Shkurka Emma, Wray Jo, Peters Mark J, Shannon Harriet
Physiotherapy 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.
Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
Physiotherapy. 2023 Jun;119:17-25. doi: 10.1016/j.physio.2022.11.004. Epub 2022 Nov 18.
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.
Cross-sectional study, using an anonymous, electronic survey.
Qualified physiotherapists working in UK NHS paediatric intensive care units (PICUs).
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.
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.
胸部物理治疗是机械通气儿童的一种治疗选择。然而，关于其价值缺乏共识，非正式讨论表明实践存在差异。本研究描述了英国机械通气儿童的胸部物理治疗实践，并探讨了与其实施相关的临床决策。
横断面研究，采用匿名电子调查。
在英国国民保健服务体系儿科重症监护病房（PICUs）工作的合格物理治疗师。
回复率为61%（72/118），其中包括来自26/27（96%）个PICUs的物理治疗师。所有参与者均报告“总是”或“经常”使用手法过度通气和体位改变。某些技术，包括Metaneb®和叩击，实践中存在明显差异。脱氧核糖核酸酶（DNase，99%，71/72）和高渗盐水（90%，65/72）是最常用的黏液促排剂：91%（59/65）的物理治疗师报告仅雾化高渗盐水，69%（49/71）同时使用雾化和滴注DNase。N-乙酰半胱氨酸的使用和给药方式不一致（仅雾化55%，26/47；仅滴注15%，7/47；两者都用30%，14/47）。胸部物理治疗最常由护士协助进行（67%，48/72）。物理治疗师之间的临床决策过程具有可比性，包括三个主要要素：个体患者评估、多学科团队参与以及风险与效益分析。
一系列胸部物理治疗方法和辅助手段用于机械通气儿童。差异明显，可能是由于培训人员的个人偏好或当地政策所致。需要进行务实的干预性研究以确定最佳实践。有必要进一步探索以了解实践差异和决策的复杂性。
