The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

THE CURRENT STATE-WIDE USE OF AIRWAY CLEARANCE TECHNIQUES

Sarah Varekojis, PhD, RRT, Sarah McNee, B.S., RRT, Christine Snider, B.S., RRT, and Katrina Strayer, B.S., CRT; Respiratory Therapy Division, School of Allied Medical Professions, The Ohio State University, Columbus, Ohio.

Background: Patients with impaired airway clearance can experience many pulmonary complications which can lead to higher medical expenses.  A variety of techniques have been shown to be clinically effective in removing bronchial secretions. The purpose of this survey is to describe the use of airway clearance techniques in Ohio hospitals as reported by respiratory therapy department managers, and determine if current practice differs by use of therapist-driven protocols, region of the state, type of hospital, size of hospital, or size of department.

Methods:
A survey research design was employed to answer the research questions. A survey instrument was developed to measure the various aspects of airway clearance technique use in Ohio hospitals and to obtain demographic information about each hospital. The survey instrument was mailed with an accompanying cover letter and postage-paid return envelope to the manager of the respiratory therapy department at every hospital in Ohio . Descriptive statistics were employed to address several research questions and chi square and t-tests were employed as appropriate. The alpha level was set a priori at 0.05.

Results:
67 of the 174 department managers returned the survey. The most frequently used technique was incentive spirometry. IS, cough and deep breathe, suctioning, and PD&P were used always to sometimes, bed percussion, huff coughing, cough assist, and AcapellaTM were used sometimes to rarely, and EzPAP®, HFCWO, IPV®, IPPB, and Flutter® were all used rarely to never. Autogenic drainage was used least frequently, almost never. The three factors with the most influence on how frequently a technique is used were physician preference, therapist preference, and protocols or clinical pathways, with availability of equipment and patient preference the next most influential, and cost and time the least influential. PD&P, Acapella, and HFCWO are the most expensive techniques, and IS, cough and deep breathe and suctioning are the least expensive. HFCWO, PD&P, and IPV are allotted the most time for administration and huff coughing, cough and deep breathe, and suctioning are allotted the least time for administration.

Conclusions:
There appears to be a trend toward use of simple airway clearance techniques in Ohio 's hospitals. However, there are some notable differences in practice with larger hospitals and departments, community hospitals, and hospitals with protocols more likely to use the newer devices like IPV®, HFCWO, EzPAP® and AcapellaTM. It is recommended that this study be repeated on a national scale to determine if the findings in Ohio are similar to the rest of the country. 

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