Publish in this journal
Journal Information
Vol. 46. Issue 6.
Pages 341-345 (June 2022)
Share
Share
Download PDF
More article options
Visits
...
Vol. 46. Issue 6.
Pages 341-345 (June 2022)
Scientific Letter
Full text access
Respiratory physiotherapy in Spanish Pediatric and Neonatal Intensive Care Units
Fisioterapia respiratoria en Unidades de Cuidados Intensivos pediátricas y neonatales españolas
Visits
...
L. Torreiro Diégueza, J.-D. Martíb, S. Souto Cambac,d, L. González Donizc,d, A. López Garcíac,d, A. Lista-Pazc,d,
Corresponding author
ana.lista@udc.es

Corresponding author.
a Asociación de Personas con Lesión Medular y Otras Discapacidades Físicas de Galicia (ASPAYM Galicia), A Coruña, Spain
b UCI de cirugía cardiovascular, Instituto Clínico Cardiovascular (ICCV), Hospital Clinic, Barcelona, Spain
c Facultad de Fisioterapia de la Universidade da Coruña. Campus Universitario de Oza, A Coruña, Spain
d Grupo de investigación en Intervención Psicosocial y Rehabilitación Funcional. Universidade da Coruña, Campus Universitario de Oza, A Coruña, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Additional material (1)
Full Text
Dear Editor,

Patients admitted to the Pediatric Intensive Care Unit (PICU) or Neonatal Intensive Care Unit (NICU) often suffer respiratory complications1 and could benefit from respiratory physiotherapy (RP) techniques that can shorten hospital stay.2 While the international literature has addressed the role of physiotherapy in PICUs/NICUs,3,4 no such studies have been published in Spain to date. The present study analyzes the situation of RP in Spanish PICUs/NICUs.

An internal validation was carried out involving 6 experts in RP and with training in Intensive Care and Pediatrics, in order to assess the suitability of form and contents. Following due approval from the Teaching and Research Ethics Committee of the University of A Coruña (CEID-UDC-2018-0019), in September 2019 an electronic survey was sent to the 45 Spanish PICUs/NICUs of the registry of the Spanish Society of Pediatric Intensive Care (Sociedad Española de Cuidados Intensivos Pediátricos),5 addressed to the Physiotherapy coordinator at each center. A period of 6 months was allowed for receiving the reply, with a total of three reminders if needed.

A total of 24 hospitals answered the survey (53.3%): 22 public centers (91.7%) and two private centers (8.3%), with 26.1 ± 17.4 staff physiotherapists, of which two (1–3) were in charge of the service in the PICU/NICU (Table 1). The mean number of beds was 19.3 ± 12.9 (range 5–50), with a physiotherapist / bed ratio of 1/8. The implementation of physiotherapy was dependent upon referral by the Department of Rehabilitation or the specialist in Intensive Care in 16 (66.7%) and four (16.7%) hospitals, respectively. In another four centers (16.7%), RP consultation was directly requested from any specialized physician or – in the case of consultation for motor physiotherapy – from the Department of Rehabilitation. Twenty answers were obtained regarding the percentage of children that received physiotherapy; specifically, 37.1 ± 32.1% of the patients received treatment both in the PICU and in the NICU in 15 Units (75%). In three Units (15%), estimates were made for PICU (17.1 ± 4% of the patients) and NICU (14.5 ± 16.3% of the admitted patients). The remaining two Units (10%) considered the seasonal factor: children treated in summer (18.4 ± 2.3%) and in winter (90 ± 14.1%). In one of the NICUs, physiotherapy was provided for all infants with a gestational age of under 28 weeks. The duration of the sessions ranged from 10−35 min, with an average of 22.5 ± 7.7 min. The service was available only in the mornings in 19 of the Units (79.2%), and only on working days in 19 Units (79.2%). On the other hand, 70.8% of those surveyed considered that the number of physiotherapists associated to the service was insufficient to cover the care needs. In 22 of the Units (91.7%), the physiotherapists were not exclusively dedicated to work in the Unit; 14 (63.6%) also offered RP to patients in the ward and 9 (19.8%) to ambulatory patients. In addition, 18 (81.8%) performed physiotherapy in patients admitted to the ward and 14 (63.6%) in outpatient clinics.

