van der Lee Lisa, Hill Anne-Marie, Patman Shane
School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat Street, Fremantle, Western Australia, 6959, Australia.
Allied Health, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia, 6150, Australia.
J Eval Clin Pract. 2017 Aug;23(4):812-820. doi: 10.1111/jep.12722. Epub 2017 Mar 27.
RATIONALE, AIMS, AND OBJECTIVES: Community-acquired pneumonia (CAP) is a common cause for intensive care unit (ICU) admission resulting in high morbidity and mortality. There is a paucity of evidence regarding respiratory physiotherapy for intubated and mechanically ventilated patients with CAP, and anecdotally clinical practice is variable in this cohort. The aims of this study were to identify the degree of variability in physiotherapy practice for intubated adult patients with CAP and to explore ICU physiotherapist perceptions of current practice for this cohort and factors that influence physiotherapy treatment mode, duration, and frequency.
A survey was developed based on common aspects of assessment, clinical rationale, and intervention for intubated and mechanically ventilated patients. Senior ICU physiotherapists across 88 Australian public and private hospitals were recruited.
The response rate was 72%. Respondents (n = 75) stated their main rationale for providing a respiratory intervention were improved airway clearance (98%, n = 60/61), alveolar recruitment (74%, n = 45/61), and gas exchange (33%, n = 20/61). Respondents estimated that average intervention lasted between 16 and 30 minutes (70% of respondents, n = 41/59) and would be delivered once (44%) or twice (44%) daily. Results indicated large variability in reported practice; however, trends existed regarding positioning in alternate side-lying (81%, n = 52/64) or affected lung uppermost (83%, n = 53/64) and use of hyperinflation techniques (81%, 52/64). Decisions regarding duration were reported to be based on sputum volume (95%), viscosity (93%) and purulence (88%), cough effectiveness (95%), chest X-ray (87%), and auscultation (84%). Sixty percent reported that workload and staffing affected intervention duration and frequency. Intervention time was more likely increased when there was greater staffing (P = .03).
Respiratory physiotherapy treatment varies for intubated patients with CAP. Further research is required to determine what is considered best practice for this patient population.
原理、目的和目标：社区获得性肺炎（CAP）是重症监护病房（ICU）收治的常见病因，会导致高发病率和死亡率。关于对插管并接受机械通气的CAP患者进行呼吸物理治疗的证据不足，而且在这一群体中，临床实践也存在差异。本研究的目的是确定插管成年CAP患者物理治疗实践的差异程度，并探讨ICU物理治疗师对该群体当前实践的看法以及影响物理治疗治疗方式、持续时间和频率的因素。
基于对插管并接受机械通气患者的评估、临床原理和干预的常见方面制定了一项调查。招募了澳大利亚88家公立和私立医院的资深ICU物理治疗师。
回复率为72%。受访者（n = 75）表示，他们进行呼吸干预的主要理由是改善气道清除（98%，n = 60/61）、肺泡复张（74%，n = 45/61）和气体交换（33%，n = 20/61）。受访者估计，平均干预持续时间在16至30分钟之间（70%的受访者，n = 41/59），并且每天进行一次（44%）或两次（44%）。结果表明，报告的实践存在很大差异；然而，在交替侧卧位（81%，n = 52/64）或患侧肺在上位（83%，n = 53/64）的体位摆放以及使用肺膨胀技术方面（81%，52/64）存在趋势。据报告，关于持续时间的决定是基于痰液量（95%）、粘度（93%）和脓性（88%）、咳嗽效果（95%）、胸部X光（87%）和听诊（84%）。60%的人报告说工作量和人员配备会影响干预的持续时间和频率。当人员配备更多时，干预时间更有可能增加（P = 0.03）。
插管CAP患者的呼吸物理治疗方法各不相同。需要进一步研究以确定该患者群体的最佳实践方法。
