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Can early extubation and intensive physiotherapy decrease length of stay of acute quadriplegic patients in intensive care? A retrospective case control study
Author(s) -
Berney Sue,
Stockton Kellie,
Berlowitz David,
Denehy Linda
Publication year - 2002
Publication title -
physiotherapy research international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.509
H-Index - 49
eISSN - 1471-2865
pISSN - 1358-2267
DOI - 10.1002/pri.237
Subject(s) - medicine , intensive care , retrospective cohort study , physical therapy , acute care , emergency medicine , physical medicine and rehabilitation , intensive care medicine , health care , surgery , economics , economic growth
Abstract Background and Purpose Respiratory complications remain a major cause of morbidity and mortality in the acute quadriplegic patient population. The literature has suggested that early insertion of a tracheostomy facilitated pulmonary management and an earlier discharge from the intensive care unit (ICU). Recently, a change in practice has meant that these patients are considered for extubation and intensive physiotherapy treatment, including an overnight on‐call service, rather than tracheostomy. The aim of the present retrospective, case‐controlled study was to determine if either practice resulted in a difference in length of stay in intensive care and if an on‐call physiotherapy service for these patients was cost effective. Method A case control design was used. Between April 1997 and November 1999, seven patients who did not require a tracheostomy were identified; case control subjects were matched for severity with seven patients who did receive a tracheostomy. Length of stay in intensive care and on the acute ward, days from injury to fixation and the overall number of respiratory physiotherapy and night physiotherapy treatments were recorded. Results Five of the seven patients in the non‐tracheostomy group received on‐call overnight physiotherapy treatment, with an average of five sessions over a total of three nights. This group's length of stay in an ICU was significantly less than patients who were tracheostomized (p = 0.02). The overall number of physiotherapy treatments between the two groups was not significantly different. Conclusions The results of this study suggest that if extubation and intensive physiotherapy is undertaken for suitable patients, the length of stay in intensive care can be significantly reduced. This represents a considerable cost saving for ICUs and more than covers the added cost of providing an after hours on‐call physiotherapy treatment service. A prospective evaluation is required to confirm these findings. Copyright © 2002 Whurr Publishers Ltd.