Fizjoterapia klatki piersiowej kierowana elektryczną tomografią impedancyjną u pacjentów oddziału intensywnej terapii z chorobami płuc: wprowadzenie do metodyki i realizacji w praktyce

Patients

The study was conducted in a rehabilitation hospital. In our department (Pulmonary and Critical Care Medicine), patients are critically ill with clinically relatively stable situation but still have single or multisystem organ failure. The current study included patients who have left the ICU but cannot be transferred to the general ward (so-called „high-dependency care units”, HDU patients) (13).

Patients meeting the eligibility criteria described in the previous section were enrolled. The exclusion criteria were 1. viral pneumonia; 2. thoracic spinal deformity; 3. pegnant or lactating women; 4. inability to cooperate with pulmonary rehabilitation; 5. acute exacerbation of chronic obstructive pulmonary disease or acute attack of bronchial asthma. All participants provided written informed consent.

To demonstrate the clinical benefit of the EIT-guided program, patients treated with traditional program (without EIT) from July 1 to December 31, 2019 were retrospectively reviewed as control group. Clinical Pulmonary Infection Score (CPIS), length of stay and cost of hospitalization were evaluated.

Outcome measures and data analysis

The primary outcome was the acceptability of the patients, including the dropout rate and patients’ satisfaction with the treatment. Secondary outcomes included acceptability of physiotherapists, and practicalities of the program (e.g. additional workload, adverse events, preparation time for EIT measurement and physiotherapists’ education). Exploratory outcomes were the difference in CPIS, length of stay and cost between the prospective study group and the retrospective control group. Patient’s satisfaction was assessed by a survey questionnaire administered at the end of the treatment phase. The questionnaire was a 5-point Likert-scaled response satisfaction survey. The questionnaire from the Australian Lung Foundation pulmonary rehabilitation toolkit was adopted and modified (14). The six-item measure asks the participants to rate the effectiveness of the CPT components on a scale of 1 = strongly disagree to 5 = strongly agree (S-Table 1). Cronbach’s alpha of the scale was 0.86. The item regarding physical exercise program was excluded.

Results

A total of 82 patients were included in this treatment, among which 7 were mechanically ventilated, 65 were on high-flow oxygen therapy, and 10 were non-invasive ventilation. Chest x-ray indicated improvement after the treatment in 57 subjects and the findings matched that from EIT measurements. Tidal volume before and after treatment were available for the patients under invasive ventilation (n=7) and the changes were statistically significant (S-Table 2). Respiratory rate and oxygen saturation (SpO₂) at 30% oxygen concentration were recorded for all studied subjects. Statistically significant improvements were found after the treatment. These results are summarized in S-Table 2.

A total 79 patients treated with traditional program were retrospectively reviewed. The differences in CPIS between the study group and the control group were insignificant before (T1) and at the end of the treatment (T4), but they became significant on Day 3 and 7 after the treatment start (T2 and T3; S-Table 3). The patients in both study and control group would only be discharged after the symptoms have been improved. Hence, the CPIS score was similar at T4. Nevertheless, the length of stay was significantly shorter and the cost of hospitalization was significantly lower in the study group (S-Table 4).

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