- Email: [email protected]
A randomised controlled trial of hypertonic saline inhalation to enhance airway clearance physiotherapy in adults hospitalised with cystic fibrosis (CF)
eS356
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Physical Therapy Association, Australian Physiotherapy Association, and 41 other WCPT member organisations. Ethics approval: Ethics approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.567 Research Report Platform State of the Art Presentation Number: RR-PLSoA-3380 Monday 4 May 2015 10:45 Hall 404 A RANDOMISED CONTROLLED TRIAL OF HYPERTONIC SALINE INHALATION TO ENHANCE AIRWAY CLEARANCE PHYSIOTHERAPY IN ADULTS HOSPITALISED WITH CYSTIC FIBROSIS (CF) R. Dentice, M. Elkins, P. Bye Royal Prince Alfred Hospital, Respiratory Medicine, Sydney, Australia Background: CF is a genetically inherited disease that causes pulmonary secretion retention, leading to chronic infection and progressive lung damage. This progressive disease course is interspersed with acute exacerbations, which are often treated with admission to hospital for intravenous antibiotics and intensive physiotherapy to promote clearance of secretions from the airways. Purpose: To determine the effects of hypertonic saline (HS) during hospitalisation for CF pulmonary exacerbation on length of hospital stay, lung function, oxygenation, bacterial load, symptom scores, quality of life, exercise tolerance, and time to relapse. Methods: 132 adults, mean (SD) age 28 (9) y, FEV1 48 (20) %pred, were randomised to thrice-daily inhalation of 4 mL nebulised 7% saline or a taste-masked control of 0.12% saline throughout their hospital admission. Hypertonic saline was inhaled immediate before (or interspersed during) physiotherapy for airway clearance. Results: No participants had an acute fall in their FEV1 of >15% after the first dose of their allocated inhalation solution. Length of stay was 12 days in the HS group and 13 days in the control group (MD 1 day, 95%CI 0–2). Exacerbations (as defined by Fuchs 1994) resolved on day 10 in the HS group and day 11 in the control group (MD 1 day, 0–2). Participants were significantly more likely to have returned to their baseline FEV1 at discharge in the HS group (75%) than the control group (57%), NNT 6 (95%CI 3–65). On a visual analogue scale of symptom severity (0–100 mm) recorded daily, the HS group had significantly greater improvement than the control group in: sleep disturbance by 15 mm (95%CI 6–23), chest congestion by 9 mm (4–14), and dyspnoea by 6 mm (1–12); and borderline significance for fatigue (8 mm, 0–15) and cough (6 mm, 0–11). At discharge, the HS group had less severe: sleep disturbance by 13 mm (4–23), chest congestion
by 10 mm (3–18), and dyspnoea by 8 mm (1–16). After a minimum of twelve months follow up, no significant difference in time to next exacerbation requiring hospitalisation has been detected between groups (p = 0.13). Conclusion(s): The resolution of exacerbation symptoms was greater in rate and magnitude in the HS group than the control group, and a greater proportion of the treated participants returned to their baseline FEV1. HS may shorten length of stay in hospital slightly or have no effect on it, but it does not increase length of stay. Implications: Hypertonic saline is safe to commence during an acute exacerbation of CF and appears to enhance the effect of airway clearance physiotherapy. While allowing a similar or slightly shorter length of stay in hospital, nebulised hypertonic saline allows patients to leave hospital with greater resolution of their exacerbation. Keywords: Airway clearance; Cystic fibrosis; Hypertonic saline Funding acknowledgements: This study was funded by the US CF Foundation. The Woolcock Institute provided a scholarship to Ruth Dentice. Ethics approval: This study was approved by the Sydney Local Health District Ethics Committee – RPAH Zone. http://dx.doi.org/10.1016/j.physio.2015.03.568 Research Report Poster Presentation Number: RR-PO-03-05-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 AN ACTION RESEARCH PROJECT TO EXPLORE, IMPLEMENT AND EVALUATE THE USE OF REHABILITATION GUIDELINES FOR PHYSIOTHERAPY IN THE CRITICALLY ILL S. Elliott Medway Maritime Hospital, Physiotherapy, Gillingham, United Kingdom Background: Rehabilitation in critical care has the potential to restore lost function and improve quality of life on discharge, but patients are often viewed as ‘too sick’ to participate in physical rehabilitation. There is a need to standardise pathways for clinical decision making in early rehab so interventions are safe, timely and consistent. Purpose: This study aims to investigate existing rehabilitation guidelines through a literature review, implement rehabilitation guidelines into critical care and evaluate their use. Methods: Action research was selected as a methodology, and included several phases including assessing feasibility of using critical care guidelines, a literature review, implementing and evaluating the use of rehabilitation guidelines before modifying for future use. Evaluation of the imple-
