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Shkurka E, Wray J, Peters MJ, Shannon H. Chest physiotherapy for mechanically ventilated children: a survey of current UK practice. Physiotherapy 2022; 119:17-25. [PMID: 36706622 DOI: 10.1016/j.physio.2022.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 11/02/2022] [Accepted: 11/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Chest physiotherapy is a treatment option for mechanically ventilated children. However, there is a lack of consensus regarding its value and informal discussions suggest variation in practice. This study describes chest physiotherapy practices for mechanically ventilated children in the UK and explores clinical decision making related to its delivery. DESIGN Cross-sectional study, using an anonymous, electronic survey. PARTICIPANTS Qualified physiotherapists working in UK NHS paediatric intensive care units (PICUs). RESULTS The response rate was 61% (72/118), this included physiotherapists from 26/27 (96%) PICUs. All participants reported using manual hyperinflations and position changes 'always' or 'often'. Variation in practice was evident for some techniques, including Metaneb® and percussion. DNase (99%, 71/72) and hypertonic saline (90%, 65/72) were the most frequently used mucoactives: 91% (59/65) of physiotherapists reported only nebulising hypertonic saline and 69% (49/71) use both nebulised and instilled DNase. Use and delivery of N-acetylcysteine was inconsistent (nebulised only 55%, 26/47; instilled only 15%, 7/47; both 30%, 14/47). Chest physiotherapy was most commonly delivered with a nurse (67%, 48/72). Clinical decision making processes were comparable between physiotherapists and encompassed three main elements: individual patient assessment, involvement of the multidisciplinary team, and risk versus benefit analysis. CONCLUSIONS A range of chest physiotherapy treatments and adjuncts were used with ventilated children. Variation was apparent and may be due to individual preferences of those training staff or local policies. Pragmatic, interventional studies are required to determine best practice. Further exploration is necessary to understand the variation in practice and intricacies of decision making.
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Affiliation(s)
- Emma Shkurka
- Physiotherapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Infection, Immunity & Inflammation Department, UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Mark J Peters
- Infection, Immunity & Inflammation Department, UCL Great Ormond Street Institute of Child Health, London, UK; Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Harriet Shannon
- Infection, Immunity & Inflammation Department, UCL Great Ormond Street Institute of Child Health, London, UK
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Ou GWM, Ng MJH, Ng CLW, Ong HK, Jayachandran B, Palanichamy V. Physiotherapy Practice Pattern in the Adult Intensive Care Units of Singapore – A Multi-Centre Survey. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058211068589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The roles of physiotherapy in Intensive Care Unit (ICU) have significantly developed from the traditional management of respiratory conditions to early rehabilitation and mobilisation of patients on mechanical ventilation. Surveys of United Kingdom, Australia and regional ICU physiotherapy practice have been published but there are no local data sets. This study aims to report the physiotherapy practices across the adult ICUs of Singapore. Methods Twenty-nine item questionnaire was mailed to 90 physiotherapists working in 15 adult ICUs across restructured and private hospitals in Singapore. Data sets were summarised from the returned questionnaires. This includes identifying common physiotherapy techniques and exercise prescription protocols for both mechanically and non-mechanically ventilated patients in the ICU. Results A total of 63 (70%) questionnaires were returned. The most used physiotherapy interventions were airway secretion clearance, techniques to improve lung ventilation and mobilisation out of bed. Positioning was most used respiratory technique (60/61, 98%). Sitting on the edge of bed is the most preferred physical activity for ICU patients (43/44, 98%). Exercise was routinely prescribed (50/61, 83%) although only a minority (8/50, 16%) have established exercise prescription protocols. For mechanically ventilated patients, active/active assisted exercises were most used (40/44, 91%). 12% of ICU use either Chelsea Critical Care Physical Assessment Tool or the Functional Status Score for the Intensive Care Unit as routine outcome measures. Conclusion Airway clearance was stated as the most used physiotherapy technique. Exercise is routinely prescribed in ICU. Validated outcome measures are only used by few.
