Chest physiotherapy for mechanically ventilated children: a survey of current UK practice
Emma Shkurka1, Jo Wray2, Mark J Peters3
1Physiotherapy 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.
Insights
Chest physiotherapy practices for mechanically ventilated children in the UK show variation. Further research is needed to establish best practices and understand decision-making processes for these treatments.
Area of Science:
- Pediatric critical care
- Respiratory physiotherapy
- Mechanical ventilation
Background:
- Chest physiotherapy is a key treatment for mechanically ventilated children.
- Current practices lack consensus and exhibit significant variation.
- Understanding current UK practices is essential for improving patient care.
Purpose of the Study:
- To describe current chest physiotherapy practices for mechanically ventilated children in UK.
- To explore the clinical decision-making processes involved in delivering these therapies.
Main Methods:
- A cross-sectional study utilizing an anonymous electronic survey.
- Survey distributed to qualified physiotherapists in UK Paediatric Intensive Care Units (PICUs).
- Data collected on techniques, mucoactive agents, and collaborative practices.
Main Results:
- High utilization of manual hyperinflations and position changes.
- Significant variation observed in techniques like Metaneb® and percussion.
- DNase and hypertonic saline are the most common mucoactives, with varied delivery methods.
- N-acetylcysteine use and delivery were inconsistent.
- Chest physiotherapy often delivered in conjunction with nursing staff.
- Clinical decision-making involves patient assessment, multidisciplinary input, and risk-benefit analysis.
Conclusions:
- A diverse range of chest physiotherapy interventions are employed for ventilated children.
- Practice variations may stem from training, individual preferences, or local policies.
- Pragmatic interventional studies are necessary to define optimal chest physiotherapy protocols.
- Further investigation into practice variations and decision-making intricacies is warranted.
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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