Bronwen Connolly1, Matthew Barclay2, Bronagh Blackwood3, Judy Bradley3, Rohan Anand3, Mark Borthwick4, Marc Chikhani5, Paul Dark6, Murali Shyamsundar3, John Warburton7, Daniel F McAuley3, Brenda O'Neill8. 1. Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK; Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK; Department of Physiotherapy, The University of Melbourne, Australia. Electronic address: b.connolly@qub.ac.uk. 2. Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St. Thomas' NHS Foundation Trust, London, UK. 3. Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK. 4. John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 5. Nottingham University Hospitals NHS Trust, Nottingham, UK; Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK. 6. Division of Infection, Immunity and Respiratory Medicine, NIHR Biomedical Research Centre, Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK. 7. Bristol Royal Infirmary, University Hospitals Bristol NHS Foundation Trust, Bristol, UK. 8. Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK. Electronic address: https://twitter.com/@OneillBon.
Abstract
OBJECTIVES: To explore and describe current UK physiotherapy practice relating to airway clearance techniques and mucoactive agents in critically ill adult patients with acute respiratory failure in the intensive care unit. DESIGN: A descriptive, qualitative study using focus group interviews. Focus groups were audio-recorded, independently transcribed, and data analysed thematically. Participants Senior, experienced physiotherapists, clinically active in critical care. RESULTS: Fifteen physiotherapists participated in four interview sessions. Five themes emerged describing airway clearance techniques: 'Repertoire of airway clearance techniques', 'Staffing and skillset', 'Commencing respiratory physiotherapy', 'Technique selection', and 'Determining effectiveness' were themes related to airway clearance techniques. Five themes were also identified in relation to mucoactive agents: 'Use in clinical practice', 'Decision to commence', 'Selection of agent', 'Stopping mucoactive agents', and 'Determining effectiveness'. A summary of key features of standard practice was developed. CONCLUSIONS: Standard UK physiotherapy practice of airway clearance techniques is variable, but patient-centred and targeted to individual need, with adjunctive use of mucoactive agents to enhance and optimise patient management if required. Based on this study, key features of airway clearance techniques have been summarised to help capture standard care, which could be used in future trials involving ACT as part of usual care.
OBJECTIVES: To explore and describe current UK physiotherapy practice relating to airway clearance techniques and mucoactive agents in critically ill adult patients with acute respiratory failure in the intensive care unit. DESIGN: A descriptive, qualitative study using focus group interviews. Focus groups were audio-recorded, independently transcribed, and data analysed thematically. Participants Senior, experienced physiotherapists, clinically active in critical care. RESULTS: Fifteen physiotherapists participated in four interview sessions. Five themes emerged describing airway clearance techniques: 'Repertoire of airway clearance techniques', 'Staffing and skillset', 'Commencing respiratory physiotherapy', 'Technique selection', and 'Determining effectiveness' were themes related to airway clearance techniques. Five themes were also identified in relation to mucoactive agents: 'Use in clinical practice', 'Decision to commence', 'Selection of agent', 'Stopping mucoactive agents', and 'Determining effectiveness'. A summary of key features of standard practice was developed. CONCLUSIONS: Standard UK physiotherapy practice of airway clearance techniques is variable, but patient-centred and targeted to individual need, with adjunctive use of mucoactive agents to enhance and optimise patient management if required. Based on this study, key features of airway clearance techniques have been summarised to help capture standard care, which could be used in future trials involving ACT as part of usual care.
Authors: Chloe Apps; Kelly Morris; Laura Allum; Neeraj Shah; Laura Mylott; Isobel Hinton; Danielle Spencer; Rachel Farley; Hannah Mitchell; Leyla Osman Journal: Physiother Res Int Date: 2022-06-18