Physiotherapy in Intensive Care Unit, by Abba Muhammad Tawfiq
Intensive Care Unit (ICU) otherwise known as intensive therapy unit or coronary care unit is a specialised unit where patients who are critically ill or who need special monitoring and therapy are managed.
It is an organised system for the provision of care to critically ill patients that provide intensive and specialised medical and nursing care, an enhanced capacity for monitoring, and multiple modalities of physiologic organ support to sustain life during a period of life-threatening organ system insufficiency (Marshall et al, 2017).
Intensive care units are staffed by highly trained and professionally skilled healthcare professionals including intensivists, critical care nurses, anaesthesiologists, and physiotherapists.
The ability to render a spectrum of care for both intubated and spontaneously breathing ICU patients with complications ranging from acute to severe lay the benchmark for physiotherapists as being a constituent part of the management of ICU patients
A study by Chaboyer et al (2004) comprehensively reflects the specific significant roles of physiotherapy practice within the multidisciplinary team in the assessment and treatment of ICU patients. This includes chest physiotherapy (manual percussion, shaking and vibration), breathing exercises, respiratory muscles strengthening, specific positioning, manual airway clearance, range of motion exercises, functional training and post-discharge rehabilitation.
These have been reported to provide several benefits which will be lucidly elucidated later in this context. And this clearly portray the hidden roles played by physiotherapists in the ICU
Intubated ICU patients are predisposed to pathogenic microorganisms that invade the body to give rise to further complications. This includes ventilator-associated pneumonia–a parenchymal lung infection occurring at least 48 hours after the initiation of mechanical ventilation (Morehead and Pinto 2000).
The medical symptoms manifested mostly by this infection include fever, increase, and decrease in the number of circulating white blood cells in the body-leucocytosis and leucopenia respectively, purulent sputum and the presence of new and persistent pulmonary infiltrate (Valles 1995).
The aforesaid symptoms are said to be the bone of contention for high costs and prolonged stay in the ICU (Bercault 2001) and indicate the presence of underlying pathophysiology and are associated with altered and unfavourable respiratory mechanisms such as decreased in the ability of the lungs to maintain its elastic quality (Lungs compliance) and increase airways resistance.
Literature revealed that the administration of intensive care medicine through the various desired routes of drug administration has impressively improved the revitalisation of critically ill patients (Bellomo et al, 2003). Unfortunately, a nexus of complications including deconditioning, muscle weakness, reduction in quality of life depression, and dyspnoea with such medical intervention are said to evolve and hence the necessity of physiotherapy.
The ultimate goal of intensive care physiotherapy is to enhance physical fitness, improve quality of life and reduce the length of hospital stay by promoting safe and early discharge from the ICU. All these can be achieved by administering mild to moderate exercise regimens, mobilizing patients early to facilitate weaning (Cirio et al, 2003), promoting lungs function and optimizing oxygenation (Dean et al 1998), improve function by increasing strength and endurance (Jones et al 1997).
Bedridden patients in the ICU bask from the benefits of physiotherapy through postural drainage and appropriate positioning that prevents and mitigates decubitus ulcers, contractures and deformities.
Abba Muhammad Tawfiq is a 500 level Medical Rehabilitation Student at the University of Maiduguri.
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Very educative and wonderful paper, thank you so much but that means only cardiopulmonary physiotherapist are in ICU
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What a nice piece? Keep inking! keep penning!