2011 OPEN FORUM Abstracts
NON-INVASIVE VENTILATION IN CYSTIC FIBROSIS: THE ITALIAN RESPIRATORY PHYSIOTHERAPISTS' POINT OF VIEW.
Sergio Zuffo, Simone Gambazza, Alessandro Capra; Rehabilitation Unit, Azienda Ospedaliero Universitaria A. Meyer, Firenze, Italy
BACKGROUND A physiological rationale has been demonstrated for the use of non-invasive ventilation (NIV) in patients with cystic fibrosis (CF) however, NIV is not part of the routine management of severe lung disease in CF. Possible explanations include the lack of clearly validated criteria to propose NIV, controversies with regard to ventilatory modes and settings, skepticism with regard to long-term efficacy, poor acceptance by patients and health workers poorly trained. Instead respiratory physiotherapists (RP) are often involved in the NIV management with different skills and tasks. AIM To survey and evaluate the role and competences of italian respiratory physiotherapists involved in the NIV management for CF and the rationale as perceived by them. METHODS A semi-structured online questionnaire consisting of 31 closed and 9 open ended questions was sent the Italian Group of Physiotherapists belonging to the Italian Society for the Study of Cystic Fibrosis, between March and April 2010. RESULTS Respondents (67%) represent 29 CF Centers (21 Centers and 8 Clinics) out of 35, which had a total of 4064 CF patients at the time of the study, 96 (2,4%) of whom were using NIV. NIV is a therapeutic choice used in 62% of those centers and RP (93%) are involved in its management. According to respondents, NIV is the first-line treatment to improve gas exchange (89%) and it is a valid tool as support to clearance techniques (68%) and exercise training (43%). Main criteria to propose NIV, according to RP, are hypercapnic pulmonary exacerbation (96%), lung transplantation waiting (96%), severe impairment of pulmonary function (89%) and difficulties experienced with clearing secretions (68%). Almost all interviewees do agree that NIV is part of the "core competence" for RP who work in CF Center (95%) and in CF Clinic (85%). A detailed picture revealed that 71% of RP choose ventilators, 96% is involved in the crucial choice of interfaces and 75% is in charge of ventilator settings. The majority of RP (93%) takes care of patients'comfort and compliance enhancement as well as periodic review of patients. CONCLUSIONS Although some limitations, this is the first italian study that explores how RP are involved in the NIV management in CF and their expectations about the benefits of NIV. CF centers and clinics take advantage of NIV and RP are involved in its management. Harmonizing the core competences of RP and the ventilatory care of CF patients is urgently needed. Sponsored Research - None