Table 1.

General characteristics of the Intensive Care Units participating in the survey.

Hospital center  Region (Autonomous Community)  City  Type of hospital center  Type of ICU  No. of beds  No. of physiotherapists in ICU  Physiotherapist dedication in ICU  Weekend availability of physiotherapy  Patient referral to physiotherapy 
H. Materno Infantil de Granada  Andalucía  Granada  Public  PICU and NICU  16  Part time  No  DR 
H. Materno Infantil de Málaga  Andalucía  Málaga  Public  PICU and NICU  14  Part time  No  DR 
H. Regional de Málaga  Andalucía  Málaga  Public  PICU and NICU  40  Part time  No  DR 
H. Universitario Virgen del Rocío  Andalucía  Sevilla  Public  PICU and NICU  38  Part time  No  Dependent on demanda 
H. Universitario Marqués de Valdecilla  Cantabria  Santander  Public  PICU  Part time  No  DR 
H. Universitario de Burgos  Castilla y León  Burgos  Public  PICU and NICU  15  Part time  No  Specialist ICU 
H. Clínico Universitario de Valladolid  Castilla y León  Valladolid  Public  Mixed  Part time  No  DR 
H. Virgen de la Salud de Toledo  Castilla y la Mancha  Toledo  Public  PICU and NICU  12  Part time  No  DR 
H. de la Santa Creu y Sant Pau  Catalonia  Barcelona  Public  PICU and NICU  Part time  Yes  DR 
H. Sant Joan de Déu  Catalonia  Barcelona  Private  PICU and NICU  24  Full time  Yes  DR 
H. Universitari Vall d'Hebron  Catalonia  Barcelona  Public  PICU and NICU  20  Part time  No  DR 
H. Universitari Parc Taulí  Catalonia  Sabadell  Private  PICU and NICU  17  Part time  No  Specialist ICU 
H. Universitario General de Castellón  Valencian Community  Castellón  Public  Mixed  Part time  Yes  DR 
H. Materno Infantil Badajoz  Extremadura  Badajoz  Public  PICU and NICU  Part time  No  DR 
H. Universitario Materno Infantil de A Coruña  Galicia  A Coruña  Public  PICU and NICU  Part time  Yes  Dependent on demanda 
H. Clínico Universitario de Santiago de Compostela  Galicia  Santiago de Compostela  Public  PICU and NICU  Part time  No  DR 
H. Nuestra Señora de Candelaria  Canary Islands  Tenerife  Public  PICU and NICU  16  Part time  No  DR 
H. Clínico San Carlos  Madrid  Madrid  Public  PICU and NICU  30  Part time  No  Specialist ICU 
H. La Paz  Madrid  Madrid  Public  PICU and NICU  50  Full time  No  DR 
H. General Gregorio Marañón  Madrid  Madrid  Public  PICU and NICU  35  Part time  Yes  DR 
H. Universitario 12 de Octubre  Madrid  Madrid  Public  PICU and NICU  35  Full time  No  DR 
H. Universitario Ramón y Cajal  Madrid  Madrid  Public  Mixed  Full time  No  Specialist ICU 
H. General Universitario Santa Lucía  Murcia  Cartagena  Public  NICU  Part time  No  Dependent on demanda 
H. Universitario de Cruces  Basque Country  Vizcaya  Public  PICU and NICU  24  Full time  No  DR 

H: hospital; DR: Department of Rehabilitation; NICU: Neonatal Intensive Care Unit; PICU: Pediatric Intensive Care Unit.

a

If consultation is due to a disorder of respiratory origin, referral is dependent on the specialist in the ICU or the pneumologist, while in the case of disorders of locomotor origin, referral is made by DR.

Academically, the participants had 20.3 ± 5.1 years of general working experience, and 11 (45.8%) had between 3–10 years of experience in the PICU/NICU. For 19 of the participants (79.2%), having specific training in RP in critical pediatric patients was not a requirement for their job position. At present, 19 (79.2%) have training in RP, and of these, 15 (62.5%) have training in pediatric RP; 14 (58.3%) have training in RP in Intensive Care; and 10 (41.7%) have training in RP and in the management of mechanical ventilation. Only 8 participants (33.3%) had training in all three areas. Lastly, 16 of the Units (66.7%) provided clinical practice training at grade or master level (Table 2).

