监测咳嗽有效性和气道清除策略的使用：一项加拿大和英国的调查。
Monitoring Cough Effectiveness and Use of Airway Clearance Strategies: A Canadian and UK Survey.
机构信息
Department of Critical Care, Sunnybrook Health Sciences Centre & Sunnybrook Research Institute, Toronto, Canada; the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, UK; the Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Canada.
Ottawa Hospital Respiratory Rehabilitation and the Ottawa Hospital Sleep Centre, University of Ottawa, Ottawa Hospital Research Institute.
出版信息
Respir Care. 2018 Dec;63(12):1506-1513. doi: 10.4187/respcare.06321. Epub 2018 Sep 11.
BACKGROUND
Regular monitoring combined with early and appropriate use of airway clearance can reduce unplanned hospital admissions for patients with neuromuscular disease (NMD) and spinal cord injury (SCI). We aimed to describe and compare knowledge of guidelines, monitoring of cough effectiveness, clinician prescription/provision of airway clearance strategies, and service provision constraints in the United Kingdom and Canada.
METHODS
This was a cross-sectional survey of clinicians affiliated with NMD and SCI clinics in Canada, 2016 attendees at the Home Mechanical Ventilation Conference in the United Kingdom, and United Kingdom physiotherapist networks.
RESULTS
We received 155 surveys (92 from Canada; 63 from the United Kingdom). More UK respondents (76%) were aware of airway clearance guidelines than Canadian (56%) respondents ( = .02). Routine assessment of cough effectiveness was reported by more UK respondents (59%) than Canadian (42%) respondents ( = .044). Cough peak flow (CPF) was the most common method used in both countries, although it was more commonly used in the UK (96%) than in Canada (81%, = .02). Fewer Canadian respondents reported using CPF before initiation of airway clearance (81% vs 94%, = .046), and fewer Canadian respondents showed results to patients for technique feedback (76% vs 97%, = .007). Similar participant numbers reported using CPF after initiation to ensure adequate technique (73% vs 72%, = .92). Mechanical insufflation-exsufflation (MI-E) + lung volume recruitment (LVR) + manually assisted cough when CPF ≤ 270 L/min was most routinely recommended (41% overall). Monotherapy was infrequent (LVR 15%, manually assisted cough 7%, and MI-E 4%). More Canadians identified constraints on service provision, specifically insufficient public funding for equipment (68% vs 39%, = .002) and inadequate community workers' knowledge (56% vs 34%, = .002). Funding for community support was a common constraint in both countries (49% vs 42%).
CONCLUSIONS
The somewhat variable cough effectiveness monitoring and airway clearance practices identified in this survey confirm the need for further work on knowledge translation related to guideline recommendations and the need to address common constraints to optimal service delivery.
背景
定期监测并及早合理使用气道清除技术，可以降低神经肌肉疾病（NMD）和脊髓损伤（SCI）患者的非计划性住院率。本研究旨在描述并比较英国和加拿大在指南认知、咳嗽有效性监测、临床医生开具/提供气道清除策略以及服务提供限制方面的情况。
方法
本研究为横断面调查，纳入了加拿大 NMD 和 SCI 诊所的临床医生、2016 年英国家庭机械通气会议的参会者以及英国物理治疗师网络。
结果
共收到 155 份调查问卷（92 份来自加拿大，63 份来自英国）。与加拿大（56%）相比，英国（76%）的受访者对气道清除指南的认知度更高（ =.02）。与加拿大（42%）相比，英国（59%）的受访者更常报告常规评估咳嗽有效性（ =.044）。在两个国家，咳嗽峰流速（CPF）均为最常用的方法，但在英国更为常用（96% vs 81%， =.02）。与英国相比，加拿大更少有受访者在开始气道清除前使用 CPF（81% vs 94%， =.046），且更少向患者展示结果以提供技术反馈（76% vs 97%， =.007）。在开始气道清除后，确保技术有效的使用 CPF 人数相近（73% vs 72%， =.92）。最常推荐使用 CPF＜270 L/min 时加用机械通气-呼气末正压通气（MI-E）+肺复张（LVR）+手动辅助咳嗽（41%）。单一疗法（LVR 15%、手动辅助咳嗽 7%、MI-E 4%）不常用。更多的加拿大受访者指出了服务提供方面的限制，特别是设备的公共资金不足（68% vs 39%， =.002）和社区工作人员知识不足（56% vs 34%， =.002）。两国都普遍存在对社区支持资金的限制（49% vs 42%）。
结论
本研究中确定的咳嗽有效性监测和气道清除实践存在一定的差异，这进一步证实了需要进一步开展指南推荐相关知识转化工作，同时需要解决服务提供方面的常见限制因素，以实现最佳服务效果。
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