+
MODEL
Respiratory Medicine (2015) xx, 1e1
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/rmed
LETTER TO THE EDITOR
Reply to the Letter to the Editor: “Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients” Annoni et al. believe that the study “Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients. Respiratory Medicine (2013) 107, 68 e 74 can be methodologically compromised. Their belief is based on the fact that most patients in group B were hospitalized with neurological diseases (cerebral infarction and brain trauma) which may have increased the risk for ventilator-associated pneumonia (VAP) and might be responsible for the increase in MV, ICU LOS and mortality rate. We believe and agree that our sample was heterogeneous; however, we do not assume our study is methodologically compromised. Quite contrary, our study was heterogeneous due to the fact that it was carried out in a cohort design with a convenience sample. Therefore, we could not interfere into patient’s disease etiology by the time of inclusion. The neurological injury and levels of consciousness may have differed, however, the study clearly state that despite the fact that minor changes might have occurred overall gravity scores (Apache II and Sofa) were not different between patients. Primarily, what matters in a cohort study is the fact that samples does differ by the time of inclusion, throughout the evaluation and until dropout independently of disease and condition differences; especially when it comes to a study that covers data collection and analysis of a comprehensive population. Another raised question was the flaw physical therapy treatment description. Annoni et al. state that physical
DOI of original j.rmed.2013.08.047.
article:
therapy was characterized by endotracheal suctioning, manual thorax percussion and general mobilization in the Materials and Methods section and weaning in the Discussion section. They believe that the study should have emphasized these aspects in the manuscript. Indeed, ventilator setting and weaning were also used as a technique just as is carried out in any general ICU (i.e., according to clinical and blood gas parameters). However, the reason we did not emphasize it in the methods section was due to the fact that every health care professional can participate in the weaning process making it not an exclusive practice of a chest physiotherapist. Therefore, in the Materials and Methods section we choose to emphasize the therapeutic procedures that only physical therapists can perform taking into account each health care professional’s area of expertise. Moreover, we know that in every general ICU setting weaning is practiced on a daily basis by every health care professional and it is carried out according to clinical and to blood gas samples. Eventually, those were the reasons we choose to leave a note concerning this matter in the Discussion section. Antonio A.M. Castro* Department of Physiotherapy, Federal University of Pampa (Unipampa), Uruguaiana, Brazil Elias F. Porto Department of Physiotherapy, Adventist University (Unasp), Sa˜o Paulo, Brazil *Corresponding author. Federal University of Pampa (Unipampa), BR 472, Km 592, Postal Code: 118, Uruguaiana, Rio Grande do Sul, 97508-000, Brazil. Tel./fax: þ55 55 34218447. E-mail address: [email protected] (A.A.M. Castro)
http://dx.doi.org/10.1016/
http://dx.doi.org/10.1016/j.rmed.2015.04.016 0954-6111/ª 2015 Published by Elsevier Ltd. Please cite this article in press as: Castro AAM, Porto EF, Reply to the Letter to the Editor: “Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients”, Respiratory Medicine (2015), http://dx.doi.org/10.1016/j.rmed.2015.04.016
MODEL
Respiratory Medicine (2015) xx, 1e1
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/rmed
LETTER TO THE EDITOR
Reply to the Letter to the Editor: “Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients” Annoni et al. believe that the study “Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients. Respiratory Medicine (2013) 107, 68 e 74 can be methodologically compromised. Their belief is based on the fact that most patients in group B were hospitalized with neurological diseases (cerebral infarction and brain trauma) which may have increased the risk for ventilator-associated pneumonia (VAP) and might be responsible for the increase in MV, ICU LOS and mortality rate. We believe and agree that our sample was heterogeneous; however, we do not assume our study is methodologically compromised. Quite contrary, our study was heterogeneous due to the fact that it was carried out in a cohort design with a convenience sample. Therefore, we could not interfere into patient’s disease etiology by the time of inclusion. The neurological injury and levels of consciousness may have differed, however, the study clearly state that despite the fact that minor changes might have occurred overall gravity scores (Apache II and Sofa) were not different between patients. Primarily, what matters in a cohort study is the fact that samples does differ by the time of inclusion, throughout the evaluation and until dropout independently of disease and condition differences; especially when it comes to a study that covers data collection and analysis of a comprehensive population. Another raised question was the flaw physical therapy treatment description. Annoni et al. state that physical
DOI of original j.rmed.2013.08.047.
article:
therapy was characterized by endotracheal suctioning, manual thorax percussion and general mobilization in the Materials and Methods section and weaning in the Discussion section. They believe that the study should have emphasized these aspects in the manuscript. Indeed, ventilator setting and weaning were also used as a technique just as is carried out in any general ICU (i.e., according to clinical and blood gas parameters). However, the reason we did not emphasize it in the methods section was due to the fact that every health care professional can participate in the weaning process making it not an exclusive practice of a chest physiotherapist. Therefore, in the Materials and Methods section we choose to emphasize the therapeutic procedures that only physical therapists can perform taking into account each health care professional’s area of expertise. Moreover, we know that in every general ICU setting weaning is practiced on a daily basis by every health care professional and it is carried out according to clinical and to blood gas samples. Eventually, those were the reasons we choose to leave a note concerning this matter in the Discussion section. Antonio A.M. Castro* Department of Physiotherapy, Federal University of Pampa (Unipampa), Uruguaiana, Brazil Elias F. Porto Department of Physiotherapy, Adventist University (Unasp), Sa˜o Paulo, Brazil *Corresponding author. Federal University of Pampa (Unipampa), BR 472, Km 592, Postal Code: 118, Uruguaiana, Rio Grande do Sul, 97508-000, Brazil. Tel./fax: þ55 55 34218447. E-mail address: [email protected] (A.A.M. Castro)
http://dx.doi.org/10.1016/
http://dx.doi.org/10.1016/j.rmed.2015.04.016 0954-6111/ª 2015 Published by Elsevier Ltd. Please cite this article in press as: Castro AAM, Porto EF, Reply to the Letter to the Editor: “Chest physiotherapy effectiveness to reduce hospitalization and mechanical ventilation length of stay, pulmonary infection rate and mortality in ICU patients”, Respiratory Medicine (2015), http://dx.doi.org/10.1016/j.rmed.2015.04.016
