1
|
Le Neindre A, Hansell L, Wormser J, Gomes Lopes A, Diaz Lopez C, Romanet C, Choukroun G, Nguyen M, Philippart F, Guinot PG, Buscher H, Bouhemad B, Ntoumenopoulos G. Thoracic ultrasound influences physiotherapist's clinical decision-making in respiratory management of critical care patients: a multicentre cohort study. Thorax 2023; 78:169-175. [PMID: 35321941 DOI: 10.1136/thoraxjnl-2021-218217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/14/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The potential influence of thoracic ultrasound on clinical decision-making by physiotherapists has never been studied. The aim of this study was to assess the impact of thoracic ultrasound on clinical decision-making by physiotherapists for critical care patients. METHODS This prospective, observational multicentre study was conducted between May 2017 and November 2020 in four intensive care units in France and Australia. All hypoxemic patients consecutively admitted were enrolled. The primary outcome was the net reclassification improvement (NRI), quantifying how well the new model (physiotherapist's clinical decision-making including thoracic ultrasound) reclassifies subjects as compared with an old model (clinical assessment). Secondary outcomes were the factors associated with diagnostic concordance and physiotherapy treatment modification. RESULTS A total of 151 patients were included in the analysis. The NRI for the modification of physiotherapist's clinical decisions was-40% (95% CI (-56 to -22%), p=0.02). Among the cases in which treatment was changed after ultrasound, 41% of changes were major (n=38). Using a multivariate analysis, the physiotherapist's confidence in their clinical diagnosis was associated with diagnostic concordance (adjusted OR=3.28 95% CI (1.30 to 8.71); p=0.014). Clinical diagnosis involving non-parenchymal conditions and clinical signs reflecting abolished lung ventilation were associated with diagnostic discordance (adjusted OR=0.06 95% CI (0.01 to 0.26), p<0.001; adjusted OR=0.26 95% CI (0.09 to 0.69), p=0.008; respectively). CONCLUSION Thoracic ultrasound has a high impact on the clinical decision-making process by physiotherapists for critical care patients. TRIAL REGISTRATION NUMBER NCT02881814; https://clinicaltrials.gov.
Collapse
Affiliation(s)
- Aymeric Le Neindre
- Respiratory Intensive Care and Clinical Research Units, Hopital Forcilles, Ferolles-Attilly, France.,UMR1231 - Lipide Nutrition Cancer, Université de Bourgogne, Dijon, France
| | - Louise Hansell
- Physiotherapy, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Sydney School of Health Sciences, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Johan Wormser
- Intensive Care Unit, Fondation Hopital Saint Joseph, Paris, France
| | - Andreia Gomes Lopes
- Physiotherapy and Clinical Research Units, Hopital Forcilles, Ferolles-Attilly, France
| | | | | | - Gerald Choukroun
- Soins intensifs respiratoires & Réadaptation post-réanimation, Hopital Forcilles, Ferolles-Attilly, Île-de-France, France
| | - Maxime Nguyen
- Anesthesiology and Intensive Care Medicine, University Hospital Centre of Dijon, Dijon, France
| | | | - Pierre-Grégoire Guinot
- Anesthesiology and Intensive Care Medicine, University Hospital Centre of Dijon, Dijon, France
| | - Hergen Buscher
- Intensive Care Unit, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Bélaid Bouhemad
- UMR1231 - Lipide Nutrition Cancer, Université de Bourgogne, Dijon, France .,Anesthesiology and Intensive Care Medicine, University Hospital Centre of Dijon, Dijon, France
| | - George Ntoumenopoulos
- Physiotherapy, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| |
Collapse
|
2
|
Wu RY, Yeh HJ, Chang KJ, Tsai MW. Effects of different types and frequencies of early rehabilitation on ventilator weaning among patients in intensive care units: A systematic review and meta-analysis. PLoS One 2023; 18:e0284923. [PMID: 37093879 PMCID: PMC10124886 DOI: 10.1371/journal.pone.0284923] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the effects of different types and frequencies of physiotherapy on ventilator weaning among patients in the intensive care unit (ICU) and to identify the optimal type and frequency of intervention. DATA SOURCES PubMed, Cochrane Library, EMBASE, and Airiti Library. STUDY SELECTION Randomized controlled trials that provided information on the dosage of ICU rehabilitation and the parameters related to ventilator weaning were included. DATA EXTRACTION AND MANAGEMENT Treatment types were classified into conventional physical therapy, exercise-based physical therapy, neuromuscular electrical stimulation (NEMS), progressive mobility, and multi-component. The frequencies were divided into high (≥ 2 sessions/day or NEMS of > 60 minutes/day), moderate (one session/day, 3-7 days/week or NEMS of 30-60 minutes/day), and low (one session/day, < 3 days/week, or NEMS of < 30 minutes/day). DATA SYNTHESIS Twenty-four articles were included for systematic review and 15 out of 24 articles were analyzed in the meta-analysis. Early rehabilitation, especially the progressive mobility treatment exerted an optimal effect in reducing the ventilator duration in patients in the ICU (standardized mean difference [SMD] = 0.91; 95% confidence interval [CI] = 0.23-1.58; P < 0.01). Regarding the treatment frequency, the high-frequency intervention did not result in a favorable effect on ventilator duration compared with the moderate frequency of treatment (SMD = 0.75; 95% CI = -1.13-2.64; P = 0.43). CONCLUSION Early rehabilitation with progressive mobility is highly recommended to decrease the ventilation duration received by patients in the ICU. Depending on clinical resources and the tolerance of patients, the frequency of interventions should reach moderate-to-high frequency, that is, at least one session per day and 3 days a week. TRIAL REGISTRATION Registration number: PROSPERO (CRD42021243331).
