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

Finally, 82 patients (93.2%) were able to complete the treatment (58:24, males vs. females; age 69.4 ± 10.7 years; BMI 22.1 ± 1.4 kg/m²; APACHE II 16.24 ± 3.52). Eleven patients had pneumonia without comorbidities and 71 with comorbidities, including coronary heart disease (n = 18), hypertension (n = 43), diabetes (n = 22), cerebrovascular events (n = 29), malignant tumors (n = 12) and renal insufficiency (n = 3). Patients were satisfied with the EIT-guided CPT program (satisfaction score 23.82 ± 0.98 out of 30 points). Significant improvement in ventilation distribution was observed in all patients after the entire EIT-guided CPT program (p < 0.01). The program required additional planning and implementation time of 5-10 min. One trained physiotherapist was required to interpret the EIT results and adjust the therapy program accordingly. The training time for an EIT-inexperienced physiotherapist was half-day. Two physiotherapists participated in the study and found that EIT results were helpful and provided accurate and solid evidence to guide CPT.

To our best knowledge, the pilot study demonstrated systematically for the first time the feasibility of a bedside feedback method to guide CPT in patients with airway secretion retention and clearance impairment. Most of the patients were able to complete the CPT program. They were motivated and satisfied with the treatment via the real-time visual feedback.

The most important step of the program is to understand the cause of current respiratory status. The spatial and temporal ventilation distribution of the patients is often heterogeneous. After starting the EIT measurement, poorly ventilated areas are identified through the ventilation distribution (e.g., defect score [5]). The potential causes of poorly ventilated areas are discussed with the physicians combining other clinical evidence. The CPT program is designed or adjusted accordingly. Meanwhile, images are also used to illustrate changes in lung ventilation to inspire the patients.

The study has a few limitations. This was a single-center study. Patients who were unconscious and unable to complete the satisfaction assessment were not included. Experience with EIT-guided CPT is limited and could vary among physiotherapists. Since the study objective was to introduce the methodology and examine the feasibility, only a retrospective control group was included. The effectiveness of the therapy should be verified by comparing with traditional CPT in a randomized-controlled setting. Nevertheless, based on our internal statistic for previous years, the patient dropout rate of CPT program was 11.0% which was much higher than 6.8% in the present study.

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