Respiratory physiotherapy in the critical care unit

Abstract

Physiotherapists are an integral part of the multidisciplinary team in the critical care unit and are skilled in the multisystem patient assessment and treatment of both intubated and spontaneously breathing patients. In addition to respiratory management, other key roles include the management of neurological and musculoskeletal complications of critical care. Historically, the main focus of physiotherapy in critical care had been the management of respiratory complications; however, there is now evidence that survivors of critical care have long-standing weakness and limitations of functional capacity that has led to exercise rehabilitation being incorporated into standard practice. Respiratory pathologies are among the most common cause of admission to critical care. A number of patients will also progress to respiratory failure during their admission; this could be secondary to postoperative respiratory failure, the development of pneumonia, in particular ventilator-associated pneumonia (VAP) or after a failed extubation. While the exact role of the physiotherapist varies across critical care units within the UK and also worldwide, many of the techniques outlined below are likely to be used. There is a lack of randomized controlled trials to support the role of the physiotherapist, but there is a long history of physiotherapists playing a pivotal part in critical care teams. The aim of this article is to provide an overview of these techniques.