Physiotherapy In Intensive Care Unit Research Articles

Approaches of Physiotherapy in Intensive Care Unit A Point of View

Physiotherapy is the simplest way of treatment used in all world to be applied in cardiopulmonary patients. The techniques involved to give to the patients’ better conditions of life and to avoid the implications of these ills, to meliorate the physical conditions and the quality of life. This work pretends to present the utilization of physiotherapist methods and its consequences in develop better conditions through the patients. Presenting this revision guide to give a north to all physiotherapist and their patients.

Physiotherapy Practice Pattern in the Adult Intensive Care Units of Singapore – A Multi-Centre Survey

Background The roles of physiotherapy in Intensive Care Unit (ICU) have significantly developed from the traditional management of respiratory conditions to early rehabilitation and mobilisation of patients on mechanical ventilation. Surveys of United Kingdom, Australia and regional ICU physiotherapy practice have been published but there are no local data sets. This study aims to report the physiotherapy practices across the adult ICUs of Singapore. Methods Twenty-nine item questionnaire was mailed to 90 physiotherapists working in 15 adult ICUs across restructured and private hospitals in Singapore. Data sets were summarised from the returned questionnaires. This includes identifying common physiotherapy techniques and exercise prescription protocols for both mechanically and non-mechanically ventilated patients in the ICU. Results A total of 63 (70%) questionnaires were returned. The most used physiotherapy interventions were airway secretion clearance, techniques to improve lung ventilation and mobilisation out of bed. Positioning was most used respiratory technique (60/61, 98%). Sitting on the edge of bed is the most preferred physical activity for ICU patients (43/44, 98%). Exercise was routinely prescribed (50/61, 83%) although only a minority (8/50, 16%) have established exercise prescription protocols. For mechanically ventilated patients, active/active assisted exercises were most used (40/44, 91%). 12% of ICU use either Chelsea Critical Care Physical Assessment Tool or the Functional Status Score for the Intensive Care Unit as routine outcome measures. Conclusion Airway clearance was stated as the most used physiotherapy technique. Exercise is routinely prescribed in ICU. Validated outcome measures are only used by few.

Physical Therapy Intervention with Adult Patients in an Intensive Care Unit

Some events that prove something hints that higher doses of getting something ready for action could have benefits on functional status. However, the effect of increasing the availability of Physical Therapist in the intensive care unit to provide critical care for these conditions is unclear. Early getting something ready for action of patients in the intensive care unit (ICU) is related to positive health benefits. Research books don’t have understanding of the current status of ICU physical therapy (PT) practice in the different area of the world. Aim to figure out the current standard of ICU PT practice, point of view, and things that block or stop other things. Critical care is full of possible upsetting things. Common upsetting things include pain, sleeplessness, mechanical machines that bring fresh air, tubes in the nose and mouth, genitourinary thin flexible tube inserted into the body, noise, seeing or hearing things that aren't there, discomfort due to medical procedures, thoughts of death, and doubt. Left untreated, not enough drug-induced calmness or sleep can lead to unplanned exudation, lung-related and heart-related difficulties, increased time on mechanical machines that bring fresh air and lengthy ICU stay.

Perception, experience and knowledge of early physiotherapy in intensive care units of Rome: a survey.

Early physiotherapy (EP) programs on critically ill patients in the intensive care unit (ICU) have proven to be safe, feasible and effective. However, despite being considered by all the professionals involved as a fundamental aspect of integrated care, in most cases they are inadequately applied or not performed at all. The main objective of this study is to evaluate the knowledge, perceptions and activities related to EP among physician, nurses and physiotherapists who practice in ICUs of Rome. Obstacles to its application and possible strategies to overcome them are also examined. The study was conducted according to the CHERRIES recommendations. Two questionnaires with 29 questions were created on the Google Form platform and were sent by mail to all the ICUs of public hospitals or accredited private hospitals with the National Health Service in Rome. Thirty (60%) of the contacted ICUs responded. The physiotherapist is present in 76.7% of ICUs and carries out its activities mainly during daytime hours (60.9%), for less than 3 hours in 39.1% of cases and only after a request for specialist advice (65.2%). Only in 4.3% of cases the service is guaranteed even at weekends but only after a request. All 29 professionals interviewed consider both the presence of a physiotherapist within the interdisciplinary team of the ICU and the implementation of an EP program to be necessary, supporting the positive effects of this program. The most frequently obstacles to the implementation of an EP program are clinical instability (69%), low priority to EP practice (62.1%), cardiovascular instability (58.6%) and lack of experience (58.6%). The most frequently indicated strategies to overcome these obstacles are to organize interdisciplinary briefings (86.2%), to avoid excluding patients from treatment without specific motivation (75.9%), to invest in staff training (75.9%), to use protocols and guidelines (58.6%). EP is not currently exploited to its full potential due to lack of funds, culture, experience, training and a hospital organization that limits the provision of effective patient care and efficient service to the National Health Service.

Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multicentre Cross-Sectional Survey.

Background Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia. Aim To determine the current standard of ICU PT practice, attitude, and barriers. Methods A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU. Results The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (n = 111, 89%) and stroke (n = 102, 82.3%) as compared to congestive heart failure (n = 20, 16.1%) and pulmonary infections (n = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (n = 102, 82.2%) and positioning (n = 73, 58.8%), whereas functional electrical stimulation (n = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (n = 89, 71.7%) followed by inadequate training (n = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (n = 8, 6.4%). Conclusion PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.

24/7 Physical Therapy Intervention With Adult Patients in a Chilean Intensive Care Unit: A Cost-Benefit Analysis in a Developing Country

ObjectivesPhysiotherapy in an adult intensive care unit (ICU) affects health outcome. To justify the investment in ICU physical therapy, the cost savings associated with its benefits need to be established. The main objective of this study is to evaluate the potential cost savings of implementing 24-hour, 7-days-per-week physiotherapist (24/7-PT) in a Chilean public high-complex specialized ICU. MethodsUsing clinical data from a literature review and a micro-costing technique, we conducted a cost-benefit analysis in the National Institute of Thorax in Chile. Our example scenario involves 697 theoretical admissions of adult patients with cardiovascular or respiratory diseases, and the costs and benefits by reduction of length of stay in ICU, days of mechanical ventilation, and days with respiratory infections during the first year and 5 years of admissions. A sensitivity analysis was considered according to the variability in total costs, production income, and clinical benefits. ResultsNet cost savings generated in our example scenario demonstrate that the implementation of 24/7-PT produces a minimum saving for the institution of $16 242 during the first year and $69 351 over a 5-year interval considering individual income production. Out of the 30 scenarios included in the sensitivity analyses, 26 (87%) demonstrated net savings. ConclusionsA financial model, based on literature review and actual cost data, projects that 24/7-PT intervention is a cost-benefit alternative in adult ICU patients with cardiovascular or respiratory diseases in Chile. It is necessary a scenario of at least 3 sessions per day with insurance payment for individual treatments to support the long-term implementation of a 24/7-PT program.

The Place of Early Rehabilitation in Intensive Care Unit for COVID-19.