Collapse
Affiliation(s)
- Ruo-Yan Wu
- Division of Physical Medicine and Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- The Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huan-Jui Yeh
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- The Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Kai-Jie Chang
- Division of Physical Medicine and Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Mei-Wun Tsai
- The Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
3
|
Shpata V, Kreka M, Tani K. Current Physiotherapy Practice in Intensive Care Units Needs Cultural and Organizational Changes: An Observational Cross-Sectional Study in Two Albanian University Hospitals. J Multidiscip Healthc 2021; 14:1769-1781. [PMID: 34262288 PMCID: PMC8275147 DOI: 10.2147/jmdh.s319236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 06/14/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Although physiotherapy is beneficial to intensive care unit (ICU) patients and recommended by guidelines, the role of physiotherapy in ICU settings is not fully explored in Albania. Purpose To provide an overview of the current physiotherapy practice in Albanian ICUs and explore the involvement of physiotherapists and intensive care nurses regarding respiratory therapy and early mobility in the ICU. Patients and Methods This was an observational cross-sectional study, which included all ICU nurses working in six ICUs of University Hospital Center “Mother Theresa” and University Hospital of Trauma and all physiotherapists working in these hospitals. ICU nurses and hospital physiotherapists were approached to complete the survey regarding respiratory therapy and early mobility in critically ill patients. Results One hundred thirty-one completed questionnaires were returned from 189 questionnaires distributed to the survey participants (151 nurses and 38 physiotherapists); the response rate was 69.3%. Physiotherapy procedures were performed on a non-regular basis in ICUs in Tirana, Albania. Physiotherapists were not actively involved or exclusively employed in the ICU, and these ICUs did not use protocols for physiotherapist consultation. Physiotherapists occasionally performed respiratory therapy and early mobility in patients without an artificial airway. Nursing staff regularly performed airway suctioning in mechanically ventilated patients (100%) and participated in adjusting ventilator settings (82.2% regularly and 17.8% occasionally). In contrast, physiotherapists did not participate in these procedures and the early mobility of mechanically ventilated patients. Conclusion We report limited physiotherapy involvement in Albanian ICUs. Efforts should focus on improving physiotherapy practice in ICU, potentially making organizational and cultural changes in the ICU, and establishing protocols and guidelines.
Collapse
Affiliation(s)
- Vjollca Shpata
- Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania
| | - Manika Kreka
- Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania.,University Hospital Center "Mother Theresa", Tirana, Albania
| | - Klejda Tani
- Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania
| |
Collapse
|
4
|
Chest physiotherapy for the prevention of ventilator-associated pneumonia: A meta-analysis. Am J Infect Control 2019; 47:755-760. [PMID: 30642672 DOI: 10.1016/j.ajic.2018.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) remains a frequent and severe complication in mechanically ventilated patients. We undertook a meta-analysis to evaluate the efficacy of chest physiotherapy (CPT) for the prevention of VAP. METHODS A systematic literature search of PubMed and Embase databases were searched up until November 25, 2018 for published studies of mechanically ventilated patients comparing CPT with controls and reporting on the occurrence of VAP. Two authors independently selected studies and abstracted data on study quality and outcomes. We pooled data using random-effects models. RESULTS A total of 6 randomized (n = 704) controlled trials were identified. CPT did not significantly reduce the incidence of VAP (risk ratio = 1.02; 95% confidence interval, 0.82-1.26; P = .87), but reduced hospital mortality (risk ratio = 0.68; 95% confidence interval, 0.48-0.95; P = .02). No significant differences were observed regarding intensive care unit mortality, length of intensive care unit stay, and duration of mechanical ventilation. CONCLUSIONS CPT may not significantly reduce the incidence of VAP and alter other important clinical outcomes in adult patients receiving mechanical ventilation. However, the results should be interpreted cautiously owing to the heterogeneity and the limited trials. Further large-scale, well-designed randomized controlled trials are needed.
Collapse
|
5
|
Rotta BP, Silva JMD, Fu C, Goulardins JB, Pires-Neto RDC, Tanaka C. Relationship between availability of physiotherapy services and ICU costs. ACTA ACUST UNITED AC 2019; 44:184-189. [PMID: 30043883 PMCID: PMC6188682 DOI: 10.1590/s1806-37562017000000196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 03/04/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether 24-h availability of physiotherapy services decreases ICU costs in comparison with the standard 12 h/day availability among patients admitted to the ICU for the first time. METHODS This was an observational prevalence study involving 815 patients ≥ 18 years of age who had been on invasive mechanical ventilation (IMV) for ≥ 24 h and were discharged from an ICU to a ward at a tertiary teaching hospital in Brazil. The patients were divided into two groups according to h/day availability of physiotherapy services in the ICU: 24 h (PT-24; n = 332); and 12 h (PT-12; n = 483). The data collected included the reasons for hospital and ICU admissions; Acute Physiology and Chronic Health Evaluation II (APACHE II) score; IMV duration, ICU length of stay (ICU-LOS); and Omega score. RESULTS The severity of illness was similar in both groups. Round-the-clock availability of physiotherapy services was associated with shorter IMV durations and ICU-LOS, as well as with lower total, medical, and staff costs, in comparison with the standard 12 h/day availability. CONCLUSIONS In the population studied, total costs and staff costs were lower in the PT-24 group than in the PT-12 group. The h/day availability of physiotherapy services was found to be a significant predictor of ICU costs.
