Physiotherapy in ICU

Role of Physiotherapist in ICU

Aims of Physiotherapy Management

·        To gain the patient‘s confidence

·        To promote relaxation

·        To relieve pain

·        To assist in removal of excess bronchial secretions

·        To maintain adequate ventilation in all parts of lungs

·        To improve and maintain joint ROM and flexibility

·        To maintain mobility and regain strength of muscles

·        Prevent pressure sores

·        Prevent tightness, contractures and deformity

·        Correction of posture and gait pattern

·        Prevent postoperative complications, respiratory and circulatory complications

·        To provide functional independence and early ambulation

Means of Physiotherapy Management

 

1. Postural drainage

·        Modified postural drainage is used due to drainage tubes, catheters and ventilators

·        Avoid tipping in case of neurosurgical patient

·        The aim is to mobilize the secretions from the central to peripheral airways by

·        positioning the patient in various gravity assisted positions

·        The therapist must consider the patients conditions and hemodynamic status

2. Manual techniques

Percussion

·        It involves rhythmic movements by clapping over the patient’s chest wall with flexion and extension of wrist

·        Towel or cloth may be placed over the chest

Vibration

·        The hands are placed either anteriorly, posteriorly or laterally in case of side lying

·        At the end of inspiration vigorous shaking is given to remove tenacious secretions

Shaking

·        It is similar to vibration but more vigorous and bouncing movements to the chest wall is given

·        It is done during expiratory phase 
 

Clinical indication to manual techniques

·        Hemoptysis

·        Multiple ribs fractures

·        Pulmonary tuberculosis

·        Osteoporosis

·        Severe pleuritic chest pain

·        Pulmonary embolism

·        Pneumothorax

3. Breathing exercises

·        Controlled deep breathing exercises

·        Diaphragmatic breathing or segmental expansion can be taught

·        Positioning is important usually in ½ lying or semiflowers position

4. Coughing and huffing

·        Teach the patient how to produce and effective cough

·        Manual assisted and cough techniques can be given

·        Tracheal stimulation

·        It helps in expectoration of airway secretions

·        Incisional support with pads or pillow is necessary to overcome pain during coughing

·        During coughing “k” sound is produced while during huffing “ha” sound is produced

5. Manual hyperinflation technique

·        It is a method to mobilize and remove secretions and aids in re-expansion of collapsed lungs

·        It is done with an AMBU bag or water bag circuit

·        One person squeezes and releases the AMBU bag and other person gives percussions, shaking maneuver along with suctioning (done after 6-8 inflation)

6. Suctioning

·        It is done in case of prolonged intubated patients to remove thick and tenacious secretions

 Pressure: Negative pressure is maintained

Size of catheter: 12 FG with water soluble lubricating gel

                  Time: Adult (15-20 sec) and children (6-8 sec)

Route: Oropharyngeal and Nasopharyngeal

                  Contraindications: Head injury with leakage of CSF, hemoptysis and severe bronchospasm

7. Active cycle of breathing technique (ACBT)

8. Exercises for mobility and ROM

·        Bed mobility exercises (lying to sitting to standing)

·        Mat exercises

·        Ankle/toe movements

·        Passive and active movements of upper limb and lower limb

·        Proper positioning with pillows, splints to maintain joint ROM and prevent deformities or contractures

·        General mobility exercises of shoulder girdle, hip, knee and ankle

·        Muscles strengthening using weights and resistance

9. Prevention of bed sores

·        Proper positioning with special mattresses

·        Turning the patient every two hours

·        Skin care

·        Padding over bony prominence

10. Functional training

·        Teaching normal gait pattern using walking aides (crutches, frames)

·        Postural awareness using mirror and medicine ball

·        To improve CVS endurance (staircase climbing, slow walking, cycling)

11. Education and counseling

·        Parental education with psychotherapy

·        Group therapy

·        Social support