Shkurka, Emma;
Wray, Jo;
Peters, Mark;
Shannon, Harriet;
(2023)
Chest physiotherapy for mechanically ventilated children: a survey of current UK practice.
Physiotherapy
, 119
pp. 17-25.
10.1016/j.physio.2022.11.004.
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Abstract
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.
| Type: | Article |
|---|---|
| Title: | Chest physiotherapy for mechanically ventilated children: a survey of current UK practice |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.physio.2022.11.004 |
| Publisher version: | https://doi.org/10.1016/j.physio.2022.11.004 |
| Language: | English |
| Additional information: | © 2022 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
| Keywords: | Infant/child, respiration artificial, physical therapy modalities, lung, respiratory therapy |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10159911 |
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