Collapse
Affiliation(s)
- Bruna Peruzzo Rotta
- . Hospital do Servidor Público Estadual de São Paulo, São Paulo (SP) Brasil.,. Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Janete Maria da Silva
- . Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. JMS Ciência e Saúde, São Paulo (SP) Brasil
| | - Carolina Fu
- . Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Juliana Barbosa Goulardins
- . Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Universidade Nove de Julho, São Paulo (SP) Brasil
| | - Ruy de Camargo Pires-Neto
- . Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Clarice Tanaka
- . Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil.,. Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| |
Collapse
|
6
|
Terzi N, Guerin C, Gonçalves MR. What's new in management and clearing of airway secretions in ICU patients? It is time to focus on cough augmentation. Intensive Care Med 2018; 45:865-868. [PMID: 30519901 DOI: 10.1007/s00134-018-5484-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/26/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Nicolas Terzi
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire Grenoble, Grenoble, France.,Université de Grenoble, Grenoble, France.,INSERM, U1042, University of Grenoble-Alpes, HP2, 38000, Grenoble, France
| | - Claude Guerin
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire Grenoble, Grenoble, France. .,INSERM, U1042, University of Grenoble-Alpes, HP2, 38000, Grenoble, France. .,Service de Médecine intensive-Réanimation, Hospices civils de Lyon, Lyon, France. .,Université de Lyon, Lyon, France. .,INSERM 955, Créteil, France.
| | - Miguel R Gonçalves
- Noninvasive Ventilatory Support Unit, Pulmonology Department, São João University Hospital, Porto, Portugal.,Intensive Care Medicine Department, São João University Hospital, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
7
|
Physiotherapy in the neurotrauma intensive care unit: A scoping review. J Crit Care 2018; 48:390-406. [PMID: 30316038 DOI: 10.1016/j.jcrc.2018.09.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/20/2018] [Accepted: 09/30/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE This scoping review summarizes the literature on the safety and effectiveness of physiotherapy interventions in patients with neurological and/or traumatic injuries in the intensive care unit (ICU), identifies literature gaps and provides recommendations for future research. MATERIALS AND METHODS We searched five databases from inception to June 2, 2018. We included published retrospective studies, case studies, observation and randomized controlled trials describing physiotherapy interventions in ICU patients with neurotrauma injuries. Two reviewers reviewed the databases and independently screened English articles for eligibility. Data extracted included purpose, study design, population (s), outcome measures, interventions and results. Thematic analysis and descriptive numerical summaries are presented by intervention type. RESULTS 12,846 titles were screened and 72 met the inclusion criteria. Most of the studies were observational studies (44 (61.1%)) and RCTs (14 (19.4%)). Early mobilization, electrical stimulation, range of motion, and chest physiotherapy techniques were the most common interventions in the literature. Physiotherapy interventions were found to be safe with few adverse events. CONCLUSIONS Gaps in the literature suggest that future studies require assessment of long term functional outcomes and quality of life, examination of homogenous populations and more robust methodologies including clinical trials and larger samples.
Collapse
|
8
|
Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, Cavero-Redondo I, López Muñoz P, Martínez-Vizcaíno V. Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. J Physiother 2018; 64:222-228. [PMID: 30220625 DOI: 10.1016/j.jphys.2018.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/04/2018] [Accepted: 08/09/2018] [Indexed: 12/31/2022] Open
Abstract
QUESTION In intubated adult patients receiving mechanical ventilation, does multimodality respiratory physiotherapy prevent ventilator-associated pneumonia, shorten length of intensive care unit (ICU) stay, and reduce mortality? DESIGN A systematic review with meta-analysis of randomised controlled trials. PARTICIPANTS Intubated adult patients undergoing mechanical ventilation who were admitted to an intensive care unit. INTERVENTION More than two respiratory physiotherapy techniques such as positioning or postural drainage, manual hyperinflation, vibration, rib springing, and suctioning. OUTCOMES MEASURES Incidence of ventilator-associated pneumonia (VAP), duration of ICU stay, and mortality. RESULTS Five trials were included in the meta-analysis. Random-effects models were used to calculate pooled weighted mean difference (WMD) for length of ICU stay and pooled risk ratio (RR) for incidence of VAP, and fixed-effects model was used to calculate pooled RR for mortality. The effect on the incidence of VAP was unclear (RR 0.73 in favour of multimodality respiratory physiotherapy, 95% CI 0.38 to 1.07). The effect on length of stay was also unclear (WMD -0.33days shorter with multimodality respiratory physiotherapy, 95% CI -2.31 to 1.66). However, multimodality respiratory physiotherapy significantly reduced mortality (RR 0.75, 95% CI 0.58 to 0.92). CONCLUSION Multimodality respiratory physiotherapy appeared to reduce mortality in ICU patients. It was unclear whether this occurred via a reduction in the incidence of VAP and/or length of stay because the available data provided very imprecise estimates of the effect of multimodality respiratory physiotherapy on these outcomes. These very imprecise estimates include the possibility of very worthwhile effects on VAP incidence and length of ICU stay; therefore, these outcomes should be the focus of further investigation in rigorous trials. REGISTRATION PROSPERO CRD42018094202. [Pozuelo-Carrascosa DP, Torres-Costoso A, Alvarez-Bueno C, Cavero-Redondo I, López Muñoz P, Martínez-Vizcaíno V (2018) Multimodality respiratory physiotherapy reduces mortality but may not prevent ventilator-associated pneumonia or reduce length of stay in the intensive care unit: a systematic review. Journal of Physiotherapy 64: 222-228].
Collapse
Affiliation(s)
| | - Ana Torres-Costoso
- School of Nursing and Physiotherapy, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Celia Alvarez-Bueno
- Social and Health Care Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
| | - Iván Cavero-Redondo
- Social and Health Care Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain
| | | | - Vicente Martínez-Vizcaíno
- Social and Health Care Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| |
Collapse
|
9
|
Zeiser E. [Physiotherapy interventions in the ICU : Outcome-relevant measurement parameters]. Med Klin Intensivmed Notfmed 2017; 112:356-370. [PMID: 28116462 DOI: 10.1007/s00063-016-0259-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/28/2016] [Accepted: 10/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Guidelines cannot provide differentiated recommendations for physiotherapy (PT) in intensive care medicine. Scientific publications for PT in the intensive care unit (ICU) usually only have low levels of evidence and often express safety and feasibility of PT in the ICU. OBJECTIVE Which measurement parameters are relevant for defining outcome and what interventions should one take into consideration? MATERIALS AND METHODS A literature review was conducted. This was based on a PubMed search with full text access, as well as specific definitions for physical therapy, intensive care and four out of seven conditions from the manual "Physiotherapy in intensive care". RESULTS The availability of 172 studies clearly shows that there is certainly PT research concerning the critical environment of the ICU. However, parameters for quantitative and qualitative detection of vigilance and state of consciousness as well as assessments to evaluate the mobility and the ability to help themselves are important for everyday use. CONCLUSIONS The difficulties of using PT in the ICU are not useful in ensuring the safety of the patient or performing a PT treatment. The conditions of the intensive care environment are not an obstacle. It is of immanent importance to use the limited resources of PT in an optimal and targeted manner in the ICU environment. The determination of ICU-adapted goals plays a crucial role.
