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  1. Article ; Online: Are Short-Term Changes in Physiological Variables in ICU Patients as a Result of Physiotherapy of Any Clinical Relevance?

    Ntoumenopoulos, George

    Respiratory care

    2023  Volume 68, Issue 4, Page(s) 549–552

    MeSH term(s) Humans ; Clinical Relevance ; Physical Therapy Modalities ; Intensive Care Units
    Language English
    Publishing date 2023-03-22
    Publishing country United States
    Document type Editorial
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.10897
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: We Can Move Mucus: But Is That Enough?

    Ntoumenopoulos, George

    Respiratory care

    2022  Volume 67, Issue 12, Page(s) 1637–1641

    MeSH term(s) Humans ; Mucus
    Language English
    Publishing date 2022-11-25
    Publishing country United States
    Document type Editorial ; Comment
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.10675
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  3. Article: An international survey exploring the adoption and utility of diagnostic lung ultrasound by physiotherapists and respiratory therapists in intensive care.

    Lau, Yin Hung / Hayward, Simon / Ntoumenopoulos, George

    Journal of the Intensive Care Society

    2023  Volume 24, Issue 4, Page(s) 364–371

    Abstract: Introduction: Lung ultrasound (LUS) is an emerging assessment tool for intensive care unit (ICU) therapists (physiotherapists, physical therapists and respiratory therapists) to aid pathology identification, intervention selection, clinical reasoning ... ...

    Abstract Introduction: Lung ultrasound (LUS) is an emerging assessment tool for intensive care unit (ICU) therapists (physiotherapists, physical therapists and respiratory therapists) to aid pathology identification, intervention selection, clinical reasoning and as an outcome measure to assess intervention efficacy. However, the extent of LUS adoption and use by ICU therapists internationally has not been described in the literature.
    Objectives: This survey explored the interest in LUS amongst ICU therapists internationally. In addition, LUS training, use in clinical practice and barriers to implementation were also explored. The survey findings were used to facilitate recommendations for future adoption.
    Methods: International ICU therapists were invited to answer a 37 question cross-sectional open e-survey, distributed using the online survey tool REDCap
    Results: Three hundred twenty ICU therapists from 30 countries responded with most respondents coming from either the United Kingdom (
    Conclusions: To the authors' knowledge this is the first study to explore the international adoption and utility of LUS by ICU therapists. LUS is a growing technique with widespread interest from ICU therapists internationally with a desire to adopt LUS into their assessments and upskill their practice. ICU therapists' use of LUS could allow more targetted and appropriate treatment for patients on ICU. Barriers to LUS adoption could be mitigated by having access to quality training programmes and mentorship. Development of profession specific guidance and policies within local infrastructure should facilitate growth and ensure robust quality assurance and governance processes.
    Language English
    Publishing date 2023-02-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 2701626-2
    ISSN 1751-1437 ; 1751-1437
    ISSN (online) 1751-1437
    ISSN 1751-1437
    DOI 10.1177/17511437221148920
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  4. Article ; Online: The Impact of High-Frequency Chest-Wall Compression on Mechanical Ventilation Delivery and Flow Bias.

    Ntoumenopoulos, George / Jones, Alison / Koutoumanou, Eirini / Shannon, Harriet

    Respiratory care

    2023  

    Abstract: Background: It is unclear if high-frequency chest-wall compression (HFCWC) has a role to assist with secretion clearance in patients on mechanical ventilation. The effect of HFCWC on the delivery of mechanical ventilation is unknown. This study ... ...

    Abstract Background: It is unclear if high-frequency chest-wall compression (HFCWC) has a role to assist with secretion clearance in patients on mechanical ventilation. The effect of HFCWC on the delivery of mechanical ventilation is unknown. This study describes the effect of HFCWC on mechanical ventilation delivery and flow bias in an orally intubated and mechanically ventilated bench model.
    Methods: An orally intubated mannequin was mechanically ventilated in 5 commonly used modes of ventilation at settings that reflect current practice. HFCWC was applied via a randomized combination of oscillation frequencies and pressure settings. Mechanical ventilator flow, flow bias, and breathing frequency were measured before and during the application of HFCWC.
    Results: HFCWC led to 3- to 7-fold increases in ventilator-delivered breathing frequency during synchronized intermittent mandatory ventilation, bi-level (with pressure support), bi-level-assist, and pressure-regulated volume control modes of ventilation. Only in the bi-level mode without pressure support was the ventilator breathing frequency unaffected by HFCWC. During HFCWC, peak inspiratory flow to peak expiratory flow ratios toward an expiratory flow bias, particularly at higher HFCWC pressures, only in pressure-regulated volume control and synchronized intermittent mandatory ventilation modes were peak inspiratory flow to peak expiratory flow ratios of <0.9 generated that would facilitate secretion clearance.
    Conclusions: HFCWC led to 3- to 7-fold increases in ventilator breathing frequency delivered by mechanical ventilation except in the bi-level mode. The bi-level mode may be the optimal mode to use HFCWC to minimize disruption to the delivered ventilator breathing frequency. The peak inspiratory flow to peak expiratory flow ratios < 0.9, the optimal flow bias for secretion clearance, was only achieved in the pressure-regulated volume control and synchronized intermittent mandatory ventilation modes. However, the findings in this bench model with a fixed low compliance may not be generalizable to the patient in the ICU, and we recommend further investigation into the effects of HFCWC in the patient in the ICU.
    Language English
    Publishing date 2023-08-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 603252-7
    ISSN 1943-3654 ; 0098-9142 ; 0020-1324
    ISSN (online) 1943-3654
    ISSN 0098-9142 ; 0020-1324
    DOI 10.4187/respcare.10932
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  5. Article ; Online: Implementation of physiotherapy-led lung ultrasound in the intensive care unit.

