Comparing the Effectiveness of Active Cycle Breathing Technique (ACBT) with High-flow Nasal Cannula (HFNC) Versus Standard Chest Physiotherapy with HFNC in Onco-critical Care: A Retrospective Study

INTRODUCTION: Many postoperative patients diagnosed with cancer require HFNC support following extubation or to alleviate respiratory distress due to conditions such as pneumonia and pleural effusions, and often need chest physiotherapy. However, certain standard physiotherapy techniques aimed at clearing airways and promoting lung expansion may not be suitable for cancer patients due to complications such as poor blood counts, metastasis, cardiac issues, hemorrhage, osteoporosis, cancer-related fatigue etc. Consequently, there is a need to identify effective physiotherapy interventions that can maintain bronchial hygiene and enhance lung expansion in critically ill cancer patients. The Active Cycle Breathing Technique (ACBT), an established airway clearance method, is routinely used in patients with pneumonia, bronchiectasis, and COPD. However, the combined effect of ACBT and HFNC in postoperative cancer patients has not been widely studied.(1,2) AIMS & OBJECTIVES: To assess and compare the effectiveness of ACBT with standard chest physiotherapy in post-surgery cancer patients receiving HFNC treatment. MATERIALS AND METHODS: This study included 40 adult post-surgery patients (mean age 54) who had been on HFNC for at least 72 hours. One group of patients (n=19) was provided with standard chest physiotherapy manoeuvres like percussion and vibrations. The other group (n=21) received ACBT. Each patient participated in three supervised physiotherapy sessions using ACBT or standard chest physiotherapy (SCPT). The Modified Borg Rate of Perceived Exertion (RPE) score (0-10), used to assess dyspnoea, was recorded at baseline and after 72 hours of intervention. A reduction of at least 1 point on the scale indicated improvement. RESULTS: The retrospective analysis of pre and post-test data of both the ACBT and SCPT groups showed significant improvements (P=0.000). The ACBT group had a mean difference of 3.238 (Cohen's d = 2.968), while the SCPT group had a slightly higher mean difference of 3.400 (Cohen's d = 4.996) with a more pronounced effect size.(3,4) DISCUSSIONS/CONCLUSIONS: The results suggest that either intervention could be beneficial in clinical practice, depending on patient needs and specific circumstances. ACBT may enhance the benefits of HFNC by promoting airway clearance, reducing the work of breathing, and improving lung compliance and oxygenation which can be safely administered in Onco critical care. ACBT could serve as a viable alternative to SCPT, particularly based on the specific requirements of post-surgical onco-critical care. future prospective randomized controlled trials with larger sample sizes are needed to further assess this intervention's benefits.