Collapse
Affiliation(s)
- E Zeiser
- Berufsförderungswerk Mainz, DIPLOMA Hochschule - Private Fachhochschule Nordhessen, z.H. Dorit Engelmann Lortzingstraße 4, 55127, Mainz, Deutschland.
| |
Collapse
|
10
|
Spapen HD, De Regt J, Honoré PM. Chest physiotherapy in mechanically ventilated patients without pneumonia-a narrative review. J Thorac Dis 2017; 9:E44-E49. [PMID: 28203436 DOI: 10.21037/jtd.2017.01.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A beneficial adjuvant role of chest physiotherapy (CPT) to promote airway clearance, alveolar recruitment, and ventilation/perfusion matching in mechanically ventilated (MV) patients with pneumonia or relapsing lung atelectasis is commonly accepted. However, doubt prevails regarding the usefulness of applying routine CPT in MV subjects with no such lung diseases. In-depth narrative review based on a literature search for prospective randomized trials comparing CPT with a non-CPT strategy in adult patients ventilated for at least 48 h. Six relevant studies were identified. Sample size was small. Various CPT modalities were used including body positioning, manual chest manipulation (mobilization, percussion, vibration, and compression), and specific techniques such as lung hyperinflation and intrapulmonary percussion. Control subjects mostly received general nursing care and tracheal suction. In general, CPT was safe and supportive, yet had debatable or no significant impact on any relevant patient outcome parameter, including pneumonia. Current evidence does not support "prophylactic" CPT in adult MV patients without pneumonia.
Collapse
Affiliation(s)
- Herbert D Spapen
- Department of Intensive Care, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jouke De Regt
- Department of Intensive Care, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Patrick M Honoré
- Department of Intensive Care, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
11
|
Lo V. Clinician's Commentary on Devroey et al. 1. Physiother Can 2016; 68:259. [PMID: 27917995 DOI: 10.3138/ptc.2015-40-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Vincent Lo
- Physiotherapist, MSICU, Toronto General Hospital, University Health Network, Toronto;
| |
Collapse
|
12
|
Blackwood B, Clarke M, McAuley DF, McGuigan PJ, Marshall JC, Rose L. How outcomes are defined in clinical trials of mechanically ventilated adults and children. Am J Respir Crit Care Med 2014; 189:886-93. [PMID: 24512505 DOI: 10.1164/rccm.201309-1645pp] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Systematic reviews have considerable potential to provide evidence-based data to aid clinical decision-making. However, there is growing recognition that trials involving mechanical ventilation lack consistency in the definition and measurement of ventilation outcomes, creating difficulties in combining data for meta-analyses. To address the inconsistency in outcome definitions, international standards for trial registration and clinical trial protocols published recommendations, effectively setting the "gold standard" for reporting trial outcomes. In this Critical Care Perspective, we review the problems resulting from inconsistent outcome definitions and inconsistent reporting of outcomes (outcome sets). We present data highlighting the variability of the most commonly reported ventilation outcome definitions. Ventilation outcomes reported in trials over the last 6 years typically fall into four domains: measures of ventilator dependence; adverse outcomes; mortality; and resource use. We highlight the need, first, for agreement on outcome definitions and, second, for a minimum core outcome set for trials involving mechanical ventilation. A minimum core outcome set would not restrict trialists from measuring additional outcomes, but would overcome problems of variability in outcome selection, measurement, and reporting, thereby enhancing comparisons across trials.
Collapse
|
13
|
|
14
|
Potential effect of physiotherapeutic treatment on mortality rate in patients with severe sepsis and septic shock: a retrospective cohort analysis. J Crit Care 2013; 28:954-8. [PMID: 23958242 DOI: 10.1016/j.jcrc.2013.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/25/2013] [Accepted: 06/28/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of the study was to examine the onset and frequency of physiotherapeutic interventions (PTI) and their potential effects on the intensive care unit (ICU) mortality rate in patients with severe sepsis or septic shock. MATERIAL AND METHODS Retrospective data analysis. Univariate and multivariate Cox proportional-hazards regression analyses were performed. RESULTS About 6.2% of all patients (n = 999, length of ICU stay 12 days, averaged SOFA score 14) developed sepsis within three years. Of these, 77% received at least once PTI. The relative number of PTI (RNPTI index, individually calculated by the number of PTI/length of stay) in patients with sepsis was 42%. The first physiotherapeutic treatment was five days after ICU admission. Cox regression multivariate analysis adjusted by disease severity scores, sedation state and other clinical variables found RNPTI index as significant risk factor for the ICU mortality rate (hazard ratio, 0.982; 95% confidence interval, 0.974-0.990; P < .001). CONCLUSIONS Physiotherapists routinely assess and treat patients with sepsis. The frequency of PTI was associated with an improved outcome. Prospective studies are necessary to confirm the potential favorable impact.
