Comparison Effects of Postural Drainage and Positive Expiratory Pressure Technique in Community Acquired Pneumonia

Main Article Content

Muhammad Ahmad
Sidra Afzal
Noor Amjad
Misdaq Batool
Rabbyya Kausar
Nimra Fatima

Abstract

Background: Community-acquired pneumonia (CAP) is a major health concern worldwide, leading to substantial hospitalization and morbidity. Physiotherapy interventions like postural drainage and positive expiratory pressure (PEP) are commonly used in managing CAP, but their relative effectiveness in improving respiratory parameters is not fully understood.


Objective: The study aimed to compare the effects of postural drainage and PEP techniques on respiratory parameters, specifically pH values and alveolar-arterial oxygen tension, in patients with CAP.


Methods: In this randomized clinical trial, 46 patients with mild to moderate CAP were divided into two groups: postural drainage (n=23) and PEP technique (n=23). Data collection occurred pre- and post-intervention in each session, with analysis conducted using SPSS version 23. The Shapiro-Wilk test determined data normality, leading to the use of the Mann-Whitney U test for non-parametric data.


Results: Improvements in oxygen saturation were observed in both groups. However, other arterial blood gas parameters, including pH and alveolar-arterial oxygen tension, showed no significant changes post-intervention. Specifically, pH values for the postural drainage group had mean ranks of 21.13, 22.04, 24.74, and 20.70 across sessions, while the PEP technique group showed mean ranks of 25.87, 24.96, 22.26, and 26.30, with p-values ranging from 0.152 to 0.525. Similarly, alveolar-arterial oxygen tension comparisons yielded p-values between 0.056 and 0.231.


Conclusion: Both postural drainage and PEP techniques effectively improved oxygen saturation in CAP patients, but they did not significantly impact other respiratory parameters. This suggests their utility in specific areas of respiratory management in CAP, with limitations in broader pulmonary function improvement.

Article Details

How to Cite
Ahmad, M., Afzal, S., Amjad, N., Batool , M., Kausar, R., & Fatima, N. (2023). Comparison Effects of Postural Drainage and Positive Expiratory Pressure Technique in Community Acquired Pneumonia. Journal of Health and Rehabilitation Research, 3(2), 370–375. https://doi.org/10.61919/jhrr.v3i2.93
Section
Articles
Author Biographies

Muhammad Ahmad, Riphah International University-Lahore

Student

Sidra Afzal, Riphah International University-Lahore

Lecturer  

Noor Amjad, Lahore

Clinical Physiotherapist

Misdaq Batool , Department of Allied Health Sciences-University of Sargodha

Visiting Lecturer

Rabbyya Kausar, University of Lahore Sargodha campus

Lecturer

Nimra Fatima, Riphah International University-Lahore

Student

References

Voiriot G, Philippot Q, Elabbadi A, Elbim C, Chalumeau M, Fartoukh M. Risks related to the use of non-steroidal anti-inflammatory drugs in community- acquired pneumonia in adult and pediatric patients. Journal of clinical medicine. 2019;8(6):786.**

Shoar S, Musher DM. Etiology of community-acquired pneumonia in adults: a systematic review. Pneumonia. 2020;12(1):1-10.**

Tansarli GS, Mylonakis E. Systematic review and meta-analysis of the efficacy of short-course antibiotic treatments for community-acquired pneumonia in adults. Antimicrobial agents and chemotherapy. 2018;62(9):e00635-18.**

Steffens C, Sung M, Bastian LA, Edelman EJ, Brackett A, Gunderson CG. The association between prescribed opioid receipt and community-acquired pneumonia in adults: a systematic review and meta-analysis. Journal of general internal medicine. 2020;35(11):3315-22.**

Lopardo GD, Fridman D, Raimondo E, Albornoz H, Lopardo A, Bagnulo H, et al. Incidence rate of community-acquired pneumonia in adults: a population-based prospective active surveillance study in three cities in South America. BMJ open. 2018;8(4):e019439.**

El-Sokkary RH, Ramadan RA, El-Shabrawy M, El-Korashi LA, Elhawary A, Embarak S, et al. Community acquired pneumonia among adult patients at an Egyptian university hospital: bacterial etiology, susceptibility profile and evaluation of the response to initial empiric antibiotic therapy. Infection and drug resistance. 2018;11:2141.**

Jain V, Vashisht R, Yilmaz G, Bhardwaj A. Pneumonia pathology. 2018.

