Utilization of positive-pressure devices for breathing exercises in the hospital setting: a regional survey in São Paulo, Brazil.

BACKGROUND The use of breathing exercises with positive-pressure devices during hospitalization aims to prevent the development of nosocomial pulmonary complications or to facilitate recovery from pulmonary conditions already present. Although this type of intervention has potential benefits and theoretical advantages over more conventional respiratory physiotherapy techniques, the literature on the effects of breathing exercises with positive-pressure is controversial and inconsistent. OBJECTIVE To evaluate the extension of the use of breathing exercises with positive-pressure devices by physiotherapists in São Paulo, Brazil. METHODS A list of hospitals located in the city of São Paulo was obtained through the Municipal Secretary of Health. Physiotherapists at 43 hospitals were surveyed about their use of exercises with positive-pressure devices in: patients after abdominal, thoracic, and cardiac surgery; patients with chronic obstructive pulmonary disease; patients with pneumonia; and patients with neuromuscular disease. RESULTS 120 physiotherapists responded to the questionnaire. All the respondents used breathing exercises with positive-pressure devices in their clinical practice, with all types of patients addressed in the questionnaire. The devices most frequently used were continuous positive airway pressure (78%) and intermittent positive-pressure breathing (73%). The most frequently cited indications for positive-pressure breathing exercises were atelectasis and oxygenation impairment. CONCLUSIONS Despite a lack of evidence of benefit from breathing exercises with positive-pressure in the hospital setting, this type of intervention is used extensively in clinical practice for a wide variety of patients and conditions.