Collapse
|
15
|
Berti JSW, Tonon E, Ronchi CF, Berti HW, Stefano LMD, Gut AL, Padovani CR, Ferreira ALA. Manual hyperinflation combined with expiratory rib cage compression for reduction of length of ICU stay in critically ill patients on mechanical ventilation. J Bras Pneumol 2013; 38:477-86. [PMID: 22964932 DOI: 10.1590/s1806-37132012000400010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 05/10/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Although manual hyperinflation (MH) is widely used for pulmonary secretion clearance, there is no evidence to support its routine use in clinical practice. Our objective was to evaluate the effect that MH combined with expiratory rib cage compression (ERCC) has on the length of ICU stay and duration of mechanical ventilation (MV). METHODS This was a prospective randomized controlled clinical trial involving ICU patients on MV at a tertiary care teaching hospital between January of 2004 and January of 2005. Among the 49 patients who met the study criteria, 24 and 25 were randomly assigned to the respiratory physiotherapy (RP) and control groups, respectively. Of those same patients, 6 and 8, respectively, were later withdrawn from the study. During the 5-day observation period, the RP patients received MH combined with ERCC, whereas the control patients received standard nursing care. RESULTS The two groups were similar in terms of the baseline characteristics. The intervention had a positive effect on the duration of MV, as well as on the ICU discharge rate and Murray score. There were significant differences between the control and RP groups regarding the weaning success rate on days 2 (0.0% vs. 37.5%), 3 (0.0% vs. 37.5%), 4 (5.3% vs. 37.5%), and 5 (15.9% vs. 37.5%), as well as regarding the ICU discharge rate on days 3 (0% vs. 25%), 4 (0% vs. 31%), and 5 (0% vs. 31%). In the RP group, there was a significant improvement in the Murray score on day 5. CONCLUSIONS Our results show that the use of MH combined with ERCC for 5 days accelerated the weaning process and ICU discharge.
Collapse
Affiliation(s)
- Juliana Savini Wey Berti
- Hospital das Clínicas de Botucatu, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil
| | | | | | | | | | | | | | | |
Collapse
|
16
|
José A, Pasquero RC, Timbó SR, Carvalhaes SRF, Bien UDS, Dal Corso S. Efeitos da fisioterapia no desmame da ventilação mecânica. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000200004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A Fisioterapia vem atuando com o objetivo de reduzir falhas no desmame da ventilação mecânica (VM) que podem repercutir em desfechos desfavoráveis para o paciente. OBJETIVO: Avaliar os efeitos da fisioterapia no desmame da VM. MATERIAIS E MÉTODOS: Estudo transversal e controlado com pacientes adultos. A formação dos grupos estudados foi resultado de dois períodos ocorridos em uma UTI; em determinado período, a unidade contou com a presença de um profissional de Fisioterapia, em outro, não teve a presença desse profissional por razões administrativas. Registraram-se os resultados do desmame por meio de coleta diária de informações. Foram estudados 50 pacientes, 31 fizeram fisioterapia (grupo fisioterapia, GF) e 19 não fizeram (grupo controle, GC). O GF realizou dois atendimentos diários (quarenta minutos cada), composto das técnicas: compressão do tórax, hiperinsuflação manual, aspiração traqueal e de vias aéreas, movimentação e condução do desmame. O GC recebeu tratamento médico usual. RESULTADOS: Observou-se no GF e GC, respectivamente: sucesso no desmame - 71% (22) e 21% (4) (p = 0,001); tempo de VM - 152 ± 142 e 414 ± 344 horas (p = 0,04); tempo de desmame: 13 ± 48 e 140 ± 122 horas (p < 0,0001); tempo de internação na UTI - 338 ± 192 e 781 ± 621 horas (p = 0,007); tempo de internação hospitalar - 710 ± 628 e 1108 ± 720 horas (p = 0,058); mortalidade: 35% (11) e 47% (9) (p = 0,41). CONCLUSÃO: A fisioterapia esteve associada ao aumento do sucesso no desmame, à redução do tempo de desmame, tempo de VM e de internação na UTI. Não houve diferença no tempo de internação hospitalar e na mortalidade.
Collapse
|
17
|
|
18
|
Brown C. Whither Rehabilitation? A Call to Arms. J Intensive Care Soc 2013. [DOI: 10.1177/175114371301400206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Craig Brown
- Therapy Lead for Adults, Royal Brompton Hospital
| |
Collapse
|
19
|
Gonçalves MR, Honrado T, Winck JC, Paiva JA. Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation: a randomized controlled trial. Crit Care 2012; 16:R48. [PMID: 22420538 PMCID: PMC3681374 DOI: 10.1186/cc11249] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 02/01/2012] [Accepted: 03/15/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction Weaning protocols that include noninvasive ventilation (NIV) decrease re-intubation rates and ICU length of stay. However, impaired airway clearance is associated with NIV failure. Mechanical insufflation-exsufflation (MI-E) has been proven to be very effective in patients receiving NIV. We aimed to assess the efficacy of MI-E as part of an extubation protocol. Method Patients with mechanical ventilation (MV) for more than 48 hours with specific inclusion criteria, who successfully tolerated a spontaneous breathing trial (SBT), were randomly allocated before extubation, either for (A) a conventional extubation protocol (control group), or (B) the MI-E extubation protocol (study group). During the postextubation period (48 hours), group A patients received standard medical treatment (SMT), including NIV in case of specific indications, whereas group B received the same postextubation approach plus three daily sessions of mechanical in-exsufflation (MI-E). Reintubation rates, ICU length of stay, and NIV failure rates were analyzed. Results Seventy-five patients (26 women) with a mean age of 61.8 ± 17.3 years were randomized to a control group (n = 40; mean SAPS II, 47.8 ± 17.7) and to a study group (n = 35; mean SAPS II, 45.0 ± 15.0). MV time before enrollment was 9.4 ± 4.8 and 10.5 ± 4.1 days for the control and the study group, respectively. In the 48 hours after extubation, 20 control patients (50%) and 14 study patients (40%) used NIV. Study group patients had a significant lower reintubation rate than did controls; six patients (17%) versus 19 patients (48%), P < 0.05; respectively, and a significantly lower time under MV; 17.8 ± 6.4 versus 11.7 ± 3.5 days; P < 0.05; respectively. Considering only the subgroup of patients that used NIV, the reintubation rates related to NIV failure were significantly lower in the study group when compared with controls; two patients (6%) versus 13 (33%); P < 0.05, respectively. Mean ICU length of stay after extubation was significantly lower in the study group when compared with controls (3.1 ± 2.5 versus 9.8 ± 6.7 days; P < 0.05). No differences were found in the total ICU length of stay. Conclusion Inclusion of MI-E may reduce reintubation rates with consequent reduction in postextubation ICU length of stay. This technique seems to be efficient in improving the efficacy of NIV in this patient population.
