Respiratory physiotherapy in the acute tetraplegic patient - is the use of non-invasive ventilation (NIV) a useful adjunct?
This prospective randomised clinical trial aimed to establish if out-of-hours physiotherapy using intermittent non-invasive ventilation 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 explore if continuous nocturnal NIV is a viable and effective alternative to intermittent IPPB or NIV. Patients admitted with acute tetraplegia (involving from C5 to T1) were eligible for inclusion. Patients requiring prolonged invasive mechanical ventilation or with significant head injury requiring neurosurgical involvement were excluded. Randomisation of 23 subjects (17 male, mean age 36.8 yrs, SD17.4) was to either Group 1 (n = 6) receiving standard historical physiotherapy care using IPPB, Group 2 (n = 10) receiving standard physiotherapy but substituting intermittent NIV 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 demographic variables. One-way analysis of variance and Chi Square tests performed, with an intention to treat philosophy, unearthed no significant differences with daily PaO2/FiO2, NP incidence, length of ICU stay (p = 0.24), or out-of-hours physiotherapy requirements. Significant differences with mean length of acute facility stay [502.2 hrs (SD 363.5) vs 163.3 (116.0) vs 220.6 (165.1); p = 0.036], VC on day 2 [1.30l (0.24) vs 1.50 (0.37) vs 0.86 (0.46); p = 0.026] and day 3 [0.90l (0.37) vs 1.53 (0.37) vs 0.91 (0.28); p = 0.005] were apparent, the clinical significance of which is unclear.
Patman, S., & Cooling, C. (2004). Respiratory physiotherapy in the acute tetraplegic patient - is the use of non-invasive ventilation (NIV) a useful adjunct? Australian Journal of Physiotherapy, 50(3), 110.
Patman, S., & Cooling, C. (2004). Respiratory physiotherapy in the acute tetraplegic patient - is the use of non-invasive ventilation (NIV) a useful adjunct? Paper presented at the Australian Physiotherapy Association 8th International Physiotherapy Congress. Adelaide, SA, 15-18 May, 2004.