To the Editor: Coronavirus disease 2019 (COVID-19) created a previously unseen pressure on public health systems. A main issue during the peak of the disease is the availability of intensive care unit (ICU) beds to manage the severe complications of COVID-19.1 Currently, the major focus is on acute care, but the surging number of people who recover from the infection is shifting medical attention to survivors discharged from ICUs. The challenge of COVID-19 requires a multidisciplinary approach. Rehabilitative intervention should be part of the treatment pathway from the early stages of the disease. There is an urgent need to build a knowledge based on the most effective nonpharmacological measures to ensure the earliest discharge and the best recovery after complicated COVID-19 infection. Multimodal rehabilitation, in every stage of the illness, must be part of a holistic medical approach, but consensus on timing and type of intervention is still missing. In light of the pressure on ICUs during the epidemic peak, we highlight the role of an often-undervalued approach to reduce the length of hospital stay and the burden on health care systems. Early physiotherapy in acute respiratory distress syndrome, beginning early in ICU, is a critical therapeutic tool to reduce complications of immobilization in critical illness, such as myopathy, neuropathy, and ventilator dependency. Benefits include improved residual respiratory, musculoskeletal, neurological, and psychological function; it prevents readmissions in the medium and long term, improves health status, and perceived quality of life after discharge.2–4 Interventions in an acute setting may also motivate active recipients’ involvement in their rehabilitation pathway, increasing the compliance with treatment after discharge. The benefits of early rehabilitative intervention in ICU for acute respiratory distress syndrome5 are clear, but if this approach is appropriate for COVID-19, co-infection is still controversial. There are suggestions that rehabilitation is not required in the acute stage of the condition6 or recommended only after weaning.7 To clarify this topical issue, authors set up an interventional, two-arm, nonrandomized trial comparing hospital length of stay in individuals receiving early physiotherapy in ICU versus those who did not (NCT04381338). Participants are enrolled in two teaching hospitals in the Veneto region (Padova and Verona, Italy), which each provides a different standard of care, with early intervention in one but not in the other. In Padova, all individuals with COVID-19 admitted to ICU with a diagnosis of acute respiratory distress syndrome are enrolled, in an early rehabilitation intervention protocol as part of the local standard of care (for details, see https://clinicaltrials.gov/ct2/show/NCT04381338?term=rehab&cond=COVID&draw=2&rank=1). At admission, a multidisciplinary assessment confirms enrolment criteria.5 Stabile cardiovascular, respiratory, and general parameters (ie, fever, thoracic radiography) are mandatory to start and continue sessions (20 mins each, 3 times daily/6 day a week). In Verona, no rehabilitative intervention takes place during ICU admissions. The program is based on the level of consciousness (Glasgow Coma Scale8), regardless of ventilation modality: unconscious individuals (Glasgow Coma Scale score ≤ 8) are offered passive mobilization and pronation, whereas conscious persons start a hierarchical, personalized protocol. The program includes endurance, functional, respiratory, and strength training. Dysphagia, which often complicates intubation, is also treated during sessions. After ICU discharge, multimodal physiotherapy treatment continues throughout the hospital stay. An individualized program is agreed for home discharge, focusing on recovering autonomous daily-living skills and counteracting muscular and cardiovascular deconditioning. An assessment on the role of individual clinical history, pre–COVID-19 performance status, preexisting drug therapy, level of ventilator support, hemodynamic and postural management during admission, and complications to correlate with the intervention and outcomes will be made. Findings will provide essential information in case of a new wave of COVID-19 infection and will be instrumental to support timely and personalized rehabilitation in these people. In view of the difficult circumstances, it is essential that this information is shared, particularly about practices that it is not yet fully cognizant to establish whether they have a role to play. Stefano Masiero, MD Department of Neuroscience Section of Rehabilitation University General Hospital of Padova Padova, Italy Laboratory of Clinical Analysis and Biomechanics of Movement NEUROMOVE-Rehab University Hospital of Padova Padova, Italy PNC Padova Neuroscience Center Padova, ItalyDavide Zampieri, MD, PhD Department of Neuroscience Section of Rehabilitation University General Hospital of Padova Padova, ItalyAlessandra Del Felice, MD, PhD Department of Neuroscience Section of Rehabilitation University General Hospital of Padova Padova, Italy Laboratory of Clinical Analysis and Biomechanics of Movement NEUROMOVE-Rehab University Hospital of Padova Padova, Italy PNC, Padova Neuroscience Center, Padova, Italy

Comprehensive physiotherapy management in covid-19 – a narrative review

The 2019 novel coronavirus officially named as coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization, has spread to more than 180 countries. The ongoing global pandemic of severe acute respiratory syndrome coronavirus, which causes COVID-19, spread to the United Kingdom (UK) in January 2020. Transmission within the UK was confirmed in February, leading to an epidemic with a rapid increase in cases in March. As on April 25- 2020, there have been 148,377 confirmed cases of COVID-19 in the UK and 20,319 people with confirmed infection have died. Survival of critically ill patients is frequently associated with significant functional impairment and reduced health-related quality of life. Early physiotherapy and community rehabilitation of COVID-19 patients has recently been identified as an essential therapeutic tool and has become a crucial evidence-based component in the management of these patients. This comprehensive narrative review aims to describe recent progress in the application of physiotherapy management in COVID 19 patients. Assessment and evidence- based treatment of these patients should include prevention, reduction of adverse consequences in immobilization, and long-term impairment sequelae. A variety of techniques and modalities of early physiotherapy in intensive care unit are suggested by clinical research. They should be applied according to the stage of the disease, comorbidities, and patient’s level of cooperation.