    Lockstone, Jane / Brain, Matt / Zalucki, Nadia / Ntoumenopoulos, George

    Australian health review : a publication of the Australian Hospital Association

    2023  Volume 47, Issue 5, Page(s) 614–618

    Abstract: The use of lung ultrasound (LUS) in clinical settings is emerging as an important tool in the assessment of lung pathology and/or function and has gained considerable acceptance. LUS is being integrated into clinical care by trained respiratory ... ...

    Abstract The use of lung ultrasound (LUS) in clinical settings is emerging as an important tool in the assessment of lung pathology and/or function and has gained considerable acceptance. LUS is being integrated into clinical care by trained respiratory physiotherapists and has been shown to influence physiotherapists' clinical decision-making in the respiratory management of patients. Considering the use of LUS by physiotherapy is in its infancy and still evolving, there is likely variability in the ability and confidence of physiotherapists to use LUS in clinical practice, both in Australia and internationally. While the UK has had a rapid increase in the number of LUS-accredited physiotherapists (n  = 111), the number of LUS-accredited physiotherapists in Australia remains very low (n  = 4). There is a growing body of work in the UK on physiotherapy-led LUS in respiratory care, however, there is currently little work published on the practicalities of training and establishing physiotherapy-led LUS in Australia. This report describes the training and implementation of physiotherapy-led LUS in the intensive care unit from a regional hospital perspective.
    Language English
    Publishing date 2023-06-26
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 639155-2
    ISSN 1449-8944 ; 0159-5709 ; 0156-5788
    ISSN (online) 1449-8944
    ISSN 0159-5709 ; 0156-5788
    DOI 10.1071/AH23045
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  6. Article ; Online: Clinimetrics: Quadriceps muscle ultrasound.

    Hansell, Louise / Ntoumenopoulos, George

    Journal of physiotherapy

    2021  Volume 67, Issue 4, Page(s) 313

    MeSH term(s) Humans ; Muscular Atrophy ; Quadriceps Muscle/diagnostic imaging ; Ultrasonography
    Language English
    Publishing date 2021-05-28
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2543915-7
    ISSN 1836-9561 ; 1836-9553 ; 0004-9514
    ISSN (online) 1836-9561
    ISSN 1836-9553 ; 0004-9514
    DOI 10.1016/j.jphys.2021.05.001
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  7. Article ; Online: A conservative oxygenation strategy is feasible and appears to be safe compared with liberal oxygenation in mechanically ventilated patients [commentary].

    Ntoumenopoulos, George

    Journal of physiotherapy

    2016  Volume 62, Issue 1, Page(s) 51

    MeSH term(s) Female ; Humans ; Male ; Oxygen/blood ; Oxygen Inhalation Therapy/methods ; Respiration, Artificial/methods
    Chemical Substances Oxygen (S88TT14065)
    Language English
    Publishing date 2016-01
    Publishing country Netherlands
    Document type Comment ; Journal Article
    ZDB-ID 2543915-7
    ISSN 1836-9561 ; 1836-9553 ; 0004-9514
    ISSN (online) 1836-9561
    ISSN 1836-9553 ; 0004-9514
    DOI 10.1016/j.jphys.2015.10.005
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  8. Article ; Online: Upper airway assessment and its implications for interventions by respiratory physiotherapists.

    Ntoumenopoulos, George / Andersen, Tiina / Hardingham, Nicola M

    Physiotherapy theory and practice

    2022  Volume 40, Issue 1, Page(s) 184–189

    Abstract: Background: When noninvasive interventions such as chest physiotherapy fail, then more aggressive interventions for airway secretion clearance with nasotracheal airway suctioning may be required. Clinicians however have to insert the nasotracheal ... ...