Collapse
Affiliation(s)
- Miguel R Gonçalves
- Lung Function and Ventilation Unit, Pulmonology Department, University Hospital of São João, Faculty of Medicine, Av. Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | | | | | | |
Collapse
|
20
|
Hanekom SD, Louw Q, Coetzee A. The way in which a physiotherapy service is structured can improve patient outcome from a surgical intensive care: a controlled clinical trial. Crit Care 2012; 16:R230. [PMID: 23232109 PMCID: PMC3672619 DOI: 10.1186/cc11894] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 12/03/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction The physiological basis of physiotherapeutic interventions used in intensive care has been established. We must determine the optimal service approach that will result in improved patient outcome. The aim of this article is to report on the estimated effect of providing a physiotherapy service consisting of an exclusively allocated physiotherapist providing evidence-based/protocol care, compared with usual care on patient outcomes. Methods An exploratory, controlled, pragmatic, sequential-time-block clinical trial was conducted in the surgical unit of a tertiary hospital in South Africa. Protocol care (3 weeks) and usual care (3 weeks) was provided consecutively for two 6-week intervention periods. Each intervention period was followed by a washout period. The physiotherapy care provided was based on the unit admission date. Data were analyzed with Statistica in consultation with a statistician. Where indicated, relative risks with 95% confidence intervals (CIs) are reported. Significant differences between groups or across time are reported at the alpha level of 0.05. All reported P values are two-sided. Results Data of 193 admissions were analyzed. No difference was noted between the two patient groups at baseline. Patients admitted to the unit during protocol care were less likely to be intubated after unit admission (RR, 0.16; 95% CI, 0.07 to 0.71; RRR, 0.84; NNT, 5.02; P = 0.005) or to fail an extubation (RR, 0.23; 95% CI, 0.05 to 0.98; RRR, 0.77; NNT, 6.95; P = 0.04). The mean difference in the cumulative daily unit TISS-28 score during the two intervention periods was 1.99 (95% CI, 0.65 to 3.35) TISS-28 units (P = 0.04). Protocol-care patients were discharged from the hospital 4 days earlier than usual-care patients (P = 0.05). A tendency noted for more patients to reach independence in the transfers (P = 0.07) and mobility (P = 0.09) categories of the Barthel Index. Conclusions A physiotherapy service approach that includes an exclusively allocated physiotherapist providing evidence-based/protocol care that addresses pulmonary dysfunction and promotes early mobility improves patient outcome. This could be a more cost-effective service approach to care than is usual care. This information can now be considered by administrators in the management of scarce physiotherapy resources and by researchers in the planning of a multicenter randomized controlled trial. Trial registration PACTR201206000389290
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW Given that ventilator-associated pneumonia (VAP) causes substantial morbidity, mortality and costs, prevention of this infectious process is a major challenge. RECENT FINDINGS This study provides an update on the prevention of VAP, focusing on the ability of preventive measures to improve patient outcomes and concentrating wherever possible on the data published within the past 5 years. Particular attention is being paid to the latest approach to facilitate the implementation of those prevention measures known as 'care bundles'. SUMMARY Several preventive measures have been shown to reduce the rate of VAP but many less have demonstrated an impact on patient outcomes (noninvasive positive pressure ventilation, sedation and weaning protocols, selective digestive and oral decontamination and endotracheal tube with drainage of subglottic secretions). Patients at risk must be approached with a bundle of preventive measures. Beyond the theoretical frame, a great deal of attention must be given to the factors that might improve adherence to those preventive measures. Future clinical trials testing new strategies in preventing VAP should have patient outcomes (i.e. a reduction in the length under mechanical ventilation, in the duration of stay in healthcare settings or in antibiotic consumption) as primary end-points rather than VAP rates.
Collapse
|
22
|
Hanekom S, Louw QA, Coetzee AR. Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units. Physiotherapy 2012; 99:139-45. [PMID: 23219640 DOI: 10.1016/j.physio.2012.05.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To compare the physiotherapy service provided when therapists' decisions are guided by an evidence-based protocol with usual care (i.e. patient management based on therapists' clinical decisions). DESIGN Exploratory, controlled, pragmatic sequential time block clinical trial. SETTING Level 3 surgical unit in a tertiary hospital in South Africa. PARTICIPANTS All patients admitted consecutively to the surgical unit over a 3-month period were allocated to usual or protocol care based on date of admission. INTERVENTIONS Usual care was provided by clinicians from the hospital department, and non-specialised physiotherapists were appointed as locum tenens to provide evidence-based protocol care. MAIN OUTCOME MEASURES Patient waiting time, frequency of treatment sessions, tasks performed and adverse events. RESULTS During protocol-care periods, treatment sessions were provided more frequently (P<0.001) and with a shorter waiting period (P<0.001). It was more likely for a rehabilitation management option to be included in a treatment session during protocol-care periods (odds ratio 2.34, 95% confidence interval 1.66 to 3.43; P<0.001). No difference in the risk of an adverse event was found between protocol-care and usual-care periods (P=0.34). CONCLUSIONS Physiotherapy services provided in intensive care units (ICUs) when the decisions of non-specialised therapists are guided by an evidence-based protocol are safe, differ from usual care, and reflect international consensus on current best evidence for physiotherapy in ICUs. Non-specialised therapists can use this protocol to provide evidence-based physiotherapy services to their patients. Future trials are needed to establish whether or not this will improve patient outcome.
