https://doi.org/10.4081/monaldi.2024.2734

Feasibility of high-frequency percussions in people with severe acquired brain injury and tracheostomy: an observational study

Early Access
Submitted: July 31, 2023
Accepted: January 2, 2024
Published: January 17, 2024
Brain injuries, tracheostomy, pulmonary atelectasis, respiratory therapy
Abstract Views: 424
PDF_EARLY VIEW: 288
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Authors

Salvatore Andrea Sciurello
ssciurello@dongnocchi.it
https://orcid.org/0000-0002-2530-9069
IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
Francesca Graziano
https://orcid.org/0000-0003-1825-3527
Bicocca Bioinformatics Biostatistics and Bioimaging Center B4, School of Medicine and Surgery, University of Milano Bicocca; Biostatistics and Clinical Epidemiology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
Maria Marcella Laganà
IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
Elena Compalati
https://orcid.org/0000-0001-7439-184X
IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
Gabriele Pappacoda
IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
Simone Gambazza
https://orcid.org/0000-0002-6225-2989
Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy.
Jorge Navarro
IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
Pietro Cecconi
IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
Francesca Baglio
https://orcid.org/0000-0002-6145-5274
IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.
Paolo Banfi
https://orcid.org/0000-0001-8162-0751
IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.

People with severe acquired brain injury (pwSABI) frequently experience pulmonary complications. Among these, atelectasis can occur as a result of pneumonia, thus increasing the chance of developing acute respiratory failure. Respiratory physiotherapy contribution to the management of atelectasis in pwSABI is yet poorly understood. We conducted a retrospective analysis on 15 non-cooperative pwSABI with tracheostomy and spontaneously breathing, hospitalized and treated with high-frequency percussion physiotherapy between September 2018 and February 2021 at the Neurological Rehabilitation Unit of the IRCCS “S.Maria Nascente - Fondazione Don Gnocchi”, Milan. Our primary aim was to investigate the feasibility of such a physiotherapy intervention method. Then, we assessed changes in respiratory measures (arterial blood gas analysis and peripheral night-time oxygen saturation) and high-resolution computed tomography lung images, evaluated before and after the physiotherapy treatment. The radiological measures were a modified radiological atelectasis score (mRAS) assigned by two radiologists, and an opacity score automatically provided by the software CT Pneumonia Analysis® that identifies the regions of abnormal lung patterns. Treatment diaries showed that all treatments were completed, and no adverse events during treatment were registered. Among the 15 pwSABI analyzed, 8 were treated with IPV® and 7 with MetaNeb®. After a median of 14 (I-III quartile=12.5-14.5) days of treatment, we observed a statistical improvement in various arterial blood gas measures and peripheral night-time oxygen saturation measures. We also found radiological improvement or stability in more than 80% of pwSABI. In conclusion, our physiotherapy approach was feasible, and we observed respiratory parameters and radiological improvements. Using technology to assess abnormal tomographic patterns could be of interest to disentangle the short-term effects of respiratory physiotherapy on non-collaborating people.

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Ethics approval

The study protocol was approved by the Ethical Review Committee of IRCCS Fondazione Don Carlo Gnocchi IRCCS Regione Lombardia, (protocol no. 05_17/02/2021 dated 21/02/17). The protocol was registered in clinicalTrials.gov (NCT05630079).

How to Cite

Sciurello, Salvatore Andrea, Francesca Graziano, Maria Marcella Laganà, Elena Compalati, Gabriele Pappacoda, Simone Gambazza, Jorge Navarro, Pietro Cecconi, Francesca Baglio, and Paolo Banfi. 2024. “Feasibility of High-Frequency Percussions in People With Severe Acquired Brain Injury and Tracheostomy: An Observational Study”. Monaldi Archives for Chest Disease, January. https://doi.org/10.4081/monaldi.2024.2734.
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