Table 2.

PICUs and NICUs offering university clinical training in physiotherapy.

Hospital center  University  Academic title 
H. Materno Infantil Málaga  Universidad de Ciencias de la Salud de Málaga  Degree in Physiotherapy 
H. Regional de Málaga  Universidad de Ciencias de la Salud de Málaga  Degree in Physiotherapy 
H. Universitario Marqués de Valdecilla  Universidad Gimbernat de Cantabria (Campus Torrelavega)  Title not specified 
H. de la Santa Creu y Sant Pau  Universidad Autónoma de Barcelona  Title not specified 
H. Sant Joan de Déu  Universidad Autónoma de Barcelona (Escuela Universitaria de la Gimbernat)  Degree in Physiotherapy 
H. Universitari Vall d'Hebron  Universidad Autónoma de Barcelona (Escuela Universitaria de la Gimbernat)  Degree in Physiotherapy 
  Universidad Autónoma de Barcelona (Escuela Universitaria de la Gimbernat) and Escuela Universitaria de Fisioterapia de la ONCE de Madrid  Master not specified 
H. Universitari Parc Taulí de Sabadell  Universidad Autónoma de Barcelona (Escuela Universitaria de la Gimbernat) and Fundación Universitaria del Bages  Master in Thoracic Physiotherapy 
H. Materno infantil Badajoz  Universidad de Extremadura  Degree in Physiotherapy 
H. Universitario Nuestra Señora Candelaria  Universidad de La Laguna  Title not specified 
H. General Universitario Gregorio Marañón  Universidad Complutense de Madrid and Universidad Pontificia de Salamanca  Title not specified 
H. Clínico San Carlos  Universidad Complutense de Madrid  Degree in Physiotherapy 
H. La Paz  Centro Universitario La Salle, Escuela Universitaria de Fisioterapia de la ONCE de Madrid, Universidad Nebrija  Degree in Physiotherapy 
H. Universitario 12 de Octubre  Universidad Complutense and Universidad Pontificia de Comillas  Degree in Physiotherapy 
H. Universitario Ramón y Cajal  Universidad de Alcalá  Degree in Physiotherapy 
H. General Universitario Santa Lucía  Universidad Católica San Antonio de Murcia  Title not specified 
H. Universitario de Cruces  Escuela Universitaria de Fisioterapia de la ONCE de Madrid  Master in Cardiorespiratory Physiotherapy 

H: hospital.

Our results evidence low commitment of the physiotherapist to the PICU/NICU. This is in contrast to the situation found in Brazil, for example, where 21.2% of the staff physiotherapists are exclusively related to the PICU/NICU.3 Nevertheless, the physiotherapist / bed ratio is better than in the PICUs in Brazil (1:9.3), in the PICUs/NICUs in Korea (1:20),3,4 and in Spain referred to adult Intensive Care (1:13).6 In any case, the situation falls short of the recommendations of the European Society of Intensive Care Medicine (ESICM),7 which advises a ratio of 1:5.

With regard to the patient referral system, our findings are consistent with those corresponding to adult Intensive Care in Spain, with a Department of Rehabilitation referral rate of 65.1%.8 Likewise, in terms of the mean duration of each session, our data coincide with those recorded in Korea,4 where 36.2% of the participants reported a duration per session of under 10 min and 29.3% less than 30 min. The same situation was found in adult Intensive Care in Spain, where the mean duration of the rehabilitation sessions was 16−30 min.6 Thus, the characteristics identified in our study do not comply with the standards and recommendations referred to the quality of Intensive Care published by the Spanish Ministry of Health,9 which estimate that each patient requires at least 30 min a day of physiotherapy.

