Physiotherapy Treatment in ICU [Lecture Notes] Flashcards
Broad aims of Physiotherapy treatment in ICU?
- Prevention of sequelae of immobility and bed rest
- Respiratory care inventions
- Early mobilisation and rehabilitation
What is the rationale for respiratory physiotherapy in ICU?
Well the admitting diagnosis, intubation and mechanical ventilation, prolonged recumbant positioning/sedenatry, as well as altered V/Q can lead to:
- Increased atelectasis
- Increased secretion pooling
- Increased risk of ventilator associated pneumonia (VAP)
__________ may the only Rx for CV unstable patients
Positioning
Respiratory muscle weakness in ICU caused by:
Disuse atrophy (following MV)
Sepsis
CIP/CIM
Malnutrition
Absolute contraindications to exercise
- Spinal or pelvic #
- Haemodynamic instability
- Respiratory insufficiency
- High ICP or reduced CPP
- PAO2:FIO2 <200
According to evidence, what is stopping us to mobilise?
- Difficult culture to change
- Heavy sedation is needed for patients who require MV [physiologically unstable, potential dislodgement of equipment, patient comfort]
- The notion that early rehabilitation is ‘dangerous’ but in reality adverse events is <4%
- Not considered a priority/see it as an overwhelming task
The aims of hyperinflation techniques are to:
- Prevent and treat atelectasis
- Clear secretions
- Improve lung compliance
Hyperinflation can be achieved in two ways:
1) Using a ‘bagging’ circuit -> manual hyperinflation (MHI)
- Using a ventilator -> ventilator hyperinflation (VHI)
Manual hyperinflation delivers…
Larger than BASELINE (up to 50% greater) lung volumes to patient by an anaesthetic bag
Ventilator hyperinflation is achieved by
altering the ventilator settings to gradually increase lung volumes
It may produce the same effects as MHI whilst maintaining the PEEP level and controlling airway pressure limits
