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Extended scope of practice (ESoP) and advanced scope of practice (ASoP) physiotherapy roles have been in place in the UK for over 20 years. However, interest in these types of services appears to be only just evolving within Australia. Although ESoP and/or ASoP cardiorespiratory roles in intensive care units (ICU) may be perceived to be more achievable in large metropolitan teaching hospitals, at least 67% of Australian ICUs provide physiotherapy services. Very little has been published on the practicalities (e.g. training pathways, evidence for use and guidelines) of developing advanced or extended scope cardiorespiratory physiotherapy services within Australian ICUs. This report describes the development and implementation of a physiotherapy-led bronchoscopy service from a regional hospital perspective. What is known about the topic? Although ESoP and ASoP physiotherapy roles are well established in the UK, such services appear to be only just evolving in Australia. Clarity on the definitions of extended and advanced physiotherapy roles have been articulated by the Australian Physiotherapy Association. However, there is a paucity of evidence published on the practicalities of establishing advanced or extended scope cardiorespiratory physiotherapy services within Australian ICUs. What does this paper add? One of the main emerging areas of ESoP and/or ASoP in the cardiorespiratory field is the use of bronchoscopy by physiotherapists. This paper describes the framework, implementation, limitations and barriers of developing a physiotherapy-led bronchoscopy service from a regional hospital perspective. What are the implications for practitioners? This paper allows the potential for our credentialing and practice framework model to be transferred in other public hospitals commencing or considering implementing physiotherapy-led bronchoscopy services within their ICU.

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IntroductionPostoperative pulmonary complications (PPCs) are a common serious complication following upper abdominal surgery leading to significant consequences including increased mortality, hospital costs and prolonged hospitalisation. The primary objective of this study is to detect whether there is a possible signal towards PPC reduction with the use of additional intermittent non-invasive ventilation (NIV) compared with continuous high-flow nasal oxygen therapy alone following high-risk elective upper abdominal surgery. Secondary objectives are to measure feasibility of: (1) trial conduct and design and (2) physiotherapy-led NIV and a high-flow nasal oxygen therapy protocol, safety of NIV and to provide preliminary costs of care information of NIV and high-flow nasal oxygen therapy.Methods and analysisThis is a single-centre, parallel group, assessor blinded, pilot, randomised trial, with 130 high-risk upper abdominal surgery patients randomly assigned via concealed allocation to either (1) usual care of continuous high-flow nasal oxygen therapy for 48 hours following extubation or (2) usual care plus five additional 30 min physiotherapy-led NIV sessions within the first two postoperative days. Both groups receive standardised preoperative physiotherapy and postoperative early ambulation. No additional respiratory physiotherapy is provided to either group. Outcome measures will assess incidence of PPC within the first 14 postoperative days, recruitment ability, physiotherapy-led NIV and high-flow nasal oxygen therapy protocol adherence, adverse events relating to NIV delivery and costs of providing a physiotherapy-led NIV and a high-flow nasal oxygen therapy service following upper abdominal surgery.Ethics and disseminationEthics approval has been obtained from the relevant institution and results will be published to inform future multicentre trials.Trial registration numberACTRN12617000269336; Pre-results.