An implementation protocol for noninvasive ventilation prescription: The physiotherapist's role in an Italian hospital

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BACKGROUND: For patients with chronic respiratory failure or sleep breathing disorders, adaptation and training are important prerequisites for successful home noninvasive ventilation (NIV) and CPAP. In Europe, management of NIV/CPAP is sometimes performed by physiotherapists (PTs). However, their role within the NIV/CPAP management team is not well defined. OBJEC-TIVE: To describe the implementation of a standardized protocol to NIV adaptation for patients with chronic respiratory disease. Secondary outcomes were to evaluate the PT's role and timeconsumption. METHODS: We enrolled 201 patients with chronic respiratory disease, referred to the cardiopulmonary rehabilitation service (CPRS). Anthropometric and clinical data, adaptation sessions, ventilator typology, side effects, plus activities conducted by the CPRS were recorded. The time spent on a single protocol task plus total time spent on the entire management procedure for NIV/CPAP adaptation was also documented. RESULTS: Adaptation to NIV/CPAP was completed in 8.2 ± 3.2 sessions, lasting 17.2 ± 15.4 min/session. Total CPRS activity included 61% adaptation procedures, 22% educational sessions, 8% evaluation, 7% monitoring and follow-up, and 2% administrative activities. CPRS time-consumption per patient was 149.5 ± 113.7 min. Total CPRS time-consumption was 28,870 min, corresponding to 1.52 hours/working day and 21% of total PT daily activity. After protocol implementation, PTs were able to cover 65% and 35% of the time devoted to ventilation procedures typically carried out by physicians and nurses, respectively. Amyotrophic lateral sclerosis/neuromuscular patients required more time for adaptation and education, compared to patients with obstructive sleep apnea syndrome (P

Original languageEnglish
Pages (from-to)662-668
Number of pages7
JournalRespiratory Care
Issue number4
Publication statusPublished - Apr 1 2013


  • Chronic respiratory failure
  • CPAP
  • Pulmonary rehabilitation
  • Sleep related disorders

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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