The PhLIP team: Feasibility of a physiotherapy-led intensive prone positioning team initiative during the COVID-19 pandemic.
Thomas C Rollinson, Joleen Rose, Luke A McDonald and 6 others
PMID 36934044WHAT IT FOUND
A physiotherapy-led prone team conducted 154 of 161 proning episodes in 51 of 93 ICU patients with COVID-19, with no accidental extubations, hypoxia complications, neuromuscular injuries, manual handling injuries, or staff exposures to COVID-19.
Key findings
01During the Delta wave, 93 patients with COVID-19 were admitted to ICU, and 51 (55%) were positioned prone across 161 episodes (362 turns).
02The PhLIP team conducted 154 of 161 proning episodes (94%) after 23 physiotherapists were upskilled and deployed, adding 2.0 equivalent full time to the daily service.
03There were three potential airway adverse events (1.8%), with no hypoxia-related complications, accidental extubations, prone-related neuromuscular injuries, manual handling injuries, or staff exposures to COVID-19.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Single-site retrospective audit with no comparison group, so the team model cannot be shown to have caused the outcomes. The PhLIP team was one component of a broader surge response including protocol changes, staff training, redeployment, and usual ICU care, so outcomes cannot be separated. The service ran during a period of reduced elective surgery and redeployed staff, so it may not transfer to normal hospital operations. Feasibility and fidelity were reported, but acceptability to the ICU team was not evaluated. The model could not free medical staff entirely from proning because an airway doctor was still required. Neuromuscular injury follow-up was only to ICU discharge.
Declared interests
No specific grant from public, commercial, or not-for-profit sectors was received. The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the 88% survival rate or low complication rate as proof that physiotherapy-led proning improves patient outcomes. This was a single-site audit with no comparison group, so it shows the model was feasible and safe in this surge, not that it caused better survival.