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Affiliation(s)
| | - Marcus Jun Hui Ng
- Physiotherapy, Singapore Institute of Technology, Singapore, Singapore
| | | | - Hwee Kuan Ong
- Physiotherapy, Singapore General Hospital, Singapore, Singapore
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Haruna J, Tatsumi H, Kazuma S, Sasaki A, Masuda Y. Frequent tracheal suctioning is associated with extubation failure in patients with successful spontaneous breathing trial: a single-center retrospective cohort study. JA Clin Rep 2022; 8:5. [PMID: 35024978 PMCID: PMC8758876 DOI: 10.1186/s40981-022-00495-7] [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: 10/31/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Extubation failure, i.e., reintubation in ventilated patients, is a well-known risk factor for mortality and prolonged stay in the intensive care unit (ICU). Although sputum volume is a risk factor, the frequency of tracheal suctioning has not been validated as a predictor of reintubation. We conducted this study to examine whether frequent tracheal suctioning is a risk factor for reintubation. PATIENTS AND METHODS We included adult patients who were intubated for > 72 h in the ICU and extubated after completion of spontaneous breathing trial (SBT). We compared the characteristics and weaning-related variables, including the frequency of tracheal suctioning between patients who required reintubation within 24 h after extubation and those who did not, and examined the factors responsible for reintubation. RESULTS Of the 400 patients enrolled, reintubation was required in 51 (12.8%). The most common cause of reintubation was difficulty in sputum excretion (66.7%). There were significant differences in sex, proportion of patients with chronic kidney disease, pneumonia, ICU admission type, the length of mechanical ventilation, and ICU stay between patients requiring reintubation and those who did not. Multivariate analysis showed frequent tracheal suction (> once every 2 h) and the length of mechanical ventilation were independent factors for predicting reintubation. CONCLUSION We should examine the frequency of tracheal suctioning > once every 2 h in addition to the length of mechanical ventilation before deciding to extubate after completion of SBT in patients intubated for > 72 h in the ICU.
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Affiliation(s)
- Junpei Haruna
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Satoshi Kazuma
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Aki Sasaki
- Department of Nursing, Sapporo Medical University Hospital, Sapporo, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, School of Medicine, Sapporo Medical University, South-1, West-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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Intervenções de fisioterapia respiratória utilizadas durante a hospitalização de crianças e adolescentes com asma. SCIENTIA MEDICA 2021. [DOI: 10.15448/1980-6108.2021.1.39356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objetivo: descrever e comparar as intervenções de fisioterapia respiratória utilizadas para asma durante a hospitalização em três grupos etários pediátricos. Além disso, buscou-se investigar os motivos de escolha dessas intervenções.Métodos: a amostra foi composta por fisioterapeutas atuantes em hospitais que reportaram atender crianças e adolescentes com asma. Os profissionais responderam a um questionário online sobre dados pessoais, acadêmicos, profissionais e relativo às intervenções de fisioterapia respiratória utilizadas em lactentes, pré-escolares e escolares/adolescentes. As intervenções foram agrupadas em nove classificações: convencionais, manuais, baseadas em volume, oscilação oral de alta frequência/pressão expiratória positiva (OOAF/PEP), exercícios ventilatórios, ventilação não invasiva, técnica de expiração forçada (TEF), aspiração de vias aéreas superiores (VAS) e outras.Resultados: foram incluídos 93 fisioterapeutas, com idade entre 31 e 40 anos (47,3%) e do sexo feminino (87,1%). As intervenções mais utilizadas nos lactentes foram a aspiração de VAS (78,5%), a aceleração do fluxo expiratório (AFE) (50,5%) e a terapia expiratória manual passiva (TEMP) (45,2%). Nos pré-escolares, predominou a tosse (75,3%), a aspiração de VAS (52,7%), a AFE (51,6%) e a TEMP/expiração lenta e prolongada (ELPr) (50,5%). Já nos escolares/adolescentes, a tosse (83,9%), os exercícios expiratórios variados (73,1%) e a ELPr (57,0%) sobressaíram-se. Houve menor utilização (p<0,01) de OOAF/PEP, de exercícios ventilatórios e de TEF nos lactentes e, também, de métodos convencionais, manuais, aspiração de VAS e outras terapias (p<0,01) nos escolares/adolescentes. Os profissionais relataram utilizar essas intervenções por serem mais eficazes na prática clínica (78,5%).Conclusão: as intervenções manuais e as técnicas de expectoração visando à desobstrução brônquica foram as mais frequentemente utilizadas, tendo relação com a faixa etária e a escolha devido à efetividade na prática clínica.
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Almeida MMFD, Teodoro RDJ, Chiavegato LD. Maneuvers and strategies in respiratory physical therapy: time to revisit the evidence. ACTA ACUST UNITED AC 2020; 46:e20200443. [PMID: 32901692 PMCID: PMC7567630 DOI: 10.36416/1806-3756/e20200443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Marcella Musumeci Fagundes de Almeida
- . Disciplina de Pneumologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil.,. Serviço de Fisioterapia, Hospital São Paulo, Disciplina de Pneumologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil.,. Hospital Vila Nova Star, São Paulo (SP) Brasil
| | - Renata de Jesus Teodoro
- . Disciplina de Pneumologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil.,. Universidade Nove de Julho, São Paulo (SP) Brasil.,. Liga da Fisiointensiva, São Paulo (SP) Brasil.,. Clinica Play Edu, São Paulo (SP) Brasil
| | - Luciana Dias Chiavegato
- . Disciplina de Pneumologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil.,. Serviço de Fisioterapia, Hospital São Paulo, Disciplina de Pneumologia, Universidade Federal de São Paulo - UNIFESP - São Paulo (SP) Brasil
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