Incidence of adverse physiological changes in intensive care – a multi-centre audit
There has been some concern in the literature as to whether physiotherapy causes adverse physiological changes (APC) that could be harmful to intensive care patients. A multicentre audit was performed to: investigate the incidence of APC during physiotherapy in critically ill patients over a three-month period; benchmark this against studies which have recorded spontaneous APC; and to investigate whether there were any trends in patient category, demographic characteristics, type of intervention, or seniority of physiotherapist. There were 12 800 physiotherapy treatments completed with 29 treatments resulting in adverse physiological changes (0.22%). This incidence was significantly lower than a previous study of APC (663 events/247 patients over a 24-hour period), that is, the incidence during physiotherapy was lower than during general ICU care. Significant trends in the 29 patients who had an APC during physiotherapy were apparent, with a deterioration in cardiovascular status the major APC noted (i.e. decrease in blood pressure or arrhythmia) in patients on medium to high doses of inotropes/vasopressors, having unstable baseline hemodynamic values, previous cardiac co-morbidities, receiving intervention consisting of positive pressure, and/or with junior physiotherapists completing the intervention. Combinations of incidents in these 29 patients demonstrated that a decrease in blood pressure commonly occurred if a patient on inotropes with unstable baseline values was either turned to right side lying (2 sided Fishers exact test, p = 0.006) or received positive pressure (2-sided Fishers exact test, p = 0.07). This audit has demonstrated that the overwhelming majority of physiotherapy treatments in intensive care are safe.
Zeppos, L., Paratz, J., Adsett, J., Berney, S., Bridson, J., & Patman, S. (2006). Incidence of adverse physiological changes in intensive care – a multi-centre audit. Australian Journal of Physiotherapy, 52(1), S35.
Zeppos, L., Paratz, J., Adsett, J., Berney, S., Bridson, J., & Patman, S. (2005). Incidence of adverse physiological changes in intensive care – a multi-centre audit. Paper presented at the Australian Physiotherapy Association 9th National Cardiothoracic Group Conference. Melbourne, VIC, 13-15 October, 2005.