What does respiratory physiotherapy look like for patients requiring prolonged mechanical ventilation in Australia? A prospective multicentre audit of practice

BACKGROUND: Physiotherapists play a crucial role within the healthcare team in intensive care units (ICUs), with increasing evidence supporting the impact of physiotherapy interventions in enhancing the recovery of patients experiencing prolonged mechanical ventilation (MV). Despite this, there is limited evidence available for whether this evidence has translated into usual respiratory physiotherapy practice in this patient group. In this context, a comprehensive understanding of contemporary usual care respiratory physiotherapy for ventilator-dependent patients is necessary. OBJECTIVES: The aim of this study was to describe usual care respiratory physiotherapy practice in ICU patients who have received prolonged MV (>4 days). METHODS: A prospective observational study of respiratory physiotherapy was conducted across 22 Australian ICUs in six jurisdictions from day 5 of MV for 6 weeks or until discharge from acute physiotherapy, whichever occurred first. RESULTS: In total, 288 patients across 22 hospitals received 10 551 interventions during the audit period. The most frequently delivered interventions in the ICU were suctioning (1892, 23% of ICU interventions), mobilisation (1854, 22%), and manual techniques (percussion/vibration) (834, 10%). After ICU discharge to the ward, the most frequently delivered interventions were mobilisation (1166, 53%), deep breathing (190, 9%), and education (186, 8%). These findings were broadly consistent across most regions. Some interventions with limited supporting evidence (e.g. incentive spirometry, 2%) were delivered more frequently than interventions with stronger evidence (e.g., inspiratory muscle training, 1%). CONCLUSION: This study describes the broad range of respiratory physiotherapy interventions most frequently delivered in patients receiving prolonged MV in the ICU, with consistency across most regions. Findings support the idea that a "usual care" definition can be applied broadly across Australian ICUs, but this "usual care" appears to lag behind current evidence for some interventions, including inspiratory muscle training and incentive spirometry.