1
|
Karachi F, van Nes MB, Gosselink R, Hanekom S. Patient perceptions of ICU physiotherapy: 'Your body needs to go somewhere to be recharged … '. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2023; 39:e1092. [PMID: 38357692 PMCID: PMC10866209 DOI: 10.7196/sajcc.2023.v39i3.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2023] [Indexed: 02/16/2024] Open
Abstract
Background Patient satisfaction is an essential concept to consider for the improvement of quality care in healthcare centres and hospitals and has been linked to increased patient compliance with treatment plans, better patient safety and improved clinical outcomes. Objectives As part of a before-and-after clinical trial aimed to investigate the implementation of an evidence-based and -validated physiotherapy protocol within a surgical intensive care unit (ICU), we decided to include the patient perception of physiotherapy received in the intervention unit. Methods A nested, exploratory, descriptive, qualitative study design was adopted. Purposively selected adult patients discharged from ICU during the implementation phase of the trial were interviewed. Results Eighteen patients (10 male) with a median age of 44 years and median ICU length of stay (LOS) of six days were included. Three themes and nine categories emerged: (i) linking therapy to clinical outcome (patient expectations and understanding; physiotherapy activities and the implication of mobilisation; physiotherapy benefits and progression); (ii) the importance of developing a trusting relationship (physiotherapy value; safety; continuity of care); and (iii) communication (satisfaction; interactions and patient perception and experience of physiotherapy). Conclusion While confirming barriers to early mobility, patients perceived participation in mobility activities as a marked jolt in their journey to recovery following a critical incident. Effective communication and preservation of trust between physiotherapist and patient are essential for understanding expectations and can facilitate improved outcomes. Clinicians can use the information when managing critically ill patients. Including patient-reported outcomes to measure physiotherapy interventions used in the ICU is feasible and can inform the development of such outcomes. Contribution of the study The study highlights the feasibility and importance of the use of patient-reported outcomes to measure physiotherapy interventions and informs the development of patient reported outcomes and the importance of patient centred physiotherapy care in the ICU setting.
Collapse
Affiliation(s)
- F Karachi
- Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - M B van Nes
- Physiotherapy Department, Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa
| | - R Gosselink
- Respiratory Rehabilitation, Department of Rehabilitation Sciences, KU Leuven, Belgium; and Department of Physiotherapy, Stellenbosch University,
Tygerberg, South Africa
| | - S Hanekom
- Physiotherapy Department, Department of Health and Rehabilitation Sciences, Stellenbosch University, Tygerberg, South Africa
| |
Collapse
|
2
|
Polastri M, Black C, Eden A. Does patient mobilisation culture really begin in intensive care settings? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2022.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, St Orsola University Hospital, Bologna, Italy
| | - Claire Black
- Therapies and Rehabilitation, University College London Hospitals NHS Foundation Trust, London, UK
| | - Allaina Eden
- Department of Rehabilitation, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| |
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
|
Alqahtani M, Kashoo F, Alzhrani M, Ahmad F, Seyam MK, Ahmad M, Alhusaini AA, Melam GR, Buragadda S. Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multicentre Cross-Sectional Survey. Crit Care Res Pract 2020; 2020:6610027. [PMID: 33457013 PMCID: PMC7785395 DOI: 10.1155/2020/6610027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia. AIM To determine the current standard of ICU PT practice, attitude, and barriers. METHODS A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU. RESULTS The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (n = 111, 89%) and stroke (n = 102, 82.3%) as compared to congestive heart failure (n = 20, 16.1%) and pulmonary infections (n = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (n = 102, 82.2%) and positioning (n = 73, 58.8%), whereas functional electrical stimulation (n = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (n = 89, 71.7%) followed by inadequate training (n = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (n = 8, 6.4%). CONCLUSION PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.