Collapse
Affiliation(s)
- S Hanekom
- Department of Interdisciplinary Health Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | | | | |
Collapse
|
23
|
Effectiveness of physiotherapy and occupational therapy after traumatic brain injury in the intensive care unit. Crit Care Res Pract 2012; 2012:768456. [PMID: 22550570 PMCID: PMC3328889 DOI: 10.1155/2012/768456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 01/23/2012] [Indexed: 11/18/2022] Open
Abstract
Physiotherapy and occupational therapy are frequently administered in intensive care units (ICUs) after traumatic brain injury (TBI) to promote recovery. The increasing economic pressure and the growing need for evidence of therapeutic effectiveness are reasons for reviewing the currently available scientific data. The databases of OTseeker, PEDro, Medline, and Cochrane were searched for studies on frequently applied therapeutic procedures in the ICU following a TBI. It becomes evident that the currently available data on physiotherapy and occupational therapy are very limited. Consequently, it is not possible to give conclusive recommendations within an evidence-based context. Studies of other neurological disorders indicate that early mobilisation positively influences outcome parameters such as the ability to walk. It can be concluded from three studies that physiotherapy for the prevention or treatment of ventilator-associated pneumonia is not effective. The proof of effectiveness for other physiotherapeutic and occupational therapy interventions must still be demonstrated.
Collapse
|
24
|
|
25
|
Pour ou contre la ventilation à percussions intrapulmonaires en réanimation ? MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-011-0441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
26
|
Clinical and economic burden of postoperative pulmonary complications: Patient safety summit on definition, risk-reducing interventions, and preventive strategies*. Crit Care Med 2011; 39:2163-72. [DOI: 10.1097/ccm.0b013e31821f0522] [Citation(s) in RCA: 147] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
27
|
Hanekom S, Berney S, Morrow B, Ntoumenopoulos G, Paratz J, Patman S, Louw Q. The validation of a clinical algorithm for the prevention and management of pulmonary dysfunction in intubated adults--a synthesis of evidence and expert opinion. J Eval Clin Pract 2011; 17:801-10. [PMID: 20630012 DOI: 10.1111/j.1365-2753.2010.01480.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulmonary dysfunction (PDF) in intubated patients remains a serious and costly complication of intensive care unit care. Optimal cardiopulmonary therapy strategies to prevent and manage PDF need clarification to reduce practice variability. The purpose of this paper is to report on the content validation of an evidence-based clinical management algorithm (EBCMA) aimed at the prevention, identification and management of PDF in critically ill patients. METHODS Forty-four draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by research clinicians (n = 7) in an electronic three-round Delphi process. Statements which reached a priori defined consensus [semi-interquartile range (SIQR) <0.5] were collated into the EBCMA. RESULTS One hundred per cent response rate. Forty-four statements were added after round one. Consensus was reached on rating of 83% (73/88) statements. Differences in interpretation of the existing evidence base, and variations in accepted clinical practice were identified. Four themes were identified where panel failed to reach consensus. CONCLUSION The internationally agreed hierarchical framework of current available evidence and clinical expertise developed through this Delphi process provides clinicians with a tool to inform clinical practice. This tool has the potential to reduce practice variability thereby maximizing safety and treatment outcome. The clinical utility of the EBCMA requires further evaluation.
Collapse
Affiliation(s)
- Susan Hanekom
- Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.
| | | | | | | | | | | | | |
Collapse
|
28
|
Guérin C. La mobilisation précoce du patient — Intérêts et risques. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-010-0138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
29
|
Ntoumenopoulos G. More about chest physiotherapy and ventilator-associated pneumonia prevention. Indian J Crit Care Med 2010; 14:220. [PMID: 21572757 PMCID: PMC3085227 DOI: 10.4103/0972-5229.76090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
30
|
Appelboam R, Williams MP, Duffy MR. Sand aspiration: a case report and review of the radiological features and management. Anaesthesia 2010; 65:848-54. [PMID: 20569250 DOI: 10.1111/j.1365-2044.2010.06405.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We report a case of severe sand aspiration in association with near-drowning, which led to respiratory failure secondary to the acute respiratory distress syndrome, necessitating mechanical ventilation, repeated therapeutic bronchoscopic lavage, and a stay in the intensive care unit that exceeded one month.
Collapse
Affiliation(s)
- R Appelboam
- Department of Radiology, Derriford Hospital, Plymouth, UK.
| | | | | |
Collapse
|
31
|
Affiliation(s)
- Rik Gosselink
- Respiratory Rehabilitation and Critical Care Medicine University Hospitals, Katholieke Universiteit Leuven B-3000, Belgium.
| | | |
Collapse
|
32
|
Manejo de las secreciones pulmonares en el paciente crítico. ENFERMERIA INTENSIVA 2010; 21:74-82. [DOI: 10.1016/j.enfi.2009.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 10/23/2009] [Indexed: 11/19/2022]
|
33
|
Bach JR, Gonçalves MR, Hamdani I, Winck JC. Extubation of patients with neuromuscular weakness: a new management paradigm. Chest 2009; 137:1033-9. [PMID: 20040608 DOI: 10.1378/chest.09-2144] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Successful extubation conventionally necessitates the passing of spontaneous breathing trials (SBTs) and ventilator weaning parameters. We report successful extubation of patients with neuromuscular disease (NMD) and weakness who could not pass them. METHODS NMD-specific extubation criteria and a new extubation protocol were developed. Data were collected on 157 consecutive "unweanable" patients, including 83 transferred from other hospitals who refused tracheostomies. They could not pass the SBTs before or after extubation. Once the pulse oxyhemoglobin saturation (Spo(2)) was maintained at > or = 95% in ambient air, patients were extubated to full noninvasive mechanical ventilation (NIV) support and aggressive mechanically assisted coughing (MAC). Rather than oxygen, NIV and MAC were used to maintain or return the Spo(2) to > or = 95%. Extubation success was defined as not requiring reintubation during the hospitalization and was considered as a function of diagnosis, preintubation NIV experience, and vital capacity and assisted cough peak flows (CPF) at extubation. RESULTS Before hospitalization 96 (61%) patients had no experience with NIV, 41 (26%) used it < 24 h per day, and 20 (13%) were continuously NIV dependent. The first-attempt protocol extubation success rate was 95% (149 patients). All 98 extubation attempts on patients with assisted CPF > or = 160 L/m were successful. The dependence on continuous NIV and the duration of dependence prior to intubation correlated with extubation success (P < .005). Six of eight patients who initially failed extubation succeeded on subsequent attempts, so only two with no measurable assisted CPF underwent tracheotomy. CONCLUSIONS Continuous volume-cycled NIV via oral interfaces and masks and MAC with oximetry feedback in ambient air can permit safe extubation of unweanable patients with NMD.
