, N., Syed, A., & Moghadam, B. A. (2023). Safety and efficacy of pulmonary physiotherapy in hospitalized patients with severe COVID-19 pneumonia (PPTCOVID study): A prospective, randomised, single-blind, controlled trial. PLoS ONE, 18(1 January). https://doi.org/10.1371/journal.pone.0268428
Jeitziner, M. M., Jenni-Moser, B., Que, Y. A., Thurnheer Zürcher, M. C., Furrer, H., & Jakob, S. M. (2021). Importance of critical care staffing and standard intensive care therapy in the COVID-19 era: A descriptive study of the first epidemic wave at a Swiss tertiary intensive care unit. Swiss Medical Weekly, 151(25–26), 1–5. https://doi.org/10.4414/smw.2021.20529
Kang, J. K., & Vyas, N. J. (2021). The Effect of Positioning Exercises on Dyspnea and Fatigue in Patients Treated with COVID-19. International Journal of Health Sciences and Research, 11(10), 1–4. https://doi.org/10.52403/ijhsr.20211001
Li, L., Yu, P., Yang, M., Xie, W., Huang, L., He, C., Gosselink, R., Wei, Q., & Jones, A. Y. M. (2021). Physical Therapist Management of COVID-19 in the Intensive Care Unit: The West China Hospital Experience. Physical Therapy, 101(1). https://doi.org/10.1093/ptj/pzaa198
Liu, X., Liu, H., Liu, S., Zhou, W., Lan, Q., Duan, J., Li, X., & Zheng, X. (2022). Effects of Prone Positioning for Patients with Acute Respiratory Distress Syndrome Caused by Pulmonary Contusion: A Single-Center Retrospective Study. Canadian Respiratory Journal, 2022. https://doi.org/10.1155/2022/4579030
Livnat, G., Yaari, N., Stein, N., Bentur, L., Hanna, M., Harel, M., Adir, Y., & Shteinberg, M. (2021). 4-week daily airway clearance using oscillating positive-end expiratory pressure versus autogenic drainage in bronchiectasis patients: A randomised controlled trial. ERJ Open Research, 7(4). https://doi.org/10.1183/23120541.00426-2021
Mahesh, A. H., Mahadevan, R., & Krishnarao, C. S. (2022). Impact of Physiotherapy on Functional Status and Length of Stay of Patients Admitted to Intensive Care Unit. Current Respiratory Medicine Reviews, 18(4), 267–274. https://doi.org/10.2174/1573398x18666220818095151
Muelas-Gómez, L., Martínez-Gimeno, L., Escudero-Gómez, C., Atin Arratibel, M. Á., Cebrià i Iranzo, M. A., & Solís-Muñoz, M. (2024). Efficacy of Physiotherapy Interventions on the Respiratory Musculature Through Respiratory Training Techniques in Post-operative Lung Transplant Recipients: Systematic Review. Open Respiratory Archives, 6(1). https://doi.org/10.1016/j.opresp.2023.100288
Muñoz, G., De Gracia, J., Buxó, M., Alvarez, A., & Vendrell, M. (2018). Long-term benefits of airway clearance in bronchiectasis: A randomised placebo-controlled trial. European Respiratory Journal, 51(1). https://doi.org/10.1183/13993003.01926-2017
Rodriguez Hortal, M. C., Nygren-Bonnier, M., & Hjelte, L. (2017). Non-invasive Ventilation as Airway Clearance Technique in Cystic Fibrosis. Physiotherapy Research International, 22(3). https://doi.org/10.1002/pri.1667
Sousa, M. L. de A., Coimbra, V. R. de M., Takei, M. T., Melo, C. C. de A., Feltrim, M. I. Z., & Nozawa, E. (2021). Physiological abnormalities and adverse events during physical therapy in the intensive care unit after cardiac surgery: A prospective observational study. Brazilian Journal of Physical Therapy, 25(5), 623–631. https://doi.org/10.1016/j.bjpt.2021.04.001
Stanford, G., Parrott, H., Bilton, D., Agent, P., Banya, W., & Simmonds, N. (2019). Randomised cross-over trial evaluating the short-term effects of non-invasive ventilation as an adjunct to airway clearance techniques in adults with cystic fibrosis. BMJ Open Respiratory Research, 6(1). https://doi.org/10.1136/bmjresp-2018-000399
Tranter, K. E., Harvey, L. A., Ross, J., Wadsworth, B., Berlowitz, D. J., Bye, E. A., Chen, L. W., Patterson, H., McDonald, M., Calthorpe, S., Agostinello, J., Gollan, E., Denis, S., Blecher, L., Wilson, D., Peach, J., McDonald, T., Walters, M., Mather, J., … Glinsky, J. V. (2025). Physiotherapy interventions for the respiratory management of people with spinal cord injury: recommendations from an Australian and New Zealand clinical practice guideline. Spinal Cord, 63(11), 588–598. https://doi.org/10.1038/s41393-025-01116-7
Vaidya, A. C., Kapre, V. M., Dobhal, S. P., Shukla, M. P., Mishra, A. S., & Tiwari, V. (2025). Effect of Early and Progressive Rehabilitation Protocol on Fatigue, Functional Outcome, and Kinesiophobia in Patients on Non-invasive Ventilation: A Randomized Controlled Trial. Indian Journal of Critical Care Medicine, 29(6), 510–515. https://doi.org/10.5005/jp-journals-10071-24992
Verceles, A. C., Wells, C. L., Sorkin, J. D., Terrin, M. L., Beans, J., Jenkins, T., & Goldberg, A. P. (2018). A multimodal rehabilitation program for patients with ICU acquired weakness improves ventilator weaning and discharge home. Journal of Critical Care, 47(3), 204–210. https://doi.org/10.1016/j.jcrc.2018.07.006
Wibart, P., Réginault, T., Garcia-Fontan, M., Barbrel, B., Bader, C., Benard, A., Parreira, V. F., Gonzalez-Antón, D., Bui, N. H., Gruson, D., Hilbert, G., Martinez-Alejos, R., & Vargas, F. (2023). Effects of mechanical in-exsufflation in preventing postextubation acute respiratory failure in intensive care acquired weakness patients: a randomized controlled trial. Critical Care Science, 35(2), 168–176. https://doi.org/10.5935/2965-2774.20230410-en
Zhang, S. M., Muhetaer, Y., & Liu, K. (2025). Assessments and exercises of cough strength in critically ill patients: a literature review. Journal of Thoracic Disease, 17(2), 1080–1102. https://doi.org/10.21037/jtd-24-1673
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