Respiratory physiotherapy to prevent infections

Respiratory infections in ventilated patients are serious complications which lead to an increase in ventilator days, a longer length of stay on the ICU and an increase in mortality,[1] and therefore we should welcome each initiative to diminish these complications. Spapen et al. suggest in this issue that a special form of respiratory therapy, the combination of intrapulmonary percussive ventilation (IPV) with assisted autogenic drainage physiotherapy (AADP) tends to decrease the occurrence of ventilator-associated Gram-negative infections.(2) However, this study is small and underpowered and the study population is unbalanced, which makes it difficult to assess the value of this pilot. A much larger study would be required to be able to draw any definite conclusions. In addition, there are several other problems with this pilot study, a number of which are neatly addressed by the authors.