Surviving ICU Flashcards
Why might patients in ICU have respiratory problems?
- Due to reason for admission or PMHx
eg chest trauma, rib #, lung contusion
thoracic or abdominal surgery, pain, altered resp mechanics,
effects of anaesthetic
medical, community acquired pneumonia, asthma, COPD,
covid etc - Result of mechanical ventilation + other factors associated with ICU care
What is the ABCDEF bundle?
Has good preventative outcomes for PICS.
- Awakening (w/ light or minimal sedation)
- Breathing (spontaneous breathing rituals)
- Co-ordination of care & communication across disciplines
- Delirium assessment, prevention, and management
- Early ambulation and mobility
- Family engagement and empowerment
What can be the end result of respiratory complications in the ICU?
- Atelectasis
- Hypoxaemia
- Increased volume of airway secretions
- Reduced airway clearance
- Ventilator assisted pneumonia (VAP), more significant resp compromise, difficulties weaning from vent, death
What factors can cause respiratory complications in the ICU?
- Mechanical ventilation
- Medication
- Position (decreased FRC, VQ mismatch)
- Immobility (muscle mass loss incl resp muscles, limited position changes altering airway clearance and vent)
- Sedation (lack of spont. cough, decreased cilial movement, less frequent position change)
- NGT
What are some cardiovascular complications in ICU?
- Cardiac deconditioning
- Multisystem pathologies (eg sepsis, ARDS)
- Arrhythmia
- Hypo/hypertension
- Thromboembolism
How much muscle mass can be lost within 10 days in ICU?
Around 20%
What are some complications of muscle atrophy and weakness?
- Immobility
- Inflammation
- Dysfunctional micro-circulation
- Electrolyte disturbances
What are some neurological complications in ICU?
- Decreased level of consciousness
- Delirium
What are some additional complications in ICU?
- ICU acquired weakness, myopathies and neuropathies
- Multi organ dysfunction syndrome (MODS)
What are some commonly used functional outcome measures for patients in ICU?
- Physical Function in Intensive Care Test scored (PFIT-s)
- Functional Status Score for the ICU (FSS-ICU)
What is a common outcome measure for level of consciousness/sedation?
Richard Agitation Assessment Scale (RASS)
-5 = unarousable; 0 = alert and calm; +4 = combative
What is a common outcome measure for delirium?
Confusion Assessment Method for the ICU (CAM-ICU)
CAM-ICU positive (delirium present) = feature 1 + 2 AND either 3 or 4
ie acute change or fluctuating course of mental status + inattention AND altered level of consciousness (from RASS) or disorganised thinking
What are some examples of SHORT term physiotherapy goals for someone in ICU?
- Maintain strength and function
- Weaning from ventilator
- Prevent resp complications
What are some examples of LONG term goals for someone in ICU?
- Address ICU acquired weakness, any injuries/conditions arising from being in ICU
- Address trauma, depression, anxiety, patient’s “new normal”
What three domains can Post Intensive Care Syndrome (PICS) manifest?
- Physical
- Cognitive
- Psychological/mental health
