Immediate effects and outcomes of respiratory physical therapy on critically ill patients in Kenyatta National Hospital intensive care unit.

Abstract

Background Respiratory physical therapy is an integral treatment intervention and is part of the multidisciplinary approach to the management of critically ill patients in intensive care units all over the world. It is prescribed by medical practitioners, and performed by attendant physiotherapists and nurses. Different techniques - their indications and benefits - have been described in literature. This treatment has adverse effects, therefore, careful assessment and monitoring is recommended to ensure safety. Study Question What were the immediate effects and outcomes of respiratory physical therapy treatment on critically ill patients in KNH ICUs? Study Objectives The main objective of this study was to describe the effects and outcomes of respiratory physical therapy on critically ill patients admitted to KNH ICUs. Methodology This was a prospective observational study, carried out at the KNH main intensive care units. It included critically ill endo-tracheally intubated patients undergoing respiratory physiotherapy. Written consent was sought from the next of kin of the recruited patients. 74 patients were studied. Results 78.4% of the study subjects were male. Tracheal suctioning was the most common treatment modality applied, followed by vibrations and compressions. 16.2% of the patients received manual hyperinflation and only one patient received ventilator hyperinflation. 71.6% of the patients were sedated. There was an increase in blood pressure (SBP, DBP, and MAP) and heart rate from the baseline immediately after treatment. These changes were not statistically or clinically significant. There was slight elevation of respiratory rates and the tidal volumes immediately after treatment; and at 5, 10 and 15 minutes. The pain scores increased significantly immediately following treatment and declined with time up to 15 minutes. Conclusion. Multimodal respiratory physiotherapy was applied to critically ill patients and it was not associated with significant adverse physiological events. Pain was associated with respiratory physiotherapy and it was undertreated.