    Abstract Background: When noninvasive interventions such as chest physiotherapy fail, then more aggressive interventions for airway secretion clearance with nasotracheal airway suctioning may be required. Clinicians however have to insert the nasotracheal suction catheter "blindly" and the success of being able to trigger a cough and pass through the vocal folds with a suction catheter is low.
    Case description: The patient, a 48-year-old male underwent a heart and lung transplant. Following extubation, the patient developed secretion retention with a weak ineffective cough and swallow and required physiotherapy interventions with frequent "blind" passes of nasotracheal suctioning.
    Outcomes: The patient required nasotracheal suction with frequent multiple failed attempts before successful passage of the suction catheter to trigger a cough reflex and clear secretions. A combined physiotherapist and speech and language therapist intervention during fiberoptic endoscopic evaluation of swallow (FEES) was recorded to both evaluate swallow and passage of the suction catheter. The video illustrated the successful passage of a suctioning catheter through the vocal folds leading to an effective cough and airway clearance.
    Discussion: We present a case report demonstrating that it is feasible to visualize the upper airways during nasotracheal suctioning as an objective means to guide the more accurate successful insertion of the suction catheter past the vocal folds. Rather than "blind" placement of nasotracheal suction catheters visualization using transnasal laryngoscopy should be useful to increase chances of passing through the vocal folds.
    MeSH term(s) Male ; Humans ; Middle Aged ; Physical Therapists ; Respiratory Therapy ; Cough
    Language English
    Publishing date 2022-07-29
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 1045333-7
    ISSN 1532-5040 ; 0959-3985
    ISSN (online) 1532-5040
    ISSN 0959-3985
    DOI 10.1080/09593985.2022.2106916
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  9. Article ; Online: Rehabilitation during mechanical ventilation: Review of the recent literature.

    Ntoumenopoulos, George

    Intensive & critical care nursing

    2015  Volume 31, Issue 3, Page(s) 125–132

    Abstract: Mechanically ventilated patients are at increased risk of developing physical and psychological complications that are associated with prolonged weaning from mechanical ventilation, increased morbidity and mortality. These complications include intensive ...

    Abstract Mechanically ventilated patients are at increased risk of developing physical and psychological complications that are associated with prolonged weaning from mechanical ventilation, increased morbidity and mortality. These complications include intensive care unit acquired weakness, delirium and a loss of physical function that may persist well beyond ICU and hospital discharge. Factors such as the requirement for intubation and mechanical ventilation, sedation, systemic inflammation and immobility are associated with the development of these physical and psychological complications. Implementation of rehabilitation in mechanically ventilated patients has been demonstrated to be both safe and feasible and provide benefits in terms of physical and psychological function and assist with weaning from mechanical ventilation. The recent relevant literature on the role of rehabilitation interventions in the mechanically ventilated patient will be discussed.
    MeSH term(s) Critical Illness/nursing ; Critical Illness/rehabilitation ; Humans ; Intensive Care Units ; Nursing Process ; Patient Discharge ; Randomized Controlled Trials as Topic ; Ventilator Weaning
    Language English
    Publishing date 2015-06
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 1105892-4
    ISSN 1532-4036 ; 0964-3397
    ISSN (online) 1532-4036
    ISSN 0964-3397
    DOI 10.1016/j.iccn.2015.02.001
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  10. Article ; Online: An Update on Cardiorespiratory Physiotherapy during Mechanical Ventilation.

    Tronstad, Oystein / Martí, Joan-Daniel / Ntoumenopoulos, George / Gosselink, Rik

    Seminars in respiratory and critical care medicine

    2022  Volume 43, Issue 3, Page(s) 390–404

    Abstract: Physiotherapists are integral members of the multidisciplinary team managing critically ill adult patients. However, the scope and role of physiotherapists vary widely internationally, with physiotherapists in some countries moving away from providing ... ...

    Abstract Physiotherapists are integral members of the multidisciplinary team managing critically ill adult patients. However, the scope and role of physiotherapists vary widely internationally, with physiotherapists in some countries moving away from providing early and proactive respiratory care in the intensive care unit (ICU) and focusing more on early mobilization and rehabilitation. This article provides an update of cardiorespiratory physiotherapy for patients receiving mechanical ventilation in ICU. Common and some more novel assessment tools and treatment options are described, along with the mechanisms of action of the treatment options and the evidence and physiology underpinning them. The aim is not only to summarize the current state of cardiorespiratory physiotherapy but also to provide information that will also hopefully help support clinicians to deliver personalized and optimal patient care, based on the patient's unique needs and guided by accurate interpretation of assessment findings and the current evidence. Cardiorespiratory physiotherapy plays an essential role in optimizing secretion clearance, gas exchange, lung recruitment, and aiding with weaning from mechanical ventilation in ICU. The physiotherapists' skill set and scope is likely to be further optimized and utilized in the future as the evidence base continues to grow and they get more and more integrated into the ICU multidisciplinary team, leading to improved short- and long-term patient outcomes.
    MeSH term(s) Adult ; Critical Illness/therapy ; Humans ; Intensive Care Units ; Physical Therapy Modalities ; Respiration, Artificial
    Language English
    Publishing date 2022-04-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1183617-9
    ISSN 1098-9048 ; 1069-3424
    ISSN (online) 1098-9048
    ISSN 1069-3424
    DOI 10.1055/s-0042-1744307
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