Physiotherapy and Rehabilitation Implementation in Intensive Care Units: A Survey Study.

Physiotherapy in the intensive care unit (ICU) improves patient outcomes. We aimed to determine the characteristics of physiotherapy practice and critical barriers toward applying physiotherapy in ICUs. A 54-item survey for determining the characteristics of physiotherapists and physiotherapy applications in the ICU was developed. The survey was electronically sent to potential participants through Turkish Physiotherapy Association network. Sixty-five physiotherapists (47F and 18M; 23-52 years; ICU experience: 6.0±6.2 years) completed the survey. The data were analyzed using quantitative and qualitative methods. The duration of ICU practice was 3.51±2.10 h/day. Positioning (90.8%), active exercises (90.8%), breathing exercises (89.2%), passive exercises (87.7%), and percussion (87.7%) were the most commonly used applications. The barriers were related to physiotherapist (low level of employment and practice, lack of shift); patient (unwillingness, instability, participation restriction); teamwork (lack of awareness and communication); equipment (inadequacy, non-priority to purchase); and legal (reimbursement, lack of direct physiotherapy access, non-recognition of autonomy) procedures. The most common interventions were positioning, active, passive, and breathing exercises and percussion. Critical barriers toward physiotherapy are multifactorial and related to physiotherapists, patients, team, equipment, and legal procedures. Physiotherapist employment, service maintenance, and multidisciplinary teamwork should be considered for physiotherapy effectiveness in ICUs.

Hemodynamic Effects of Early Physiotherapy in Intensive Care Unit after Chest Surgery

Amaç: Çalışmamızın amacı torokotomi sonrası yoğun bakım ünitesinde yatmakta olan hastalarda erken dönemde uygulanan fizyoterapinin hemodinamik etkilerinin belirlenmesidir.Gereç ve Yöntemler: Torokotomi yapılan ve cerrahi yoğun bakımda 24 saatlerini tamamlayan hastalar çalışmaya dahil edildi. Hastalara solunum egzersizleri, insentif spirometre çalışması, destekli öksürme ve mobilizasyon içerikli fizyoterapi programı, cerrahi yoğun bakım ünitesinde uygulandı. Hastaların tedavi öncesinde, sonrasında ve 5 dakika toparlanmalarının ardından sistolik (SKB) ve diastolik kan basınçları (DKB), kalp hızı (KH) ve oksijen saturasyonları (SpO2) kaydedildi. Ağrı seviyeleri ise vizüel analog skalası (VAS, 0-10) kullanılarak değerlendirildi.Bulgular: Yirmiikisi (%30) kadın, 50 (%70)’si erkek, yaş ortalaması 59 olan 72 hasta çalışmaya alındı. Tedavi öncesi ve sonrası karşılaştırılmasında DKB’de yükselme (p=,006), tedavi sonrası ve 5 dakika toparlanma karşılaştırılmasında KH’de düşme (p=,008), tedavi öncesi ve 5 dakika toparlanma karşılaştırmasında ise KH’deki düşme (p=,026) ve DKB’deki yükselme (p=,014) istatistiksel olarak anlamlıydı. Meydana gelen hemodinamik değişimler fizyolojik limitler içindeydi. Sonuç: Çalışmamızdan elde edilen sonuçlara göre cerrahi yoğun bakım ünitesinde uygulanan erken dönem fizyoterapi güvenlidir. Fizyolojik yanıtları gözlemlemek ve hasta güvenliğini sağlamak amacıyla fizyoterapi sırasında hemodinamik parametreler sürekli monitorize edilmelidir.