Collapse
Affiliation(s)
- Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Faizan Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Fuzail Ahmad
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mohammed K. Seyam
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mehrunnisha Ahmad
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Adel A. Alhusaini
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ganeswara Rao Melam
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Syamala Buragadda
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
Christakou A, Seitaridi A, Koutsioumba E, Papaioannou S, Spinou A, Anaouni E, Grigoriadis K, Mpempeletsi P, Rekliti E, Patsaki E. Current physiotherapy practice in Greek intensive care units: a national study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1523459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Anna Christakou
- First Critical Care Department, General Hospital “Evagelismos”, University of Athens, Athens, Greece
- Department of Physiotherapy, University of Western Attica, Athens, Greece
| | | | | | | | - Arietta Spinou
- Health, Sports and Bioscience, University of East London, London, UK
| | | | - Konstantinos Grigoriadis
- Department of Physiotherapy, University of Western Attica, Athens, Greece
- General University Hospital of Attikon, Athens, Greece
| | | | - Eleni Rekliti
- General Hospital Nosematon Thorakos “Sotiria”, Athens, Greece
| | - Eirini Patsaki
- First Critical Care Department, General Hospital “Evagelismos”, University of Athens, Athens, Greece
- Department of Physiotherapy, University of Western Attica, Athens, Greece
| |
Collapse
|
6
|
Raios C, Skinner EH, Keating JL. Lung management protocols increase the incidence of lung procurement and organ transplantation: A meta-analysis. Physiother Theory Pract 2018; 36:459-468. [DOI: 10.1080/09593985.2018.1488907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Cassandra Raios
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia
- Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
| | - Elizabeth H Skinner
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia
- Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
- Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer L Keating
- Department of Physiotherapy, School of Primary Health Care, Faculty of Medicine Nursing and Health Science, Monash University, Frankston, Victoria, Australia
| |
Collapse
|
7
|
Volpe MS, Naves JM, Ribeiro GG, Ruas G, Tucci MR. Effects of manual hyperinflation, clinical practice versus expert recommendation, on displacement of mucus simulant: A laboratory study. PLoS One 2018; 13:e0191787. [PMID: 29432468 PMCID: PMC5809045 DOI: 10.1371/journal.pone.0191787] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/03/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Manual hyperinflation (MH), a maneuver applied in mechanically ventilated patients to facilitate secretion removal, has large variation in its performance. Effectiveness of MH is usually evaluated by its capacity to generate an expiratory flow bias. The aim of this study was to compare the effects of MH—and its resulting flow bias—applied according to clinical practice versus according to expert recommendation on mucus movement in a lung model simulating a mechanically ventilated patient. Methods Twelve physiotherapists were asked to apply MH, using a self-inflating manual resuscitator, to a test lung as if to remove secretions under two conditions: according to their usual clinical practice (pre-instruction phase) and after verbal instruction to perform MH according to expert recommendation was given (post-instruction phase). Mucus simulant movement was measured with a photodensitometric technique. Peak inspiratory flow (PIF), peak inspiratory pressure (PIP), inspiratory time (TINSP), tidal volume (VT) and peak expiratory flow (PEF) were measured continuously. Results It was found that MH performed post-instruction delivered a smaller VT (643.1 ± 57.8 ml) at a lower PIP (15.0 ± 1.5 cmH2O), lower PIF (38.0 ± 9.6 L/min), longer TINSP (1.84 ±0.54 s) and lower PEF (65.4 ± 6.7L/min) compared to MH pre-instruction. In the pre-instruction phase, MH resulted in a mean PIF/PEF ratio of 1.73 ± 0.38 and mean PEF-PIF difference of -54.6 ± 28.3 L/min, both out of the range for secretion removal. In the post-instruction phase both indexes were in the adequate range. Consequently, the mucus simulant was moved outward when MH was applied according to expert recommendation and towards the test lung when it was applied according to clinical practice. Conclusions Performance of MH during clinical practice with PIF higher than PEF was ineffective to clear secretion in a lung model simulating a mechanically ventilated patient. In order to remove secretion, MH should result in an adequate expiratory flow bias.
