Authors (including presenting author) :
Lo KC, Lam HW, Chiu TY, Tang NC, So YT
Affiliation :
Physiotherapy department, Caritas Medical Centre
Introduction :
Designated ventilator beds are limited and could not cope with the service demand for patients who need invasive / non-invasive ventilation. A multi-disciplinary respiratory team including respiratory specialist, nurses and physiotherapists was formed in early 2023 to cover and provide holistic care for ventilator patients (both invasive (IMV) and non-invasive (NIV)) whom is outside designated ventilator beds.
Patients who need mechanical ventilations are triaged into three categories
Category I: good premorbid, good potential for recovery
Category II: fair premorbid, intermediate potential for recovery
Category III: poor premorbid, lower potential for recovery
For category I and II patients
B.D chest physiotherapy, weaning support and early mobilization once condition stable would be provided.
For category III patients
Essential chest physiotherapy, +/- BD chest physiotherapy and maintenance physiotherapy to prevent complication of bed rest would be provided.
Weekly multi-disciplinary ward round was introduced to discuss the care plan of each patient under the program.
Objectives :
1. Improve standard of care for patients on invasive / non-invasive mechanical ventilation.
2. Enhance the communication within the team on patient’s management.
3. Enhance the scope and intensity of PT support for NIV/IMV patients
Methodology :
For the purpose of service review, data were collected from Oct, 2023 to Jan, 2024.
Additionally, for patients who finally independent from mechanical ventilation and follow command, modified functional ambulatory category (MFAC) and hand grip strength were recorded for analysis.
Result & Outcome :
Total 105 (35 female and 70 male) patients were under the program in the review period. Mean age was 78.15±11.6.
Category 1 patient 36%
Category 2 patient 31%
Category 3 patient 33%
A total 986 times BD treatment sessions were provided in weekdays during the 4 months.
17 have been transferred to rehab ward for further training
Mean hand grip strength improved from:
Left hand 13.66 kg to 14.38 kg
Right hand 14.38 kg to 16.09 kg
Although the results have not yet reached statistical significance, a trend of improvement has been shown. It is believed that as sample size increases, a more significant difference could be found.
Upon discharge 72% of the category 1 and 2 patients were able to walk with or without assistance +/- walking aids (MFAC ≥3)
Deconditioning is very common after recovering from life threatening situations in patients who need mechanical ventilation. Advanced age is another risk factor contributing to deterioration in mobility. Therefore, post discharge reconditioning plans for patients with rehabilitation potential are suggested in weekly case rounds to facilitate further training in outpatient or community settings.
