Non-invasive positive airway pressure added to chest physiotherapy promotes a faster resolution of pleural effusion after drainage: A randomised controlled trial

Abstract

AIM: To test the effects of non-invasive positive airway pressure added to CPT on resolution of pleural effusions after drainage.

METHODS: This trial (NCT02246946) enrolled 150 patients with pleural effusion and chest drainage in situ for <24h randomly assignedinto 3 groups: G1=Non-invasive positive pressure at 15cmH₂O + CPT (n=51), G2=CPT (n=50) and G3=Control (sham intervention, n=49). All patients received 3 daily interventions until the drain was removed for a maximum of 7 days. Chest drainage output and X-ray (criteria for removal of drain=output over 24h ≤200ml + full lung expansion on X-ray) were assessed daily. Days of chest tube drainage, length of hospital stay, pulmonary complications (pneumonia, atelectasis, or lung entrapment) and side effect of positive pressure (aerophagia or pleural fistula) were recorded until hospital discharge. Outcome assessors and statisticians were blinded to the random allocation. ANOVA, Kaplan-Meier and chi-square tests were used.

RESULTS: G1 presented shorter chest tube drainage time (4±2 vs 6±6 vs 6±3; p<0.0001) and hospital stay (5±4 vs 7±7 vs 7±6; p<0.0001) compared to G2 and G3. In addition, G1 had decreased need for antibiotics (15% vs 36% vs 47%; p<0.0001) and a lower rate of pneumonia (0% vs 16% vs 20%; p=0.004) compared to G2 and G3. All groups has the same rate of side effect (9% vs 2% vs 6%; p>0.05).

CONCLUSION: The addition of positive pressure in the conventional therapy decreases the thoracic drainage time, hospitalization time, the rate of pulmonary complications and antibiotic use in patients with pleural effusion.