Collapse
Affiliation(s)
- Marcia S. Volpe
- Department of Human Movement Sciences, Federal University of São Paulo, Santos, São Paulo, Brazil
- * E-mail:
| | - Juliane M. Naves
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Gabriel G. Ribeiro
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Gualberto Ruas
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Minas Gerais, Brazil
| | - Mauro R. Tucci
- Laboratory for Medical Research 09, School of Medicine, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
Faria LM, Barbosa SDFF. Assessment of functional status in the ICU: instruments used in Brazilian settings. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.001.ar02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: Physical function impairment is a significant concern for patients who survive their intensive care unit (ICU) stay, due to its impact on the patient’s independence and functional status. In this context, the choice of a suitable instrument for the assessing functional status is important, because an inappropriate assessment could lead to incorrect conclusions regarding patient prognosis, treatment benefits, and condition. Objective: To identify which functional assessment tools are used in Brazil to assess patients who are in ICU. Additionally, we investigated the translation, adaptation, and validation of these instruments for use in this population. Methods: We searched Pubmed, SCIELO, Lilacs, and Scopus in November 2015. No language or date restrictions were applied to the search. Results: Ten studies and seven instruments were identified. The most commonly used instruments were the Karnofsky Performance Status Scale Scores and the Functional Independence Measure. Conclusion: The instruments found in the review were neither specifically developed to assess the functional status of ICU patients, nor were they validated for use in this population in Brazil. Transcultural development or adaptation studies should be conducted, followed by a validation process.
Collapse
|
9
|
Raios C, Keating JL, Stitt N, Opdam HI, Skinner EH. Challenges in Providing Timely Physiotherapy and Opportunities to Influence Outcomes for Potential Lung Donors. Prog Transplant 2016; 27:112-124. [PMID: 28617166 DOI: 10.1177/1526924816680098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT There is a critical shortage of donor lungs however, considerable ethical considerations are associated with the conduct of research to optimize care of the potential organ donor. OBJECTIVE To investigate pathways of consent, respiratory care by physiotherapists and donation rates to contextualize future research on physiotherapy effects on donor lung suitability for procurement. DESIGN Retrospective audit. SETTING Australian tertiary hospital. PATIENTS Potential organ donors (defined as patients who may have been eligible to donate organs for transplantation via either brain death or circulatory death) 75 years or younger presenting to the emergency department or the intensive care unit (ICU) between September 2011 and December 2012. MAIN OUTCOME MEASURES Donation rates, timing of organ procurement from initial hospital presentation, number of persons designated to make health-care decisions approached for and consenting to donation and clinical research, and number of patients assessed and/or treated by physiotherapists. RESULTS Records of 65 potentially eligible donors were analyzed. Eighteen (28%) of the 65 became donors. Organ procurement occurred at a median of 48 hours (interquartile range: 34-72 hours) after ICU admission. All decision-makers approached regarding participation in clinical research (4 [6%] of the 65) consented. Physiotherapists assessed 48 (74%) of the 65 patients at least once and provided 28 respiratory treatments to 18 (28%) of the 65 patients, including lung hyperinflation and positioning. Limitations were the retrospective, single-center design and the "potential organ donor" definition. CONCLUSION Organ procurement occurs early. There is potential for early intervention to improve lung donor rates. Randomized controlled trials investigating protocolized respiratory packages of care may increase the potential donor pool and transplantation rates.