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS26–eS426
Physical Therapy Association, Australian Physiotherapy Association, and 41 other WCPT member organisations. Ethics approval: Ethics approval was not required. http://dx.doi.org/10.1016/j.physio.2015.03.567 Research Report Platform State of the Art Presentation Number: RR-PLSoA-3380 Monday 4 May 2015 10:45 Hall 404 A RANDOMISED CONTROLLED TRIAL OF HYPERTONIC SALINE INHALATION TO ENHANCE AIRWAY CLEARANCE PHYSIOTHERAPY IN ADULTS HOSPITALISED WITH CYSTIC FIBROSIS (CF) R. Dentice, M. Elkins, P. Bye Royal Prince Alfred Hospital, Respiratory Medicine, Sydney, Australia Background: CF is a genetically inherited disease that causes pulmonary secretion retention, leading to chronic infection and progressive lung damage. This progressive disease course is interspersed with acute exacerbations, which are often treated with admission to hospital for intravenous antibiotics and intensive physiotherapy to promote clearance of secretions from the airways. Purpose: To determine the effects of hypertonic saline (HS) during hospitalisation for CF pulmonary exacerbation on length of hospital stay, lung function, oxygenation, bacterial load, symptom scores, quality of life, exercise tolerance, and time to relapse. Methods: 132 adults, mean (SD) age 28 (9) y, FEV1 48 (20) %pred, were randomised to thrice-daily inhalation of 4 mL nebulised 7% saline or a taste-masked control of 0.12% saline throughout their hospital admission. Hypertonic saline was inhaled immediate before (or interspersed during) physiotherapy for airway clearance. Results: No participants had an acute fall in their FEV1 of >15% after the first dose of their allocated inhalation solution. Length of stay was 12 days in the HS group and 13 days in the control group (MD 1 day, 95%CI 0–2). Exacerbations (as defined by Fuchs 1994) resolved on day 10 in the HS group and day 11 in the control group (MD 1 day, 0–2). Participants were significantly more likely to have returned to their baseline FEV1 at discharge in the HS group (75%) than the control group (57%), NNT 6 (95%CI 3–65). On a visual analogue scale of symptom severity (0–100 mm) recorded daily, the HS group had significantly greater improvement than the control group in: sleep disturbance by 15 mm (95%CI 6–23), chest congestion by 9 mm (4–14), and dyspnoea by 6 mm (1–12); and borderline significance for fatigue (8 mm, 0–15) and cough (6 mm, 0–11). At discharge, the HS group had less severe: sleep disturbance by 13 mm (4–23), chest congestion
by 10 mm (3–18), and dyspnoea by 8 mm (1–16). After a minimum of twelve months follow up, no significant difference in time to next exacerbation requiring hospitalisation has been detected between groups (p = 0.13). Conclusion(s): The resolution of exacerbation symptoms was greater in rate and magnitude in the HS group than the control group, and a greater proportion of the treated participants returned to their baseline FEV1. HS may shorten length of stay in hospital slightly or have no effect on it, but it does not increase length of stay. Implications: Hypertonic saline is safe to commence during an acute exacerbation of CF and appears to enhance the effect of airway clearance physiotherapy. While allowing a similar or slightly shorter length of stay in hospital, nebulised hypertonic saline allows patients to leave hospital with greater resolution of their exacerbation. Keywords: Airway clearance; Cystic fibrosis; Hypertonic saline Funding acknowledgements: This study was funded by the US CF Foundation. The Woolcock Institute provided a scholarship to Ruth Dentice. Ethics approval: This study was approved by the Sydney Local Health District Ethics Committee – RPAH Zone. http://dx.doi.org/10.1016/j.physio.2015.03.568 Research Report Poster Presentation Number: RR-PO-03-05-Sat Saturday 2 May 2015 12:15 Exhibit halls 401–403 AN ACTION RESEARCH PROJECT TO EXPLORE, IMPLEMENT AND EVALUATE THE USE OF REHABILITATION GUIDELINES FOR PHYSIOTHERAPY IN THE CRITICALLY ILL S. Elliott Medway Maritime Hospital, Physiotherapy, Gillingham, United Kingdom Background: Rehabilitation in critical care has the potential to restore lost function and improve quality of life on discharge, but patients are often viewed as ‘too sick’ to participate in physical rehabilitation. There is a need to standardise pathways for clinical decision making in early rehab so interventions are safe, timely and consistent. Purpose: This study aims to investigate existing rehabilitation guidelines through a literature review, implement rehabilitation guidelines into critical care and evaluate their use. Methods: Action research was selected as a methodology, and included several phases including assessing feasibility of using critical care guidelines, a literature review, implementing and evaluating the use of rehabilitation guidelines before modifying for future use. Evaluation of the imple-