209 Non-invasive ventilation (NIV) administered by respiratory physiotherapists (RPs): a national survey

Background: A physiological rationale has been demonstrated for the use of NIV in patients with cystic fibrosis (CF) however, NIV is not part of the routine management of severe lung disease in CF. RPs are often involved in the NIV usage with different skills and tasks. Aim: To survey and evaluate the role and competences of italian RPs involved in the NIV management for CF and the rationale as perceived by them. Methods: A semi-structured online questionnaire consisting of 31 closed and 9 open ended questions was sent to the Italian Group of Physiotherapists belonging to the Italian Society for the Study of Cystic Fibrosis, between March and April 2010. Results: Respondents (67%) represent 29 CF Centers out of 35, which had a total of 4064 CF patients, 96 (2.4%) of whom were using NIV. NIV is a therapeutic choice used in 62% of those centers and RPs (93%) are involved in its management. NIV is the first-line treatment to improve gas exchange (89%) and it is a valid tool as support to clearance techniques (68%) and exercise training (43%). Main criteria to propose NIV are hypercapnic pulmonary exacerbation (96%), lung transplantation waiting (96%), severe impairment of pulmonary function (89%) and difficulties experienced with clearing secretions (68%). A detailed picture revealed that 71% of RPs choose ventilators, 96% is involved in the crucial choice of interfaces and 75% is in charge of ventilator settings. Conclusions: CF centers and clinics take advantage of NIV and RPs are involved in its management. Harmonizing the core competences of RPs and the ventilatory care of CF patients is urgently needed.