Application of Airway Clearance Combined with Postural Care in Patients with Severe Traumatic Brain Injury

Abstract

Objective: To explore the systemic changes in respiratory function, the progression of pulmonary complications, and the potential for neurological recovery in patients with severe traumatic brain injury (sTBI) when applying an integrated approach that combines systematic airway clearance techniques with posture adjustment guided by cranial-cerebral physiological data. Methods: A total of 104 eligible sTBI patients were randomly assigned to a study group receiving integrated intervention (54 cases) and a control group receiving standard care (50 cases). Standard care followed general guidelines for neurocritical care, while the integrated intervention group underwent an additional comprehensive procedure: twice-daily airway clearance including positioning percussion, high-frequency vibration drainage, and image-guided pulmonary drainage, along with individualized progressive posture adjustments (such as phased elevation of the head of the bed and selective lateral positioning under image guidance) based on continuous monitoring of intracranial pressure (ICP) and cerebral perfusion pressure (CPP). Oxygenation index (PaO₂/FiO₂), respiratory mechanics parameters (plateau pressure, lung compliance), incidence of clinical pulmonary infection (CPIS criteria), duration of antimicrobial agent use, length of stay in the intensive care unit (ICU), and Glasgow Outcome Scale (GOS) at day 28 were evaluated and compared between the two groups before intervention, and on days 3 and 7. Results: By day 7 of intervention, the oxygenation index and lung compliance measurements in the study group were significantly higher than those in the control group (P<0.01). The proportion of patients with clinical pneumonia and the constituent ratio of severe pneumonia (CPIS≥8) in the study group were significantly reduced (P<0.05). The median duration of mechanical ventilation and the median length of ICU stay in the study group were shorter than those in the control group (P<0.01). The 28-day outcome assessment showed that the proportion of patients with favorable recovery outcomes (GOS 4–5) in the study group was higher than that in the control group (P<0.05). Conclusion: Implementing an integrated approach that combines structured airway maintenance with intracranial pressure-based posture control can effectively promote the recovery of pulmonary gas exchange efficiency in sTBI patients and reduce mechanical ventilation-related stress injury to lung tissue.