Practice of airway clearance in critically ill patients: a cross-sectional survey of respiratory therapists and physiotherapists in China.

Background: Airway clearance therapy is crucial for managing critically ill patients with impaired secretion clearance. However, clinical practices and preferences among respiratory therapists (RTs) and physiotherapists (PTs) in China are not well understood. This study aimed to investigate the current practices of airway clearance techniques, device utilization, and implementation barriers among respiratory therapists and physiotherapists in intensive care units across China. Methods: A cross-sectional online survey was conducted from July to August 2023, targeting RTs and PTs across the Chinese mainland. The survey collected demographic information, ACT application patterns, experiences with four specific devices: percussion therapy device, high-frequency chest wall oscillation (HFCWO), mechanical insufflation-exsufflation (MI-E), and continuous high-frequency oscillation therapy (CHFO), as well as perceived implementation challenges. Inferential nonparametric tests were used to analyze the data. Results: Of 1,204 complete responses, 984 reported clinically performing airway clearance therapy. Most practitioners were employed in tertiary hospitals (90.7%) and general ICU (46.7%). The frequency of different ACT modalities varied; conventional methods such as nebulization, humidification, and suctioning were common, whereas device-based methods showed significant variation. While the details of implementing ACT differed, a general consensus was found. The main barriers to ACT implementation included limited equipment availability, shortage of dedicated personnel, and lack of awareness. Conclusions: ACT is widely used in Chinese ICUs, but practices vary significantly. These findings highlight the urgent need for standardized protocols, dedicated training, and increased investment in ACT devices to support evidence-based practices.