Pinto-Concha J.J.1,2, Aranis N.1, Leppe J.1, Molina J.1, Castro-Avila A.1,3, Fu C.4, Merino-Osorio C.1
1Universidad del Desarrollo, School of Physical Therapy, Santiago, Chile, 2Centro de Paciente Crítico Clínica INDISA, Kinesiología Intensiva y Terapia Respiratoria, Santiago, Chile, 3University of York, Department of Health Sciences, York, United Kingdom, 4Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil
Background: Only 4% of all patients who underwent physical therapy intervention (PT) in the adult intensive care unit (ICU), have reported adverse events associated with its execution. An international consensus on established safety criteria has been used to define PT success. In Chile, the use of such recommendations within the clinical practice is still unknown. Knowledge on how physiotherapists consider such criteria in ICU will allow the promotion of PT strategies that may enhance the quality of care of these patients.
Purpose: The safety of ICU patients requires an accurate decision-making selection during PT. The aim of this study was to describe which factors are considered by physiotherapists when starting, progressing, monitoring and ending PT of adult patients in ICU.
Methods: A cross-sectional study was conducted, where a telephone-based survey was used to collect data from physiotherapists of a Chilean Public Adult-ICU. Respondents were requested to report through a Likert scale, how frequently they considerate the use of the following factors: a) clinical: oxygen saturation (SaO2), heart-rate (HR), respiratory-rate (RR), blood-pressure (BP), spontaneous-breathing, level-of-ventilatory-support, BORG-Scale, pain, dizziness perception, presence of patients perspiration and level-of-anxiety; b) clinical staff: assistance-required-to-move, staff-availability; c) medical prescription; and d) clinical reasoning (CR). Respondents were asked to report if they routinely considered these factors at four different PT stages: at the interventions beginning, progression, monitoring and ending. The STATA 13.0 software was used for statistical analysis.
Results: Nineteen Adult-ICU were included in this study. Clinical reasoning was considered in all stages of PT decision-making by 100% of respondents. Other criteria always considered were BP (84%), HR and pain (79%) at starting-; BP (84%), HR (79%), level-of-anxiety and pain (74%) at progressing-; HR (89%), BP (84%), as well as SaO2 and pain with 79% at monitoring-PT. Finally, the main criteria used at the ending-PT stage included HR and BP (95%), pain (84%), and level-of-anxiety (79%). The main criteria never considered by physiotherapists at starting- were: spontaneous-breathing (26%), staff-availability (21%) and SaO2 (16%); medical prescription and staff-availability (16%) at progressing-; staff-availability (37%) and medical prescription (26%) at monitoring-PT. To progress- and monitoring-PT, the criteria level-of-ventilatory-support, spontaneous-breathing and BORG-Scale were never used as reported by 11% of respondents. Staff-availability (26%), spontaneous-breathing (21%) and medical prescription (16%) were reported as never used by the respondents.
Conclusion(s): Clinical Reasoning, HR, BP and pain were always considered in all PT stages with a high frequency of use. All respondents considered CR as a key factor in all stages of PT decision-making. Physiotherapists reported as never used the spontaneous-breathing and staff-availability as criteria in any PT stage. All factors used by physiotherapists in Chile, are included in the international consensus of safety criteria for PT in ICU settings. Future studies should identify the frequency of use of such factors within particular and specific patient contexts.
Implications: Safety during PT care in critically ill patients decreases the frequency of adverse events, therefore optimizing the quality and time for recovery. Physiotherapists adherence to the existing consensus criteria of safety will enhance the positioning of interventional teams in Chilean ICUs.
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.
