• Elinaldo da Conceição Dos Santos and Adriana Claudia Lunardi.
• Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo; Department of Biological and Health Sciences, Universidade Federal do Amapá
• J Physiother. 2015 Apr 1; 61 (2): 93.

IntroductionChest drainage for pleural effusion can cause pain and changes in respiratory function. It can also increase the risk of pulmonary complications and impair functional ability, which may increase length of hospital stay and the associated costs. For these reasons, surgical and clinical strategies have been adopted to reduce the duration of chest drainage.ObjectivesTo evaluate the efficacy of the addition of intermittent positive airway pressure applied by the Muller reanimator via a rubber facial mask versus conventional physiotherapy on the duration of chest drainage (primary objective), and its effect on the recovery of respiratory function, length of hospital stay and incidence of pulmonary complications (secondary objectives).DesignRandomised, controlled trial.Participants And SettingInpatients with pleural effusion, aged over 18 years, who have had chest drainage in situ for < 24hours will be recruited from two university hospitals. Patients will be excluded if they have any contraindication for the use of non-invasive positive airway pressure.Intervention And Control GroupsAfter initial assessments of lung function, 156 patients will be randomised into a positive airway pressure group (positive airway pressure at 15 cmH2O plus conventional chest physiotherapy), a conventional chest physiotherapy group (conventional chest physiotherapy plus non-therapeutic positive airway pressure at 4 cmH2O) or a control group (non-therapeutic positive airway pressure at 4 cmH2O). All groups will receive treatment three times per day for 7 consecutive days.MeasurementsA blinded assessor will conduct all assessments. Peripheral oxygenation and chest drainage output will be measured over 7 consecutive days. Lung function will be re-assessed on Day 4 and Day 8. The criteria for removal of the chest drain will be a transudate output ≤ 200ml over 24hours and full lung expansion on chest radiography, as assessed by a blinded physician. Duration of chest drainage, length of hospital stay, and any pulmonary complications diagnosed during hospitalisation will be recorded.AnalysisIntention to treat using: survival analysis for duration of chest drainage, and length of hospital stay; analysis of variance for chest-tube output, lung function and peripheral oxygen saturation; and chi-square tests for comparing the incidence of pulmonary complications between groups.DiscussionConventional chest physiotherapy and intermittent positive airway pressure breathing are widely indicated for people with pleural effusion and chest drains; however, no studies have evaluated the real benefit of this type of treatment. Our hypothesis is that optimised lung expansion achieved through the application of intermittent positive airway pressure will accelerate the reabsorption of pleural effusion, decrease the duration of chest drainage and respiratory system impairment, reduce the length of hospital stay, and reduce the incidence of pulmonary complications.Copyright © 2014 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

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