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Castro Avila A.C.1,2, Aranis N.1, Pinto J.J.1, Leppe J.1, Molina J.1, Merino-Osorio C.1
1Universidad del Desarrollo, School of Physical Therapy, Santiago, Chile, 2University of York, Department of Health Sciences, York, United Kingdom
Background: Several systematic reviews, as well as international consensus, recommend the use of early mobilisation during ICU stay in order to improve functional status of patients. Results from a pilot study performed in three ICUs in Santiago, Chile, showed that chest physiotherapy interventions were the most common therapeutic strategy, despite conflicting evidence on its benefits. Information at national level can shed light on regional patterns and areas for improvement.
Purpose: To determine therapeutic strategies used by Physiotherapists (PTs) and reasons for not using therapeutic strategies in Public ICUs in Chile.
Methods: Cross-sectional, telephone-based survey of PTs from Adult ICUs belonging to the Chilean National Health System (i.e. FONASA). Data were collected from chief PT on characteristics of the unit (i.e. region, complexity, number of beds, and number, working scheme and years of experience of PTs), duration of sessions, proportion of patients receiving procedures and reasons for not performing certain procedures. Data is presented in absolute and relative frequency or median (min-max). Analyses were carried out in STATA SE 14.0
Results: 19 ICUs across 8 regions were surveyed representing 35.8% of public ICUs in Chile. Median (min-max) number of PTs per unit was 6 (1-13), per shift was 2 (1-4), which translates into 6 (2.5-12) patients per PT during business hours and 8 (4-33) during weekends and night shifts. During night shifts, the most commonly reported procedures (expressed as proportion of patients in the unit receiving the procedure) were mucus clearance techniques (75%), breathing exercises (66%), mechanical ventilator parameters adjustment (60%) and oxygen therapy (50%). In contrast, during day shifts, PTs report to perform breathing exercises (100%), passive range of motion [ROM] (100%), mucus clearance techniques (100%), active ROM (66%), ROM against resistance (60%), and transfers in bed (55%). No differences were found across regions. Electrical stimulation, cycle ergometer, steps, and external weights were not used in ICU in 13 (68%) centres. Lack of equipment (69%) and severity of patients (31%) were the most common reasons for not using them.
Conclusion(s): Therapeutic strategies used by PTs in Chilean ICUs surveyed rely heavily on chest physiotherapy and respiratory therapy interventions, especially during night shifts. Higher functional activities are not commonly performed, which could be explained by PTs perception about patients severity. Future research should focus on obstacles to the implementation of early mobilisation strategies in these ICUs and assess what could be done to facilitate greater use.
Implications: Careful consideration should be given to the balance between traditional PT roles (i.e. recovery of physical function) and roles associated with respiratory therapy given the current evidence on beneficial interventions in the intensive care setting. Efforts should focus on increasing the use of active forms of mobilisation in ICU.
Funding acknowledgements: None
Topic: Critical care
Ethics approval: Approved by the Ethics Research Committee of the Faculty of Medicine at the Universidad del Desarrollo-Clínica Alemana, Chile.
All authors, affiliations and abstracts have been published as submitted.
