OUTCOME OF PER-PROTOCOL CHEST PHYSIOTHERAPY VERSUS ADD-ON PATIENT-DIRECTED SELF-PRONING IN CRITICALLY ILL RESPIRATORY PATIENTS: A QUASI-EXPERIMENTAL STUDY

Abstract

Background: Acute respiratory failure due to diverse underlying clinical conditions is a common cause of hospitalization and intensive care admission, often requiring supplemental oxygen and supportive respiratory interventions. Chest physiotherapy and awake prone positioning have independently demonstrated benefits in improving oxygenation and pulmonary mechanics. However, evidence regarding their effectiveness when combined in a mixed population of critically ill respiratory patients remains limited.

Objective: To compare the clinical outcomes of chest physiotherapy alone versus chest physiotherapy combined with patient-directed self-proning in critically ill respiratory patients requiring supplemental oxygen.

Methods: This prospective quasi-experimental study was conducted at a Tertiary Care Military Hospital (PEMH). A total of 106 adult patients with acute or acute-on-chronic respiratory illness requiring more than 2 L/min of supplemental oxygen were allocated to either chest physiotherapy alone (Group A) or chest physiotherapy plus patient-directed self-proning (Group B). Primary outcomes included reduction in oxygen requirement, improvement in respiratory distress score, and improvement in WHO functional class. Secondary outcomes included the need for escalation to high-flow nasal oxygen (HFNO), non-invasive ventilation (NIV), shifting to Medical ITC, endotracheal intubation, and length of hospital stay. Statistical analysis was performed using SPSS, with a p-value <0.05 considered statistically significant.

Results: Patients receiving chest physiotherapy combined with self-proning demonstrated greater improvement in oxygenation, respiratory distress scores, and WHO functional class compared with those receiving chest physiotherapy alone. The self-proning group also exhibited lower rates of escalation to HFNO/NIV, reduced intubation requirements, and shorter hospital stays. The intervention was well tolerated and associated with favorable clinical outcomes.

Conclusion: The addition of patient-directed self-proning to standard chest physiotherapy significantly improves oxygenation, functional recovery, and respiratory outcomes in critically ill respiratory patients. This low-cost and easily implementable intervention may reduce the need for advanced respiratory support and should be considered as an adjunctive strategy in the management of hypoxemic respiratory failure in addition to standard care as per guidelines.