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Resende ASDO, Bacci SLLDS, Paula ÍR, Pereira LA, Johnston C, Luszczynski VCN, Azevedo VMGDO. Performance and labor conditions of physiotherapists in Brazilian intensive care units during the COVID-19 pandemic. What did we learn? CRITICAL CARE SCIENCE 2023; 35:273-280. [PMID: 38133157 PMCID: PMC10734813 DOI: 10.5935/2965-2774.20230359-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/20/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To describe the role of physiotherapists in assisting patients suspected to have or diagnosed with COVID-19 hospitalized in intensive care units in Brazil regarding technical training, working time, care practice, labor conditions and remuneration. METHODS An analytical cross-sectional survey was carried out through an electronic questionnaire distributed to physiotherapists who worked in the care of patients with COVID-19 in Brazilian intensive care units. RESULTS A total of 657 questionnaires were completed by physiotherapists from the five regions of the country, with 85.3% working in adult, 5.4% in neonatal, 5.3% in pediatric and 3.8% in mixed intensive care units (pediatric and neonatal). In intensive care units with a physiotherapists available 24 hours/day, physiotherapists worked more frequently (90.6%) in the assembly, titration, and monitoring of noninvasive ventilation (p = 0.001). Most intensive care units with 12-hour/day physiotherapists (25.8%) did not apply any protocol compared to intensive care units with 18-hour/day physiotherapy (9.9%) versus 24 hours/day (10.2%) (p = 0.032). Most of the respondents (51.0%) received remuneration 2 or 3 times the minimum wage, and only 25.1% received an additional payment for working with patients suspected to have or diagnosed with COVID-19; 85.7% of them did not experience a lack of personal protective equipment. CONCLUSION Intensive care units with 24-hour/day physiotherapists had higher percentages of protocols and noninvasive ventilation for patients with COVID-19. The use of specific resources varied between the types of intensive care units and hospitals and in relation to the physiotherapists' labor conditions. This study showed that most professionals had little experience in intensive care and low wages.
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Affiliation(s)
| | - Suzi Laine Longo dos Santos Bacci
- Hospital de Clínicas de Uberlândia, Empresa
Brasileira de Serviços Hospitalares, Universidade Federal de
Uberlândia - Uberlândia (MG), Brazil
| | - Ítalo Ribeiro Paula
- Hospital de Clínicas de Uberlândia, Empresa
Brasileira de Serviços Hospitalares, Universidade Federal de
Uberlândia - Uberlândia (MG), Brazil
| | - Leandro Alves Pereira
- Faculdade de Matemática, Universidade Federal de
Uberlândia - Uberlândia (MG), Brazil
| | - Cíntia Johnston
- Department of Pediatrics, Faculdade de Medicina, Universidade de
São Paulo - São Paulo (SP), Brazil
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Vitti JD, de Castro AAM, Serrão NF. Use of noninvasive mechanical ventilation weaning protocol in neonatal intensive care units in Brazil: a descriptive study. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2021382. [PMID: 37194837 PMCID: PMC10184999 DOI: 10.1590/1984-0462/2023/41/2021382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/13/2022] [Indexed: 05/18/2023]
Abstract
OBJECTIVE This study aimed to investigate whether neonatal intensive care units (NICUs) in Brazilian hospitals use a protocol for weaning from noninvasive ventilation (NIV), how this ventilatory support is withdrawn, and whether there is consensus among the methods used by the institutions. METHODS A cross-sectional survey was conducted from December 2020 to February 2021, based on responses to an electronic questionnaire, filled out by physical therapists working in NICU in Brazilian hospitals about the routine of physical therapy and the use of NIV and its weaning. RESULTS A total of 93 answers to the electronic questionnaire met the study criteria: 52.7% were from public health institutions, with an average of 15 NICU beds (15.2±15.9), 85% of the physical therapists worked exclusively in the NICU, 34.4% of the NICU had 24-h physical therapy care, 66.7% of the units use the continuous positive airway pressure (CPAP) as ventilatory mode, and 72% the nasal prong as NIV interface; 90% of the NICU physical therapists answered that their NICU had no NIV weaning protocol, with various methods of weaning reported, the most cited being pressure weaning. CONCLUSIONS Most Brazilian NICUs have no NIV weaning protocol. The most used method among institutions, with or without a protocol, is pressure weaning. Although most of the participating physical therapists work exclusively in NICU, many hospitals do not have the recommended workload, which can be one of the negative factors in the organization of protocols and in the progress of ventilatory weaning.
