The use of non-invasive ventilation (NIV) as an adjunct to physiotherapy in the treatment of the acute tetraplegic patient – preliminary results
This randomised clinical trial investigated if out-of-hours physiotherapy using intermittent non-invasive ventilation (NIV) is more beneficial than traditional intermittent positive pressure breathing (IPPB) in maintenance of lung function and prevention of nosocomial pneumonia (NP) in acute tetraplegics, and explored if continuous nocturnal NIV is a viable and effective alternative to intermittent IPPB or NIV. Patients admitted with acute tetraplegia (involving spinal levels from C5 to T1) were eligible for inclusion. Patients requiring prolonged invasive mechanical ventilation or who had significant head injury requiring neurosurgical involvement were excluded. Randomisation was to: Group 1 receiving historical standard physiotherapy care using IPPB; Group 2 receiving standard physiotherapy but using intermittent NIV as a substitute for IPPB; or Group 3 receiving continuous nocturnal NIV. Ethical constraints prevented the use of a control group. Dependent variables were vital capacity (VC), arterial to inspired oxygen ratio (PaO2/FiO2), NP incidence, length of stay at the acute facility, and utilisation of out-of-hours physiotherapy service. Groups were similar with respect to demographic variables. One-way analysis of variance and chi squared tests performed on the dependent variables of 21 subjects (Group 1 = 7, Group 2 = 8), with an intention-to-treat philosophy, found no significant differences with daily PaO2/FiO2, NP incidence, length of ICU stay (p = 0.403), or out-of-hours physiotherapy requirements. Significant differences with length of acute facility stay [502.2 hours (363.5) vs 163.3 (116.0) vs 228.6 (183.3); p = 0.046], VC on Day 2 [1.30l (0.24) vs 1.58 (0.32) vs 0.85 (0.53); p = 0.021] and Day 3 only [1.01l (0.29) vs 1.60 (0.35) vs 0.88 (0.36); p = 0.009] were evident but the clinical significance of this is unclear.
Patman, S., & Cooling, C. (2003). The use of non-invasive ventilation (NIV) as an adjunct to physiotherapy in the treatment of the acute tetraplegic patient – preliminary results. Australian Journal of Physiotherapy, 49(3), 11.
Patman, S., & Cooling, C. (2003). The use of non-invasive ventilation (NIV) as an adjunct to physiotherapy in the treatment of the acute tetraplegic patient – preliminary results. Paper presented at the Australian Physiotherapy Association 8th National Cardiothoracic Group Conference. Brisbane, QLD, 4-6 September, 2003.