Physiotherapist’s Role in Extubation Success: A Literature Review

Abstract

Background : The failure of extubation induced morbidity and increased mortality. The physiotherapist can help to facilitate the success of extubation.

Materials and methods : A literature search was conducted from 2004 to 2014 using key databases — Medline, PEDro and Cochrane Library.

Results : A total of 11 reviews, 1 meta-analysis, 6 randomized controlled studies, 10 prospective studies, and 3 expert recommendations were analyzed. The following techniques are validated: the use of a weaning protocol, the cuff-leak test, treatment and prevention of atelectasis, early mobilization and non-invasive ventilation (grade A); manual respiratory therapy on ventilated patient (grade B), manual respiratory therapy on extubated patient (grade B) and high frequency flow oxygenation (grade B); evaluation of cough strength and bronchial obstruction (grade C), the measurement of P0.1/PI, max (grade C) and the “handgrip strength test” (grade C). Invalidated techniques are: inspiratory muscle training (grade A); evaluation of swallowing and instrumental respiratory therapy (grade C).

Conclusion : The physiotherapist can play a true role in the extubation. However, several techniques require more scientific validation