Respiratory physiotherapy in intensive care: A survey investigating respiratory physiotherapy interventions for mechanically ventilated patients in the intensive care unit

Abstract

Background

Physiotherapists play a key role in respiratory care for mechanically ventilated (MV) patients. Despite this, there is limited understanding of which interventions are commonly utilised to treat respiratory compromise in this cohort or what key barriers exist to their implementation.

Aims

The aim of this study was to identify preferred respiratory physiotherapy treatments for MV patients across Australian intensive care units (ICUs) and comprehend key barriers to their application.

Methods

A survey was sent to 145 of the 183 identified Australian ICUs listed in the Australian and New Zealand Intensive Care Society’s Centre for Outcome and Resource Evaluation report. The survey encompassed demographic details, queried the frequency of use for six interventions (using a Likert scale from “often” to “never”), and explored treatment indications, methods, and barriers through multiple-choice responses. Results were presented as proportions (counts and percentages) and relative frequencies (RFs). Group differences were assessed using chi-squared tests, with a p value <0.05 indicating significance.

Results

Of the 69 responses (48% response rate), most were from level 3 (67%, n = 46/69) public (83%, n = 57/69) ICUs, with <2.0 full-time equivalent physiotherapy staffing (49%, n = 34/69) for 5–15 beds (44%, n = 30/69). Manual techniques (e.g., percussions and vibrations) were the most common respiratory physiotherapy treatments, with 54% of respondents using them “often”, while intrapulmonary percussive ventilation was the least common, used “never” by 83%. Variation was noted in the application of hyperinflation. Calculation of maximal inspiratory pressure before completing inspiratory muscle training was common (74%). Overall, clinician competence (RF = 28%), confidence (RF = 21%), and access to clinical guidelines (RF = 20%) were the main barriers to implementing techniques, with barriers generally more prevalent among respondents from smaller, private, level 1 and 2 ICUs.

Discussion

While physiotherapists prioritise respiratory treatments for MV patients, significant variability exists in practice. This survey highlights the need for standardised guidelines, enhanced educational resources, and the requirement to support colleagues in smaller and private ICUs to ensure consistent, effective management of MV patients throughout Australian ICUs.