Collapse
Affiliation(s)
- Cassandra Raios
- 1 Faculty of Medicine, Nursing, and Health Science, Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia.,2 Department of Physiotherapy, Western Health, Footscray, Victoria, Australia
| | - Jenny L Keating
- 1 Faculty of Medicine, Nursing, and Health Science, Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia
| | - Nicola Stitt
- 3 Department of Intensive Care, Monash Health, Clayton, Victoria, Australia
| | - Helen I Opdam
- 4 Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
| | - Elizabeth H Skinner
- 1 Faculty of Medicine, Nursing, and Health Science, Department of Physiotherapy, School of Primary Health Care, Monash University, Frankston, Victoria, Australia.,2 Department of Physiotherapy, Western Health, Footscray, Victoria, Australia.,3 Department of Intensive Care, Monash Health, Clayton, Victoria, Australia.,5 Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
10
|
Leelarungrayub J, Pinkaew D, Wonglangka K, Eungpinichpong W, Klaphajone J. Short-Term Pulmonary Rehabilitation for a Female Patient with Chronic Scleroderma under a Single-Case Research Design. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2016; 10:11-17. [PMID: 27721661 PMCID: PMC5051583 DOI: 10.4137/ccrpm.s40050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 07/10/2016] [Accepted: 08/10/2016] [Indexed: 11/25/2022]
Abstract
Although previously proposed that chronic scleroderma should be cared for clinically and early rehabilitation should be performed in hospital by a chest physical therapist, little evidence is currently available on its benefits. Therefore, this study demonstrated the benefits of short-term pulmonary rehabilitation during hospitalization in a female patient with chronic scleroderma. The aim of rehabilitation was to improve ventilation and gas exchange by using airway clearance, chest mobilization, and breathing-relearning techniques, including strengthening the respiratory system and the muscles of the limbs by using the BreathMax® device and elastic bands. Gross motor function and activities of daily life were regained by balancing, sitting, and standing practices. Data on minimal chest expansion, high dyspnea, high respiratory rate, and low maximal inspiratory mouth pressure were recorded seven days before rehabilitation or at the baseline period. But there was a clinically significant improvement in dyspnea, chest expansion, maximal inspiratory mouth pressure, and respiratory rate, when compared to baseline data, which were recorded by a chest physical therapist during seven days of rehabilitation. Furthermore, physicians decided to stop using a mechanical ventilator, and improvement in functional capacity was noted. Therefore, in the case of chronic and stable scleroderma, short-term rehabilitation during hospitalization for chest physical therapy possibly shows clinical benefits by improving both pulmonary function and physical performance.
Collapse
Affiliation(s)
- Jirakrit Leelarungrayub
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Decha Pinkaew
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Khanittha Wonglangka
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Wichai Eungpinichpong
- Research Center in Back, Neck, Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
| | - Jakkrit Klaphajone
- Department of Rehabilitation Medicine. Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
11
|
Sanguinetti CM, Ambrosino N, Andò F, De Benedetto F, Donner CF, Nardini S, Polverino M, Torchio R, Vagheggini G, Visconti A. Standards of suitability for the management of chronic obstructive respiratory diseases. Multidiscip Respir Med 2014; 9:65. [PMID: 25584191 PMCID: PMC4290399 DOI: 10.1186/2049-6958-9-65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 11/28/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) ranks third as cause of mortality and disability-adjusted life years (DALY) worldwide and also in Italy it imposes a huge health, social and economic load. Early symptoms of COPD are often disregarded by patients and physicians, spirometry is underutilized, and the diagnosis is delayed till the disease has reached a distinct severity level. Despite the availability of various guidelines, the behavior of health workers involved in the management of COPD is still rather unlike. These considerations are the reason why in October 2013 AIMAR (Interdisciplinary Scientific Association for Research in Lung Disease) devised and organized a "Third Consensus Conference", aimed at pointing out the standards of suitability for COPD management. In this context three important topics of discussion were identified: early and more widespread diagnosis, management of acute and subacute phases, long-term assistance to chronic patients. METHODS The procedure recommended by the Italian Health Superior Institute (ISS) for Consensus Conferences organization was applied. The Conference was structured in three sessions, each dealing with one of the above mentioned topics and including a short update of the subject-matter and presentation, discussion and voting of some statements with a choice ranging from total agreement to total disagreement or no knowledge. The results of voting were eventually recorded in the document, reviewed