Roberts Fiona E
School of Health Science, Faculty of Health and Social Care, The Robert Gordon University, Aberdeen, Scotland.
Physiother Can. 2009 Spring;61(2):107-15. doi: 10.3138/physio.61.2.107. Epub 2009 May 12.
To investigate whether physiotherapists consider normal saline instillation (NSI) useful before endotracheal suctioning and, if so, when.
Sixty-eight respiratory physiotherapists recruited from the United Kingdom's Association of Chartered Physiotherapists in Respiratory Care agreed to participate in a Delphi study. Clinicians' opinion of when NSI should be used was established and developed into statements. Level of agreement with each statement was collated through three rounds of a questionnaire. Clinicians' experiences were also reported.
From the 52 responses to the third questionnaire, there was consensus that respiratory physiotherapists in the United Kingdom would use NSI when sputum retention is a problem, particularly when treatment options are limited (96%) and when sputum is obstructing the airway (92%). They agreed that non-bronchoscopic bronchoalveolar lavage can be used to resolve persistent atelectasis (70%). They would not use NSI for a test treatment during initial assessment without evidence of retained secretions (94%), when secretions are copious but can be cleared by alternative physiotherapy techniques (96%), to enhance a cough unless very strong evidence indicates retained secretions (81%), or to compensate for inadequate suction technique (90%).
This study provides clinicians' views about when NSI could be used.
探讨物理治疗师是否认为气管内吸痰前滴注生理盐水（NSI）有用，若有用，则在何时使用。
从英国皇家呼吸治疗师协会招募的68名呼吸物理治疗师同意参与一项德尔菲研究。确定临床医生关于何时应使用NSI的意见，并将其发展为陈述。通过三轮问卷调查整理对每条陈述的同意程度。还报告了临床医生的经验。
在对第三份问卷的52份回复中，达成的共识是，英国的呼吸物理治疗师在痰液潴留成为问题时会使用NSI，尤其是在治疗选择有限时（96%）以及痰液阻塞气道时（92%）。他们同意非支气管镜下支气管肺泡灌洗可用于解决持续性肺不张（70%）。在初始评估期间，若无分泌物潴留的证据，他们不会将NSI用于试验性治疗（94%）；当分泌物大量但可通过其他物理治疗技术清除时，他们也不会使用NSI（96%）；除非有非常有力的证据表明有分泌物潴留，否则他们不会为增强咳嗽而使用NSI（81%），也不会为弥补吸痰技术不足而使用NSI（90%）。
本研究提供了临床医生关于何时可使用NSI的观点。