Tian J, Xu Q, Liu S, Mao L, Wang M, Hou X. Comparison of clinical characteristics between coronavirus disease 2019 pneumonia and community- acquired pneumonia. Current Medical Research and Opinion. 2020;36(11):1747-52.**

Korovkina E, Kostinov M. Immune mechanisms of community-acquired pneumonia and copd due to infectious etiology and methods of immunotherapy. Журнал микробиологии, эпидемиологии и иммунобиологии. 2019.**

Assefa M, Tigabu A, Belachew T, Tessema B. Bacterial profile, antimicrobial susceptibility patterns, and associated factors of community-acquired pneumonia among adult patients in Gondar, Northwest Ethiopia: a cross-sectional study. PloS one. 2022;17(2):e0262956.**

Arias-Fernández L, Gil-Prieto R, Gil-de-Miguel Á. Incidence, mortality, and lethality of hospitalizations for community-acquired pneumonia with comorbid cardiovascular disease in Spain (1997–2015). BMC Infectious Diseases. 2020;20(1):1-8.**

McLaughlin JM, Khan FL, Thoburn EA, Isturiz RE, Swerdlow DL. Rates of hospitalization for community-acquired pneumonia among US adults: a systematic review. Vaccine. 2020;38(4):741-51.

Divino V, Schranz J, Early M, Shah H, Jiang M, DeKoven M. The annual economic burden among patients hospitalized for community-acquired pneumonia (CAP): a retrospective US cohort study. Current Medical Research and Opinion. 2020;36(1):151-60.

Dai R-X, Kong Q-H, Mao B, Xu W, Tao R-J, Wang X-R, et al. The mortality risk factor of community acquired pneumonia patients with chronic obstructive pulmonary disease: a retrospective cohort study. BMC pulmonary medicine. 2018;18(1):1-10.

Abelenda-Alonso G, Rombauts A, Gudiol C, Meije Y, Ortega L, Clemente M, et al., editors. Influenza and bacterial coinfection in adults with community- acquired pneumonia admitted to conventional wards: risk factors, clinical features, and outcomes. Open Forum Infectious Diseases; 2020: Oxford University Press US.

Restrepo MI, Babu BL, Reyes LF, Chalmers JD, Soni NJ, Sibila O, et al. Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia: a multinational point prevalence study of hospitalised patients. European Respiratory Journal. 2018;52(2).

Ståhl A, Westerdahl E. Physiotherapy to prevent hospital-acquired pneumonia in patients undergoing hip fracture surgery. Eur Respiratory Soc; 2020.

Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, Cavero- Redondo I, Muñoz PL, Martinez-Vizcaino V. Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. Journal of physiotherapy. 2018;64(4):222-8.

Sawada Y, Sasabuchi Y, Nakahara Y, Matsui H, Fushimi K, Haga N, et al. Early rehabilitation and in-hospital mortality in intensive care patients with community-acquired pneumonia. American Journal of Critical Care. 2018;27(2):97- 103.

Andersen BM. Chest Physiotherapy and Mobilization: Postoperatively. Prevention and Control of Infections in Hospitals: Springer; 2019. p. 313-21.

Eekholm S, Ahlström G, Kristensson J, Lindhardt T. Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia: a descriptive cross-sectional study. BMC infectious diseases. 2020;20(1):1-12.

Goñi-Viguria R, Yoldi-Arzoz E, Casajús-Sola L, Aquerreta-Larraya T, Fernández-Sangil P, Guzmán-Unamuno E, et al. Respiratory physiotherapy in intensive care unit: Bibliographic review. Enfermería Intensiva (English ed). 2018;29(4):168-81.

van der Lee L, Hill A-M, Patman S. After-hours respiratory physiotherapy for intubated and mechanically ventilated patients with community-acquired pneumonia: An Australian perspective. Australian Critical Care. 2018;31(6):349-54.

Ryrsø CK, Faurholt-Jepsen D, Ritz C, Pedersen BK, Hegelund MH, Dungu AM, et al. The impact of physical training on length of hospital stay and physical function in patients hospitalized with community-acquired pneumonia: protocol for a randomized controlled trial. Trials. 2021;22(1):1-14.

Chen Y-Q, Lin Y-Q, Jiang W-Z, Yang Z-Q, Pan J, Liu W-W, et al. Alveolar–arterial partial pressure difference as an early predictor for patients with acute paraquat poisoning. Journal of International Medical Research. 2021;49(9):03000605211043243.

Singh T, Kumar N, Sharma N, Patra A. Effectiveness of Active Cycle of Breathing Technique along with Postural Drainage Versus Autogenic Drainage in Patients with Chronic Bronchitis. Physiotherapy and Occupational Therapy. 2019;12(1).

Osadnik CR, McDonald CF, Miller BR, Hill CJ, Tarrant B, Steward R, et al. The effect of positive expiratory pressure (PEP) therapy on symptoms, quality of life and incidence of re-exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease: a multicentre, randomised controlled trial. Thorax. 2014;69(2):137-43.

Alam M, Hussain S, Shehzad MI, Mushtaq A, Rauf A, Ishaq S. Comparing the effect of incentive spirometry with Acapella on blood gases in physiotherapy after coronary artery bypass graft. Cureus. 2020;12(2).

Sun J, Chen J, Wang L, Lu A. The effect of vibrating positive expiratory pressure therapy on refractory Mycoplasma pneumoniae pneumonia prognosis in children. Translational Pediatrics. 2021;10(2):315.

Most read articles by the same author(s)