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Klabusayová E, Klučka J, Kratochvíl M, Musilová T, Vafek V, Skříšovská T, Djakow J, Kosinová M, Havránková P, Štourač P. Airway Management in Pediatric Patients: Cuff-Solved Problem? CHILDREN (BASEL, SWITZERLAND) 2022; 9:1490. [PMID: 36291426 PMCID: PMC9600438 DOI: 10.3390/children9101490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/14/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Traditionally, uncuffed tubes were used in pediatric patients under 8 years in pursuit of reducing the risk of postextubation stridor. Although computed tomography and magnetic resonance imaging studies confirmed that the subglottic area remains the narrowest part of pediatric airway, the use of uncuffed tubes failed to reduce the risk of subglottic swelling. Properly used cuffed tubes (correct size and correct cuff management) are currently recommended as the first option in emergency, anesthesiology and intensive care in all pediatric patients. Clinical practice particularly in the intensive care area remains variable. This review aims to analyze the current recommendation for airway management in children in emergency, anesthesiology and intensive care settings.
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Affiliation(s)
- Eva Klabusayová
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Jozef Klučka
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Milan Kratochvíl
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Tereza Musilová
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Václav Vafek
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Tamara Skříšovská
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Jana Djakow
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Paediatric Intensive Care Unit, NH Hospital Inc., 268 31 Hořovice, Czech Republic
| | - Martina Kosinová
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Pavla Havránková
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Anaesthesiology and Intensive Care Medicine, The Donaustadt Clinic, Lango Bardenstraße 122, 1220 Vienna, Austria
| | - Petr Štourač
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
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Thomas RE, Erickson S, Hullett B, Minutillo C, Lethbridge M, Vijayasekaran S, Agrawal S, Bulsara MK, Rao SC. Comparison of the efficacy and safety of cuffed versus uncuffed endotracheal tubes for infants in the intensive care setting: a pilot, unblinded RCT. Arch Dis Child Fetal Neonatal Ed 2021; 106:614-620. [PMID: 33879529 DOI: 10.1136/archdischild-2020-320764] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/25/2021] [Accepted: 04/06/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study effectiveness and safety of cuffed versus uncuffed endotracheal tubes (ETTs) in small infants in the intensive care unit (ICU). DESIGN Pilot RCT. SETTING Neonatal and paediatric ICUs of children's hospital in Western Australia. PARTICIPANTS Seventy-six infants ≥35 weeks gestation and infants <3 months of age, ≥3 kg. INTERVENTIONS Patients randomly assigned to Microcuff cuffed or Portex uncuffed ETT. MAIN OUTCOMES MEASURES Primary outcome was achievement of optimal ETT leak in target range (10%-20%). Secondary outcomes included: reintubations, ventilatory parameters, ventilatory complications, postextubation complications and long-term follow-up. RESULTS Success rate (achievement of mean leak in the range 10%-20%) was 13/42 (30.9%) in the cuffed ETT group and 6/34 (17.6%) in uncuffed ETT group (OR=2.09; 95% CI (0.71 to 6.08); p=0.28). Mean percentage time within target leak range in cuffed ETT group 28% (IQR: 9-42) versus 15% (IQR: 0-28) in uncuffed ETT group (p=0.01). There were less reintubations to optimise size in cuffed ETT group 0/40 versus 10/36 (p<0.001). No differences were found in gaseous exchange, ventilator parameters or postextubation complications. There were fewer episodes of atelectasis in cuffed ETT group 0/42 versus 4/34 (p=0.03). No patient had been diagnosed with subglottic stenosis at long-term follow-up. CONCLUSIONS There was no difference in the primary outcome, though percentage time spent in optimal leak range was significantly higher in cuffed ETT group. Cuffed ETTs reduced reintubations to optimise ETT size and episodes of atelectasis. Cuffed ETTs may be a feasible alternative to uncuffed ETTs in this group of patients. TRIAL REGISTRATION NUMBER ACTRN12615000081516.
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Affiliation(s)
- Rebecca E Thomas
- Department of Neonatology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Simon Erickson
- Department of Paediatric Critical Care, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Bruce Hullett
- Department of Anaesthetics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Corrado Minutillo
- Department of Neonatology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Martyn Lethbridge
- Department of Anaesthetics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Shyan Vijayasekaran
- Department of Otolaryngology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Sachin Agrawal
- Department of Neonatology, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Shripada C Rao
- Department of Neonatology, Perth Children's Hospital, Nedlands, Western Australia, Australia
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