On the other hand, the ESICM7 recommends that physiotherapists who work in the Intensive Care Unit (ICU) should do so full time, with a coverage of 7 days a week. While this objective is not met by the analyzed Spanish PICUs/NICUs, at European level 75% of the adult ICUs have at least one or two physiotherapists with full time dedication.10 In relation to weekly coverage of the service, our results fall short of those recorded by the hospitals in Barcelona, where the percentage reaches 47%,6 and of those published in Europe, with a percentage of 83%.10 Lastly, nocturnal service was inexistent in the Units participating in our study, and very low in the Spanish adult ICUs8 — while the figure reaches 34% in the European general ICUs.10

As limitations of the present study, replies were not obtained from all the hospitals with PICU/NICU, despite the long time allowed for them to reply. In turn, most of the centers belonged to the Spanish public healthcare system, which might not be representative of the situation of RP in the PICUs/NICUs of private centers.

The present study underscores the need to integrate physiotherapists within the interdisciplinary teams of the Spanish PICUs/NICUs, facilitating direct patient referral to physiotherapy on the part of the specialist in Intensive Care, and with exclusive and full-time dedication.

Financial support

The present study has received no financial support.

Conflicts of interest

None.

Acknowledgements

Thanks are due to María José Segrera Rovira, Mireia Pardàs Peraferrer, Roberto Martínez Alejos and Salvador Llanes Castell, as part of the panel of experts that contributed to validation of the survey, and to Mariona Farrés Tarafa, for supplying the list of Spanish PICUs and NICUs.

Appendix A
Supplementary data

The following is the supplementary data to this article:

References
[1]
C.B. Morrow, S.A. McGrath-Morrow, J.M. Collaco.
Predictors of length of stay for initial hospitalization in infants with bronchopulmonary dysplasia.
J Perinatol, 38 (2018), pp. 1258-1265
[2]
S. Andersson-Marforio, A. Lundkvist Josenby, E. Ekvall Hansson, C. Hansen.
The effect of physiotherapy including frequent changes of body position and stimulation to physical activity for infants hospitalised with acute airway infections. Study protocol for a randomised controlled trial.
[3]
J. Liberali, J. Davidson, A. Nunes dos Santos.
Availability of physical therapy assistance in neonatal intensive care units in the city of São Paulo, Brazil.
Rev Bras Ter Intensiva, 26 (2014), pp. 57-64
[4]
S.T. Kim, J.-H. Lee.
A survey on the current status of neonatal physical therapy in South Korea.
J Korean Phys Ther, 32 (2020), pp. 169-176
[5]
SECIP: Sociedad Española de Cuidados Intensivos Pediátricos.
UCIPs en España.
[6]
C. Lathrop Ponce de León, P. Castro Rebollo.
Estado actual de la labor de los fisioterapeutas en las unidades de cuidados intensivos de adultos del área metropolitana de Barcelona.
Fisioterapia, 41 (2019), pp. 258-265
[7]
A. Valentín, P. Ferdinande, ESICM Working Group on Quality Improvement.
Recommendations on basic requirements for intensive care units: structural and organizational aspects.
Intensive Care Med, 37 (2011), pp. 1575-1587
[8]
M. Raurell-Torredà, S. Arias-Rivera, J.D. Martí, M.J. Frade-Mera, I. Zaragoza-García, E. Gallart, et al.
Grado de implementación de las estrategias preventivas del síndrome post-UCI: estudio observacional multicéntrico en España.
Enferm Intensiva, 30 (2019), pp. 59-71
[9]
Unidades de cuidados intensivos: estándares y recomendaciones, Ministerio de Sanidad y Política Social, (2010),
[10]
M. Norrenberg, J.-L. Vincent, with the collaboration of the European Society of Intensive Care Medicine.
A profile of European intensive care unit physiotherapists.
Intensive Care Med, 26 (2000), pp. 988-994

Please cite this article as: Torreiro Diéguez L, Martí J-D, Souto Camba S, González Doniz L, López García A, Lista-Paz A. Fisioterapia respiratoria en Unidades de Cuidados Intensivos pediátricas y neonatales españolas. Med Intensiva. 2022;46:341–345.

Idiomas
Medicina Intensiva (English Edition)

Subscribe to our newsletter

Article options
Tools
Supplemental materials
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?