We previously published an article in Australian Health Review describing the implementation of a physiotherapy-led bronchoscopy service at Launceston General Hospital in Tasmania. 1 There has been increasing interest in this article from physiotherapy colleagues, and this letter hopes to address some of the questions asked.From our intensive care unit (ICU) perspective, the physiotherapy-led bronchoscopy service has been well received and respected by all ICU medical and nursing staff. Due to our ICU acuity, demand can fluctuate, and the number of physiotherapy-led bronchoscopies indicated and undertaken can range from two to four procedures per week, to one per month. Since credentialing, the senior ICU physiotherapist has undertaken 48 bronchoscopies and has assisted in 10 percutaneous tracheostomy procedures by being responsible for the bronchoscopy component. There have been no major adverse events or complications during any physiotherapy-led bronchoscopies.Although evidence suggests chest physiotherapy is as effective as bronchoscopy, 2,3 we find physiotherapy-led bronchoscopy to be a valuable, time-efficient treatment for significant mucous plugging and assisting airway clearance in patients who are already sedated and occasionally paralysed and/or when other physiotherapy interventions may not be appropriate or successful. Physiotherapy-led bronchoscopies can help guide future chest physiotherapy, allows an assessment of airway integrity and can be a beneficial adjunct when used in combination with other chest physiotherapy interventions.As identified when initiating the service, patients require an increase in sedatives, topical local anaesthetic and/or addition of neuromuscular blocking agents for bronchoscopies to occur safely, which physiotherapists are unable to prescribe or administer.To overcome this, we followed recommendations, and modified existing protocols from Alfred Health, Victoria, Australia, that ensures medical staff pre-prescribe the medications required and ICU nursing staff administer them. This protocol works well in our ICU and there have been no barriers to physiotherapy-led bronchoscopies due to medication prescription/administration limitations. Another concern was implementation of a physiotherapy-led bronchoscopy service may reduce physiotherapy time and resources available to focus on other physiotherapy duties within ICU, such as early mobilisation and rehabilitation. Anecdotally, we have not observed or had any reports of practice change to patients receiving timely and appropriate physiotherapy. Rather, physiotherapy-led bronchoscopy is part of a package of lung clearance therapies that spans from diagnosis (chest X-ray and physiotherapist lung ultrasound), ventilator and pharmacologic therapies for secretion burden, chest physiotherapy and where appropriate, bronchoscopy.The senior ICU physiotherapist remains the only physiotherapist who has been credentialed in physiotherapy-led bronchoscopy. This is predominantly due to our ICU physiotherapy staffing model. We have one ...

The use of lung ultrasound (LUS) in clinical settings is emerging as an important tool in the assessment of lung pathology and/or function and has gained considerable acceptance. LUS is being integrated into clinical care by trained respiratory physiotherapists and has been shown to influence physiotherapists’ clinical decision-making in the respiratory management of patients. Considering the use of LUS by physiotherapy is in its infancy and still evolving, there is likely variability in the ability and confidence of physiotherapists to use LUS in clinical practice, both in Australia and internationally. While the UK has had a rapid increase in the number of LUS-accredited physiotherapists (n = 111), the number of LUS-accredited physiotherapists in Australia remains very low (n = 4). There is a growing body of work in the UK on physiotherapy-led LUS in respiratory care, however, there is currently little work published on the practicalities of training and establishing physiotherapy-led LUS in Australia. This report describes the training and implementation of physiotherapy-led LUS in the intensive care unit from a regional hospital perspective.