South African Physiotherapists’ Perceptions of and involvement with non-invasive positive pressure ventilation therapy in the management of patients following CABG surgery

Abstract

Background Pulmonary dysfunctions after coronary artery bypass graft (CABG) surgery are a common complication that can occur after the procedure. Therefore, the main aim of physiotherapy is to decrease the incidence of pulmonary complications after CABG surgery. Non-invasive positive pressure ventilation (NPPV) is a treatment technique that can be used by physiotherapists to encourage opening of the airways and prevent them from collapsing once the air is expelled. There is, however, varied evidence regarding the efficacy of NPPV to treat pulmonary complications after CABG surgery, with further limited evidence regarding physiotherapists involvement in the use of NPPV, particularly in South Africa. The aim of this study was to provide rich descriptions of physiotherapists’ current perceptions of and involvement in the use of NPPV techniques to treat patients after CABG surgery in South Africa. Method A descriptive qualitative study using a semi-structured interview schedule was conducted. The interviews were done online via Zoom or Microsoft Teams. Physiotherapists involved in the treatment of patients after CABG surgery were contacted in the private and public sectors of South Africa. Only physiotherapists with two or more years of experience, excluding their community service year, were included in the study. An inductive approach was adopted for data analysis. Results Eleven participants were included in the study. There were seven participants who made use of NPPV techniques, whilst the other four did not make use of this technique at all. The use of NPPV techniques by participants included CPAP, BiPAP, HFNO, and IPPB. The administration and choice of NPPV was directed by the treating physician or surgeon of the patient. Lack of multidisciplinary involvement, resources and staff competency of NPPV apparatus were deemed as barriers to the use of NPPV therapy. Sufficient space in the cardiothoracic ICU and receiving support from the nursing staff allowed for a more efficient administration of NPPV therapy and was thus reported as enablers. Conclusion Findings suggest that use of NPPV in physiotherapy patient management after CABG is more common in the private sector than the public sector of South Africa. There were more barriers to use of the technique as opposed to enablers. This study contributes to the limited body of knowledge of physiotherapy management of patients after CABG surgery in South Africa.