Secretion clearance strategies in Australian and New Zealand Intensive Care Units

George Ntoumenopoulos; Naomi Hammond; Nicola R Watts; Kelly Thompson; Gabrielle Hanlon; Jennifer D Paratz; Peter Thomas; George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group

doi:10.1016/j.aucc.2017.06.002

Secretion clearance strategies in Australian and New Zealand Intensive Care Units

Aust Crit Care. 2018 Jul;31(4):191-196. doi: 10.1016/j.aucc.2017.06.002. Epub 2017 Jun 27.

Authors

George Ntoumenopoulos¹, Naomi Hammond², Nicola R Watts³, Kelly Thompson⁴, Gabrielle Hanlon⁵, Jennifer D Paratz⁶, Peter Thomas⁷; George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group

Affiliations

¹ St Vincent's Hospital, Sydney, Australia; Discipline of Physiotherapy Graduate School of Health, The University of Technology Sydney, Australia. Electronic address: [email protected].
² Critical Care and Trauma Division, The George Institute for Global Health, Australia; Sydney Medical School, University of Sydney, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Australia.
³ Critical Care and Trauma Division, The George Institute for Global Health, Australia.
⁴ Critical Care and Trauma Division, The George Institute for Global Health, Australia; Sydney Medical School, University of Sydney, Australia.
⁵ Intensive Care, Epworth Hospital Richmond, Australia.
⁶ Menzies Research Institute, Griffith University, Australia; Department of Physiotherapy, Royal Brisbane and Women's Hospital, Australia.
⁷ Department of Physiotherapy, Royal Brisbane and Women's Hospital, Australia.

PMID: 28662942
DOI: 10.1016/j.aucc.2017.06.002

Abstract

Introduction/aims: To describe the processes of care for secretion clearance in adult, intubated and mechanically ventilated patients in Australian and New Zealand Intensive Care Units (ICUs).

Methods/results: A prospective, cross-sectional study was conducted through the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) Point Prevalence Program. Forty-seven ICUs collected data from 230 patients intubated and ventilated on the study day. Secretion clearance techniques beyond standard suctioning were used in 84/230 (37%) of patients during the study period. Chest wall vibration 34/84 (40%), manual lung hyperinflation 24/84 (29%), chest wall percussion 20/84 (24%), postural drainage/patient positioning 17/84 (20%) and other techniques including mobilisation 15/84 (18%), were the most common secretion clearance techniques employed. On average (SD), patients received airway suctioning 8.8 (5.0) times during the 24-h study period. Mucus plugging events were infrequent (2.7%). The additional secretion clearance techniques were provided by physiotherapy staff in 24/47 (51%) ICUs and by both nursing and physiotherapy staff in the remaining 23/47 (49%) ICUs.

Conclusion: One-third of intubated and ventilated patients received additional secretion clearance techniques. Mucus plugging events were infrequent with these additional secretion clearance approaches. Prospective studies must examine additional secretion clearance practices, prevalence of mucus plugging episodes and impact on patient outcomes.

Keywords: Aspiration mechanical; Intensive care; Mechanical ventilation; Physical therapy modalities; Respiration artificial; Sputum.

MeSH terms

Auscultation / methods
Australia
Chest Wall Oscillation / methods
Critical Care / methods
Cross-Sectional Studies
Drainage, Postural / methods
Female
Humans
Intensive Care Units*
Intubation, Intratracheal
Male
Middle Aged
Mucus*
New Zealand
Patient Positioning
Physical Therapy Modalities*
Prospective Studies
Respiration, Artificial
Sputum*
Suction / methods