Physiotherapy role in ICU

Intensive care is the specialized care of patients with life-threatening conditions, often requiring comprehensive care and ongoing monitoring in an intensive care unit (ICU).

Patients who have been in the ICU for a long time have long-term physical and mental complications, muscle weakness, musculoskeletal problems such as joint stiffness, heart and respiratory diseases.

Therefore, they need a multidisciplinary team to work with them.

▪ Physical therapy, as part of a multidisciplinary approach to care, is integral to promoting lung function, reducing the incidence of ventilator-associated pneumonia, promoting weaning, and promoting safe and early discharge from the intensive care unit.

Table of Contents

▪Physiotherapy Techniques in ICU:

1/Positioning,

2/Manual and ventilator hyperinflation

3/Weaning from mechanical ventilation

4/Non-invasive ventilation

5/Percussion, vibration, suctioning

6/Respiratory muscle strengthening

7/Breathing exercises

8/Rehabilitation

9/early mobilization

▪ The role of the physiotherapist in the ICU can be divided into two key areas – breathing and rehabilitation.

1▪respiratory physiotherapy

Patients in the ICU may need mechanical ventilation to help them breathe. This is necessary for the body to heal, but it stops the patient from coughing and clears the daily volume of phlegm.

It gets worse if the patient has pneumonia or a chest infection because more phlegm is produced.

Physical therapists help patients remove excess phlegm, reduce the chance of chest infections, and treat infections when they occur.

2▪Physiotherapy Rehabilitation in ICU

Physical therapy is an important intervention to prevent the adverse effects of prolonged bed rest and mechanical ventilation during critical illness. Rehabilitation provided by a physiotherapist is tailored to the needs of the patient and depends on the state of consciousness, state of mind and body The power of the patient. It combines any active and passive therapy that promotes movement, including mobilization.

Early progressive physical therapy, focusing on mobility and ambulation during ventilation, is essential to minimize functional decline.

▪ Set goals based on the patient’s physical and psychological state. During his ICU stay, the physiotherapist should perform a brief clinical assessment to determine the patient’s risk for physical and non-physical illness.

▪Short-term Goals:

1/ Early Activity – Passively and actively maintain the integrity of the musculoskeletal system.

2/ Position the patient: Let gravity help the phlegm drain from the lungs.

3/ Manual techniques such as shaking and vibration: These techniques are applied to the ribs to try to loosen and remove phlegm.

4/ Suction: By inserting a small tube into the lungs to suck out excess phlegm.

They play a vital role in stopping patients from ventilating.

▪Long-term Goals:

Plan an extensive rehabilitation program to reintegrate the patient into society.

Work with the medical team to set goals for the recovery of the patient.

Rehabilitation goals are determined in communication with the patient’s family and medical team, are divided into short-term, mid-term or long-term, and are constantly changing during the patient’s critical illness recovery. They can be physical or psychological, but their concern is functional needs of patients. Goals need to be achievable and based on the patient’s periodic assessment of the physical and non-physical consequences of critical illness throughout recovery, and vary based on progression.

▪How will the physiotherapist do this?

1/ Stretches or splints of the hands or feet: Prevents muscle and joint stiffness.

2/Bed and chair bikes: These bikes can be used passively to move the legs to reduce joint stiffness and improve circulation, or they can be used actively to improve strength.

3/ Electrical Stimulation: The electrodes electronically contract the muscles, keeping them strong.

Improve the way you sit: For example, practice sitting on the edge of the bed (postural control).

4/ Incline standing with a tilt table: Strengthens muscles and bones.

5/Standing and walking practice

6/Bed exercises