by an independent jury, that forms the substance of this paper. RESULTS The essential role of spirometry, the need for distinguish between different COPD phenotypes, and the obligatoriness to base on the blood gas analysis findings the long-term oxygen therapy, were largely agreed, as well as the need for interventions aimed at decreasing the rate of acute exacerbations. More specific topics like the use of noninvasive ventilation, recognizing the factors affecting outcome and mortality, the choice of pharmacological and non pharmacological treatments in COPD patients led to lively discussing, but they did not always reach the total agreement, probably because of insufficient familiarity with these problems and of diversities in organization and instruments availability. The chronic respiratory assistance was treated with particular regard to smoking cessation, whose implementation is still insufficient. Many doubts rose due to uncertainty, lack of ability and standardization of procedures, insufficient institutional support, and difficulties to realize a network for assistance to chronic patients. CONCLUSIONS The results of this Third Consensus Conference revealed some certainties and many doubts and diversities of view also on topics whose importance is well demonstrated in scientific literature. Thus, there is still a long distance to cover before reaching a suitable standardization of COPD management and such situation urges the need for improving not only the health professional's operativeness but also the organizational support by competent institutions. In this context some initiatives organized by AIMAR in cooperation with other respiratory scientific societies and patients' associations are going on.
Collapse
Affiliation(s)
- Claudio M Sanguinetti
- />Managing Director Multidisciplinary Respiratory Disease, Senior Consultant Respiratory Diseases, Quisisana Clinical Center, Rome, Italy, Rome, Italy
| | - Nicolino Ambrosino
- />Center of Respiratory Weaning and Rehabilitation Auxilium Vitae, Volterra, (PI) Italy
| | - Filippo Andò
- />Pneumology Unit, G.Martino General Hospital, Messina, Italy
| | | | - Claudio F Donner
- />Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero, (NO) Italy
| | - Stefano Nardini
- />Pneumology Unit, General Hospital, Vittorio Veneto, (TV) Italy
| | - Mario Polverino
- />High Specialty Provincial Pulmonologic Unit, “Scarlato” Hospital, Scafati, (SA) Italy
| | - Roberto Torchio
- />Lung Function and Sleep Unit, AOU S. Luigi, Orbassano, (TO) Italy
| | - Guido Vagheggini
- />Internal Medicine and Respiratory Diseases, Center of Respiratory Weaning and Rehabilitation Auxilium Vitae, Volterra, (PI) Italy
| | | | - on behalf of the Consensus Conference 2013 Group
- />Managing Director Multidisciplinary Respiratory Disease, Senior Consultant Respiratory Diseases, Quisisana Clinical Center, Rome, Italy, Rome, Italy
- />Center of Respiratory Weaning and Rehabilitation Auxilium Vitae, Volterra, (PI) Italy
- />Pneumology Unit, G.Martino General Hospital, Messina, Italy
- />Pneumology Unit, SS.Annunziata General Hospital, Chieti, Italy
- />Mondo Medico, Multidisciplinary and Rehabilitation Outpatient Clinic, Borgomanero, (NO) Italy
- />Pneumology Unit, General Hospital, Vittorio Veneto, (TV) Italy
- />High Specialty Provincial Pulmonologic Unit, “Scarlato” Hospital, Scafati, (SA) Italy
- />Lung Function and Sleep Unit, AOU S. Luigi, Orbassano, (TO) Italy
- />Internal Medicine and Respiratory Diseases, Center of Respiratory Weaning and Rehabilitation Auxilium Vitae, Volterra, (PI) Italy
- />Scientific Secretariat, AIMAR, Arona, (NO) Italy
| |
Collapse
|
12
|
Jones CU, Kluayhomthong S, Chaisuksant S, Khrisanapant W. Breathing exercise using a new breathing device increases airway secretion clearance in mechanically ventilated patients. Heart Lung 2013; 42:177-82. [PMID: 23474003 DOI: 10.1016/j.hrtlng.2012.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Revised: 12/26/2012] [Accepted: 12/26/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of a new device (BreatheMAX) that humidifies and oscillates inspired air to increase secretion clearance in mechanically ventilated patients. BACKGROUND Poor secretion clearance is a serious problem for intubated patients leading to lung complications and delayed weaning. METHODS Double blinded crossover; fifteen patients, median age 60 years, range 16-75. Interventions consisted of spontaneous deep breathing with (treatment) and without (sham) humidification and oscillation of inspired air. Airway secretions were aspirated for 3 h before and after each intervention and wet weight and viscosity determined. RESULTS The sham intervention caused no change in secretion clearance (95% CI: -1.8, 1.8 g) but after treatment secretions increased by 4.0 g (95% CI: 1.3, 6.7; p < 0.05). Viscosity decreased 30% after treatment and was unchanged after sham. Changes in cardiopulmonary function were not clinically significant and the patients reported only mild perceptions of breathlessness. CONCLUSIONS Breathing exercise with a device that includes vibration and humidification of inspired air is effective for increasing secretion clearance with patients dependent on mechanical ventilation and was without any adverse effects.
