key: cord-0988490-teac04a9
authors: Black, Claire; Klapaukh, Roman; Gordon, Alison; Scott, Francesca; Holden, Nina
title: Unanticipated demand of Physiotherapist-Deployed Airway Clearance during the COVID-19 Surge 2020 a single centre report
date: 2021-03-20
journal: Physiotherapy
DOI: 10.1016/j.physio.2021.03.010
sha: 366090ca964269aaa8f2f8e3e3ff9f59047b3bb0
doc_id: 988490
cord_uid: teac04a9

Bronchial secretion management was not an anticipated clinical problem in patients intubated and ventilated with COVID-19. Yet 63 (62%) of our intubated and ventilated patients demonstrated a moderate or greater sputum load, as recorded by physiotherapists on 5 or more days of the patient's ICU stay. The efficacy of airway clearance in these patients was further compounded by ineffective or absent cough and increased secretion tenacity, dramatically increasing the workload of critical care physiotherapists. We provide data to support the modelling of critical care physiotherapy staffing for future COVID –19 surges.

Despite initial reports that 35% of patients severely affected by SARS CoV-2 were productive of sputum 1 , bronchial secretion management was not an anticipated clinical problem prior to the UK outbreak in March 2020 2, 3 . However it rapidly became apparent that within the first week of intubation, mechanically ventilated patients developed an airway secretion burden.

Furthermore, clearance of this excess sputum load was often hindered by the levels of sedation and neuromuscular blockade necessary to maintain lung protective strategies, which significantly impaired patients' cough reflexes. These factors necessitated a rapid reassessment of the expectation of critical care physiotherapy services. The capacity to meet the increased demand was created by redeployment of physiotherapy staff from suspended services elsewhere in the hospital. This capacity may not be available during future surges given the need to maintain normal non-COVID services.

The combination of early recommendations not to use heated humidification because of Health Care Worker Risk 4. , ineffective or absent cough and the possibility of increased secretion tenacity, may lead to retention of secretions, worsening gas exchange and potentially airway occlusion 5,6 .

We describe the patient secretion burden, the airway clearance techniques, the frequency with which they were deployed and data to allow modelling of physiotherapy staffing for future outbreaks. 

Given we expect a lower availability of physiotherapists in a second wave, in light of these findings we would recommend that their numbers should be explicitly planned for.

On behalf of all authors, the corresponding author states that there is no conflict of interest.

J o u r n a l P r e -p r o o f

Clinical characteristics of coronavirus disease 2019 in china

Respiratory physiotherapy in patients with covid-19 infection in acutesetting: a position paper of the italian association of respiratory physio-therapists (arir)

Physiotherapy management for covid-19 in the acute hospital setting: clinical practice recommendations

Airway hygiene in covid-19 pneumonia: Treatment responses of 3 critically ill cruise ship employees

Tracheobronchial slough, a potential pathology in endotracheal tube obstruction in patients with coronavirus disease 2019 (covid-19) in the intensive care setting

Cough augmentation techniques for extubation or weaning critically ill patients from mechanical ventilation

Effects of manually assisted coughing on respiratory mechanics in patients requiring full ventilatory support