Chest physiotherapy protocol based on ultrasonic signs and its preliminary clinical application in patients with severe traumatic brain injury.

OBJECTIVE

This study aimed to develop and Preliminary validate an ultrasound-guided chest physiotherapy (CPT) protocol for patients with severe traumatic brain injury (sTBI), offering guidance for clinical pulmonary care management.

MATERIALS AND

METHODS

A comprehensive search was conducted across both domestic and international databases from their inception until April 30, 2026, to gather relevant evidence for drafting an ultrasound-guided chest physiotherapy (CPT) protocol for sTBI patients. The draft underwent two rounds of revisions via the Delphi method to finalize the protocol. A convenience sampling approach was adopted to select 20 sTBI patients from a tertiary Grade A hospital in Jiangsu Province, between November 2025 and January 2026, as the experimental group, who received standardized chest physiotherapy (CPT) guided by lung ultrasound assessment. Another group of 20 sTBI patients, treated with the identical standardized chest physiotherapy (CPT) between February and April 2026, served as the control group, and the only difference between the two groups lay in pulmonary evaluation methods: the control group adopted routine pulmonary evaluation including auscultation and CT instead of ultrasound-guided assessment. To compare the pulmonary ultrasound score, clinical pulmonary infection score, oxygenation index, mechanical ventilation duration and NICU length of stay between two patient groups. Additionally, a questionnaire survey of neurointensive care unit (NICU) nurses evaluated the clinical applicability, significance, feasibility, and satisfaction of the protocol.

RESULTS

A total of 34 articles were included, with 18 experts completing two rounds of correspondence. All questionnaires were validly recovered, yielding expert authority coefficients of 0.87 and 0.95. The Kendall harmony coefficients for item importance and operability were 0.129 and 0.137, and 0.305 and 0.244, respectively. The coefficient of variation for each item ranged from 0.048 to 0.221. The final protocol consists of four primary items: personnel qualification, pulmonary ultrasound examination, quality control, and efficacy assessment, along with 11 secondary items and 28 tertiary items. After intervention, statistically significant improvements in lung ultrasound scores emerged from day 7 in the experimental group, while those in oxygenation index reached statistical significance starting on day 9 (p < 0.05). Nurses rated the protocol's clinical applicability, feasibility, and satisfaction at 4.57 ± 0.36 points, awarding a full score of 5 points for its clinical significance, indicating that this protocol has preliminary operability and potential clinical application value.

CONCLUSION

The ultrasound-guided CPT protocol for sTBI patients is scientifically,potential effectiveness and goal-oriented, providing a valuable reference for pulmonary management in this patient population.