Collapse
Affiliation(s)
- John Robert Bach
- Department of Physical Medicine and Rehabilitation, University Hospital B-403, 150 Bergen St, Newark, NJ 07103, USA.
| | | | | | | |
Collapse
|
34
|
Chen YC, Wu LF, Mu PF, Lin LH, Chou SS, Shie HG. Using chest vibration nursing intervention to improve expectoration of airway secretions and prevent lung collapse in ventilated ICU patients: a randomized controlled trial. J Chin Med Assoc 2009; 72:316-22. [PMID: 19541567 DOI: 10.1016/s1726-4901(09)70378-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Almost 80% of patients in the intensive care unit are intubated and on mechanical ventilation. Thus, their airway clearance ability is compromised and their risk of lung collapse increased. A variety of interventions are used to enhance airway clearance with the goal of preventing atelectasis and infection. The purpose of this study was to evaluate the effect of a chest vibration nursing intervention on the expectoration of airway secretions and in preventing lung collapse among ventilated critically ill patients. METHODS This was a randomized, single-blind experimental study. A total of 95 patients were enrolled from 2 ICUs and randomly assigned into either the experimental group (n = 50) or control group (n = 45). Patients in the control group received routine positioning care, which consisted of a change in body position every 2 hours. Patients in the experimental group received routine positioning care plus the use of chest vibration nursing intervention for 72 hours. This intervention consisted of placing a mechanical chest wall vibration pad on the patients back for 60 minutes when the patient was in a supine position. The chest vibration intervention was performed 6 times a day. Outcome variables were dry sputum weight (DSW) per 24 hours and lung collapse index (LCI); these were measured at 24, 48 and 72 hours. RESULTS Patients who received the chest vibration nursing intervention had greater DSW and lower LCI after 24 hours. Pre-test DSW and group could explain 48.2% of the variance in DSW at 24 hours. The LCI at 24, 48 and 72 hours were all significantly improved in the intervention group compared to the control group. The previous LCI measured was the most significant predictor of the next LCI measured. A significant difference was found between the control and experimental groups in their 24-, 48- and 72-hour DSW and LCI after vibration, when monitored by the generalized estimating equation in time sequence. CONCLUSION The results suggest that chest vibration may contribute to expectoration and thus improve lung collapse among ventilated patients in an ICU. Chest vibration nursing intervention is a safe and effective alternative pulmonary clearance method and can be used on patients who are on ventilators in ICUs.
Collapse
Affiliation(s)
- Yu-Chih Chen
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
| | | | | | | | | | | |
Collapse
|
35
|
Physiotherapy does not prevent, or hasten recovery from, ventilator-associated pneumonia in patients with acquired brain injury. Intensive Care Med 2008; 35:258-65. [DOI: 10.1007/s00134-008-1278-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2007] [Accepted: 08/11/2008] [Indexed: 01/15/2023]
|
36
|
Fowler RA, Adhikari NKJ, Scales DC, Lee WL, Rubenfeld GD. Update in critical care 2007. Am J Respir Crit Care Med 2008; 177:808-19. [PMID: 18390962 DOI: 10.1164/rccm.200801-137up] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada .
| | | | | | | | | |
Collapse
|
37
|
Jelic S, Cunningham JA, Factor P. Clinical review: airway hygiene in the intensive care unit. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2008; 12:209. [PMID: 18423061 PMCID: PMC2447567 DOI: 10.1186/cc6830] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Maintenance of airway secretion clearance, or airway hygiene, is important for the preservation of airway patency and the prevention of respiratory tract infection. Impaired airway clearance often prompts admission to the intensive care unit (ICU) and can be a cause and/or contributor to acute respiratory failure. Physical methods to augment airway clearance are often used in the ICU but few are substantiated by clinical data. This review focuses on the impact of oral hygiene, tracheal suctioning, bronchoscopy, mucus-controlling agents, and kinetic therapy on the incidence of hospital-acquired respiratory infections, length of stay in the hospital and the ICU, and mortality in critically ill patients. Available data are distilled into recommendations for the maintenance of airway hygiene in ICU patients.
Collapse
Affiliation(s)
- Sanja Jelic
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
| | | | | |
Collapse
|
38
|
Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Lemaire F, Gerlach H, Groeneveld J, Hedenstierna G, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Metnitz P, Pugin J, Wernerman J, Zhang H. Year in review in Intensive Care Medicine, 2007. II. Haemodynamics, pneumonia, infections and sepsis, invasive and non-invasive mechanical ventilation, acute respiratory distress syndrome. Intensive Care Med 2008; 34:405-22. [PMID: 18236026 DOI: 10.1007/s00134-008-1009-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 01/07/2008] [Indexed: 01/14/2023]
Affiliation(s)
- Massimo Antonelli
- Department of Intensive Care and Anaesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
|
40
|
Ntoumenopoulos G. Comment on "Chest physiotherapy prolongs duration of ventilation in the critically ill ventilated for more than 48 hours" by Drs. Templeton and Palazzo. Intensive Care Med 2007; 33:2027; author reply 2028-9. [PMID: 17721775 DOI: 10.1007/s00134-007-0838-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2007] [Indexed: 11/30/2022]
|