Collapse
Affiliation(s)
- Chulee U Jones
- School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen Province 40002, Thailand.
| | | | | | | |
Collapse
|
13
|
Rovira Soriano L, Belda Nácher J. Postoperative respiratory management of morbidly obese patient. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2012.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
14
|
Makhabah DN, Martino F, Ambrosino N. Peri-operative physiotherapy. Multidiscip Respir Med 2013; 8:4. [PMID: 23343253 PMCID: PMC3600709 DOI: 10.1186/2049-6958-8-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 01/02/2013] [Indexed: 12/16/2022] Open
Abstract
Postoperative pulmonary complications (PPC) are a major cause of morbidity, mortality, prolonged hospital stay, and increased cost of care. Physiotherapy (PT) programs in post-surgical and critical area patients are aimed to reduce the risks of PPC due to long-term bed-rest, to improve the patient's quality of life and residual function, and to avoid new hospitalizations. At this purpose, PT programs apply advanced cost-effective therapeutic modalities to decrease complications and patient's ventilator-dependency. Strategies to reduce PPC include monitoring and reduction of risk factors, improving preoperative status, patient education, smoking cessation, intra-operative and postoperative pulmonary care. Different PT techniques, as a part of the comprehensive management of patients undergoing cardiac, upper abdominal, and thoracic surgery, may prevent and treat PPC such as secretion retention, atelectasis, and pneumonia.
Collapse
Affiliation(s)
- Dewi Nurul Makhabah
- Pulmonary Rehabilitation and Weaning Center, Auxilium Vitae, Volterra, Italy.
| | | | | |
Collapse
|
15
|
Babu AS. Critical care rehabilitation: a neglected part of ICU care. Oman Med J 2012; 27:268. [PMID: 23071875 DOI: 10.5001/omj.2012.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/26/2012] [Indexed: 11/03/2022] Open
Affiliation(s)
- Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal University, Manipal-576104, Karnataka, India
| |
Collapse
|
16
|
Babu AS, Vasanthan LT. Critical care rehabilitation - is it the answer for reducing morbidity in ARDS survivors? Regarding "Acute respiratory distress syndrome: A clinical review". Pulm Circ 2012; 2:265. [PMID: 22837868 PMCID: PMC3401882 DOI: 10.4103/2045-8932.97643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
| | | |
Collapse
|
17
|
Ambrosino N. Prolonged mechanical ventilation: new facilities and new models of care. REVISTA PORTUGUESA DE PNEUMOLOGIA 2012; 18:211-3. [PMID: 22664387 DOI: 10.1016/j.rppneu.2012.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 04/05/2012] [Indexed: 12/13/2022] Open
Affiliation(s)
- N Ambrosino
- Weaning and Rehabilitation Unit, Auxilium Vitae Rehabilitation Centre, Volterra, Italy.
| |
Collapse
|