Physiotherapy contributions to weaning and extubation of patients from mechanical ventilation

Abstract

Background. Liberation of patients from mechanical ventilation (MV) is an important goal of patient care, to avoid the complications and risks associated with prolonged MV. Objective. To determine the extent of South African physiotherapists' involvement in weaning and extubation of patients from MV and whether current practice is evidence based. Method. A survey questionnaire was developed, and content validated and made available electronically and in hard copy. Physiotherapists working in adult intensive care units in public and private sector hospitals in South Africa (SA) were identified and invited to participate. Results. Response rate was 43% (n=184). The majority of respondents (n=135, 73%) 'never' or 'seldom' got involved in decision-making to wean patients from MV; a minority (n=8, 4%) were 'routinely' involved in decision-making. Some respondents (n=54, 29%) performed extubation 'often' or 'routinely'. The majority used exercises (n=149, 81%), early mobilisation out of bed (n=142, 77%) and deep breathing exercises (DBEs) (n=142, 77%) 'routinely' to aid in respiratory muscle training. The majority of respondents 'never' adjusted ventilator settings other than fraction of inspired oxygen. No association was found between type of physiotherapy degree respondents held and their involvement in weaning (p=0.24). Conclusion. SA physiotherapists' contributions towards weaning of patients from MV through prescription of exercise therapy, early outof-bed mobilisation and DBEs is evidence based. Involvement in adjustment of MV settings, decision-making regarding patient weaning, development of weaning protocols for their units and extubation is limited.