Differences in delivery of respiratory treatments by on-call physiotherapists in mechanically ventilated children: a randomised crossover trial.
OBJECTIVE
To investigate differences, if any, in the delivery of respiratory treatments to mechanically ventilated children between non-respiratory on-call physiotherapists and specialist respiratory physiotherapists.


METHODS
Paediatric, tertiary care hospital in the United Kingdom.


METHODS
93 children (aged between 3 days and 16 years), and 22 physiotherapists (10 specialist respiratory physiotherapists) were recruited to the study.


METHODS
Recruited children received two physiotherapy treatments during a single day, one delivered by a non-respiratory physiotherapist, the other by a specialist respiratory physiotherapist in a randomised order. Selection, delivery and effects of techniques were recorded for each treatment.


METHODS
Primary outcomes were selection and application of treatment components. Secondary outcomes included respiratory effects (in terms of changes in flow, volume and pressure) of selected treatment components.


RESULTS
Both non-respiratory on-call physiotherapists and specialist respiratory physiotherapists used combinations of saline instillation, manual lung inflations, chest wall vibrations and endotracheal suction during treatments. However specialist respiratory physiotherapists used combinations of chest wall vibrations with suction, and recruitment manoeuvres, significantly more frequently than non-respiratory on-call physiotherapists (92% vs 52%, and 87% vs 46% of treatments respectively, P<0.001). Chest wall vibrations delivered by non-respiratory on-call physiotherapists were 15% less effective at increasing peak expiratory flow.


CONCLUSIONS
Clinically important differences between non-respiratory and specialist respiratory physiotherapists' treatment outcomes may be related to differences in the selection and application of techniques. This suggests an important training need for non-respiratory on-call physiotherapists, particularly in the effective delivery of physiotherapy techniques.


BACKGROUND
Clinicaltrials.gov NCT01999426.
Physiotherapy Section in Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK. Electronic address: h.shannon@ucl.ac.uk.
Harriet
H
Shannon
Respiratory, Critical Care and Anaesthesia Section in Infection, Immunity, Inflammation and Physiological Medicine, University College London Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
Janet
J
Stocks
Respiratory, Critical Care and Anaesthesia Section in Infection, Immunity, Inflammation and Physiological Medicine, University College London Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom; Physiotherapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
Rachael K
RK
Gregson
Physiotherapy Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
Sarah
S
Hines
Respiratory, Critical Care and Anaesthesia Section in Infection, Immunity, Inflammation and Physiological Medicine, University College London Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom; Intensive Care Department, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London WC1N 3JH, United Kingdom.
Mark J
MJ
Peters
Physiotherapy Section in Infection, Immunity, Inflammation and Physiological Medicine, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK.
Eleanor
E
Main
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D059825:Physical Therapists; D012121:Respiration, Artificial / Q000379:methods* / Q000592:standards*; D006113:United Kingdom
Acute respiratory; After-hours care; Paediatric intensive care units; Physiotherapy specialty