A survey of clinicians regarding respiratory physiotherapy intervention for intubated and mechanically ventilated patients with community‐acquired pneumonia. What is current practice in Australian ICUs?

Abstract

Respiratory physiotherapy treatment varies for intubated patients with CAP. Further research is required to determine what is considered best practice for this patient population.

Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multiple Centre Cross-Sectional Survey

“…In our study, the most preferred treatment among PTs was chest physiotherapy (54%) irrespective of the clinical case scenario. The results of our study are in accord with similar practices observed in the USA (19), Europe (20), Australia (21,22), the UK, Hong Kong (23), and Asia (8,24,25). Based on the previous literature, the findings suggest a moderate to strong evidence of the use of chest physical therapy in maintaining bronchial hygiene (26,27).…”

Airway clearance techniques and use of mucoactive agents for adult critically ill patients with acute respiratory failure: a qualitative study exploring UK physiotherapy practice

“…Our findings are valuable as the first to our knowledge identifying UK critical care physiotherapy around physiotherapy use of ACT, which are consistent with those reported from other international settings both in terms of range of techniques used, and rationale [10,11,13], as well as recommendations laid out in previous European guidelines [15]. Furthermore they reflect recently published updated national UK guidelines on provision of intensive care services that state "Targeted airway clearance interventions should only be considered in selected patients when clinically indicated" [14].…”

“…Standard strategies to minimise secretion retention typically include suctioning and heated humidification [7]. Respiratory physiotherapy utilises additional airway clearance techniques (ACT) to manage focal secretion retention including manual and/or ventilator lung hyperinflation, patient positioning, and chest wall manual techniques [8][9][10][11]. These techniques may be supplemented by use of adjunctive therapies such as mucoactive agents for increased volume or tenacity of secretions [12].…”

“…A prospective cross-sectional point-prevalence study across 47 ICUs and including 230 patients, reported nearly 40% of patients required additional secretion clearance techniques beyond standard suctioning, predominantly delivered by physiotherapists [10]. In a survey of senior ICU physiotherapists, 98% of respondents (n=60/61) identified facilitation of sputum clearance as their rationale for delivering respiratory physiotherapy [11]. High sputum load, thick secretions unable to be cleared by other modalities, and cough ineffectiveness, were the most common clinical presentations influencing duration and frequency of treatment sessions [11].…”

“…In a survey of senior ICU physiotherapists, 98% of respondents (n=60/61) identified facilitation of sputum clearance as their rationale for delivering respiratory physiotherapy [11]. High sputum load, thick secretions unable to be cleared by other modalities, and cough ineffectiveness, were the most common clinical presentations influencing duration and frequency of treatment sessions [11]. Finally, in a prospective observational study of usual care physiotherapy during acute hospitalisation, patient positioning, ventilator lung hyperinflation, and suctioning, were the most frequently performed respiratory techniques documented by physiotherapists [13].…”