Authors (including presenting author) :
Yeung YY(1), Yip SC(1), Chan HL(1), Liu YM(1), Leung YY(1), Yeung YC(2), Mak KM(2)
Affiliation :
(1)Physiotherapy Department, Princess Margaret Hospital (2)Department of Medicine and Geriatrics, Princess Margaret Hospital
Introduction :
Since October 2020, Mobile Ventilator Team Program (Program) comprising Respiratory Specialists, Physiotherapists and Specialty Nurses was established, aiming at providing high standard of care for patients requiring mechanical ventilation to optimize weaning support across medical wards. Patients are triaged by Respiratory Specialists into 3 categories: Cat1/2 as targeted with better treatment response for weaning. Nurses are responsible for join visits with physicians and program coordination. Enhanced Physiotherapy service include additional treatment sessions of daily chest physiotherapy in weekdays and continuous chest physiotherapy in non-weekdays.
Objectives :
(1)To enhance chest conditions through b.d. chest physiotherapy (2)To provide prompt weaning support via daily communication (3)To optimise mobility status via early mobilization (4)To formulate care plan via case conference.
Methodology :
Program was compared with Baseline study for patient categorization and IMV:NIV ratio. Ventilator dependent days reflect weaning outcome. For physical ability, MFAC and handgrip were compared at ventilation start and off day using paired t-test.
Result & Outcome :
From Oct-Dec 2020, 96 patients received physiotherapy in Program with mean age 74.2 (range 32-101), 60 males and 36 females, 76 Cat1/2 and 20 Cat3. Among Cat1/2, IMV:NIV was 46:30. In Baseline from Dec-Jan 2019, 158 patients received ventilation support were reviewed with 97 Cat1/2 and 61 Cat3. Among Cat1/2, IMV:NIV was 30:67. 858 physiotherapy attendance were completed in Program. All 76(100%) Cat1/2 patients received b.d. chest physio and early mobilization in weekdays and 35(46%) patients received holiday chest physiotherapy. 70(92%) patients started mobilization at Day1.9 in average. 33(43%) patients received mobility training and 14(18%) had walking exercise. 13 conferences were conducted. In Baseline, regular physio was provided. Averaged ventilator days for Cat1/2 IMV was slightly better in Program as 10 (range 1-69) compared with 11 (range 2-32) in Baseline. For Cat1/2 NIV, ventilator days were 6 days (range < 1-13) in Program, better than 8 (range 1-21) in Baseline. For Program, MFAC of Cat1/2 significantly increased from 1.2±0.5 to 1.8±1.3 (t=3.96, p< 0.01). IMV significantly improved from 1.0±0.2 to 1.6±1.3 (t=2.56, p< 0.05), while NIV from 1.4±0.7 to 2.2±1.3 (t=3.30, p< 0.01). For handgrip, Cat1/2 patients who can perform grip at the day of on and off ventilation (n=56 left or right hands) had significant improvement from 10.6±9.0kg to 11.9±8.9kg (t=2.44, p< 0.05). To conclude, improvement in ventilators days and physical outcomes were shown. Length of stay can be further analyzed in future.
