Introduction: Intrapulmonary percussive ventilation (IPV) has been used in critical care to promote airway clearance, prevent or reverse atelectasis and improve gas exchange in various clinical conditions. However, research evidence to support the use of IPV is weak and conflicting.

Aims: To evaluate the effectiveness of IPV intervention in non-ventilated critically ill patients in reducing ICU length of stay (ICU-LOS), preventing pulmonary complications, and reducing readmission rates.

Methods: Non-ventilated, critically ill patients with impaired respiratory function were randomised to receive either IPV (using Metaneb device) or routine chest physiotherapy (CPT) twice daily for the duration of ICU stay. Outcome measures included ICU-LOS, radiological atelectasis scores (RAS), adverse events during treatment, ICU readmissions and mortality. Data were analysed using t-test and two-way ANCOVA.

Results: 106 patients were randomised, of which 100 completed the study (IPV=51, CPT=49). ICU-LOS was significantly shorter in the IPV group compared to the CPT group (median = 3.4 [IRQ 1.96 ? 5.95] vs 5.49 [IRQ 3.41 ? 10.9]days); mean difference was 0.6 ( CI=0.44 ? 0.81, p= 0.0012) days. RAS (score: 0-4) improved (reduced) significantly post-intervention in both groups (IPV= - 0.49 [CI=0.14, 0.81], CPT= - 0.5 [CI=0.08, 0.91]), with no difference between groups (p=0.65).  There were no between groups differences in ICU readmission rate or mortality and no adverse events in either groups.

Conclusions: IPV intervention resulted in shorter ICU-LOS. Improvements in pulmonary complications were seen in both IPV and CPT groups. No adverse events were recorded during IPV or CPT intervention.