Physiotherapy in the Intensive Care Unit

Physiotherapy in the Intensive Care Unit

R Gosselink, B Clerckx, C Robbeets, T Vanhullebusch, G Vanpee, J Segers

Netherlands Journal of Critical Care

Abstract: Physiotherapists are involved in the management of patients with critical illness. Physiotherapy assessment is focused on physical deconditioning and related problems (muscle weakness, joint stiffness, impaired functional exercise capacity, physical inactivity) and respiratory conditions (retained airway secretions, atelectasis and respiratory muscle weakness) to identify targets for physiotherapy. Evidence-based targets for physiotherapy are deconditioning, impaired airway clearance, atelectasis, (re-)intubation avoidance and weaning failure. Early physical activity and mobilisation are essential in the prevention, attenuation or reversion of physical deconditioning related to critical illness. A variety of modalities for exercise training and early mobility are evidence-based and must be implemented depending on the stage of critical illness, co-morbid conditions and cooperation of the patient. The physiotherapist should be responsible for implementing mobilization plans and exercise prescription and make recommendations for progression of these plans, jointly with medical and nursing staff.

Barium swallow and achalasia

A barium swallow (or esophagography) is a medical imaging procedure used to examine the upper GI (gastrointestinal) tract, which includes the esophagus and, to a lesser extent, the stomach.

Achalasia, also known as esophageal achalasia, achalasia cardiae, cardiospasm, and esophageal aperistalsis, is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter (LES). It is characterized by incomplete LES relaxation, increased LES tone, and lack of peristalsis of the esophagus (inability of smooth muscle to move food down the esophagus) in the absence of other explanations like cancer or fibrosis.

Inspired by orthopedicmanualpt.com.

The effects of long term immobilization

In many cases a Physical Therapists will start working with a patient after a long term immobilization phase. But what is the effect of immobilization on the musculoskeletal system?

Due to reduction of load, the load bearing capacity of body structures in the musculoskeletal system reduces:

• Muscle atrophy, 25% volume reduction in 1 week
• Cartilage, after 4 weeks loss of matrix
• Ligaments, loss of strength, 48% in 8 weeks
• Bone, irreversible bone-loss in 6 weeks

Some general negative effects:

• Increased resistance to insulin
• Vascular dysfnunction
• Thromboembolic disease
• Lungs failure
• Systemnic inflammation
• Nerve system: critical illness polyneuropathy
• Muscle weakness (distal more than proximal)
• Respiratory failure
• Multiple organ failure
• Contractures
• Muscle hypotonia
• Muscle athrophy
• Reduced reflexes or absence of reflexes
• Impaired sensibility

Respir Care. 2010 Apr;55(4): 400-7. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, Badet M, Bayle F, Richard JC, Guérin C.

The ICU experience

The Intensive Care Unit (ICU) is a special department of a hospital or health care facility that provides intensive-care medicine. Normally, in such a unit, you see a team of health professionals, doctors, nurses, and physical therapists, working together.

This video from Virginia Commonwealth University gives a brief overview of how an ICU works and what you should expect in it.

ICU & Acute Care Physical Therapy

This video shows the rewarding fields of acute care physical and occupational therapies helping a patient who was bedridden for several weeks in ICU due to respiratory failure and sepsis. It captures her recovery from the initial assessment in ICU, when Phyllis could barely move, to the final outcome after her rehab stay.