The role of physiotherapy in intensive care units: a critical review

Physiotherapy has been accepted as an integral part of critical care in developed countries. Preventing and managing pulmonary complications of ventilated and other critically ill patients is still considered to be the primary task of physiotherapists in India. As movement experts of the intensive care unit team, physiotherapists play a major role in preventing neuromuscular complications through early mobilization and therapeutic exercise prescription in the developed countries. This critical review analyses the physiological rationale behind the physiotherapeutic technique and existing research evidence pertaining to the role of physiotherapy in critical care. The paper also highlights the simple evidence-based protocol which was successfully implemented in a tertiary care hospital of India.

Respiratory physiotherapy in intensive care unit: Bibliographic review

Introduction and aimsPatients in intensive care unit are susceptible to complications due to different causes (underlying disease, immobilisation, infection risk…). The current main intervention in order to prevent these complications is respiratory physiotherapy, a common practice for nurses on a daily basis. Therefore, we decided to carry out this bibliographic review to describe the most efficient respiratory physiotherapy methods for the prevention and treatment of lung complications in patients in intensive care, taking into account the differences between intubated and non-intubated patients. MethodologyThe bibliographic narrative review was carried out on literature available in Pubmed, Cinahl and Cochrane Library. The established limits were language, evidence over the last 15 years and age. ResultsTechniques involving lung expansion, cough, vibration, percussion, postural drainage, incentive inspirometry and oscillatory and non-oscillatory systems are controversial regarding their efficacy as respiratory physiotherapy methods. However, non-invasive mechanical ventilation shows clear benefits. In the case of intubated patients, manual hyperinflation and secretion aspirations are highly efficient methods for the prevention of the potential complications mentioned above. In this case, other RP methods showed no clear efficiency when used individually. Discussion and conclusionsNon-invasive mechanical ventilation (for non-intubated patients) and manual hyperinflation (for intubated patients) proved to be the respiratory physiotherapy methods with the best results. The other techniques are more controversial and the results are not so clear. In both types of patients this literature review suggests that combined therapy is the most efficient.

Role of Physiotherapist in Critical Care Situations: Recent Perspective

AbstractPhysiotherapy is part of a multidisciplinary team and plays an important role in the critical care unit to improve patients’ quality of life. It is reported that a patient mechanically ventilated for more than a week shows muscular weakness approximately 25% and approximately 90% of patients have ongoing muscular weakness and poor quality of life. Physiotherapy in critical care units and high dependency units play a vital role to promote lung functions and early discharge. There are more ventilator-free days for patient with early physiotherapy in intensive care unit (ICU) compared with standard care. A large number of physical limitations are faced by patient and professionals in ICU and respiratory intermediate intensive care units. Declined pulmonary function, persistent muscle weakness, prolonged mechanical ventilation, and contracture are associated with poor quality of life and long-time staying in hospitals. Physiotherapy is a main component of patient management in critical care units and involves mobilization activities, functional positioning, passive- and active-assisted movements of extremities, sitting, bedside standing, walking with support, early mobilization, postural drainage, clear airway secretions, manual hyperinflation, percussion and vibration, assisted and resisted exercise, and electric stimulation.

Physiotherapy practice patterns in Intensive Care Units of Nepal: A multicenter survey.

Context:As physiotherapy (PT) is a young profession in Nepal, there is a dearth of insight into the common practices of physiotherapists in critical care.Aims:To identify the availability of PT services in Intensive Care Units (ICUs) and articulate the common practices by physiotherapists in ICUs of Nepal.Settings and Design:All tertiary care hospitals across Nepal with ICU facility via an exploratory cross-sectional survey.Subjects and Methods:An existing questionnaire was distributed to all the physiotherapists currently working in ICUs of Nepal with 2 years of experience. The survey was sent via E-mail or given in person to 86 physiotherapists.Statistical Analysis Used:Descriptive and inferential statistics according to nature of data.Results:The response rate was 60% (n = 52). In the majority of hospitals (68%), PT service was provided only after a physician consultation, and few hospitals (13%) had established hospital criteria for PT in ICUs. Private hospitals (57.1%) were providing PT service in weekends compared to government hospitals (32.1%) (P = 0.17). The likelihood of routine PT involvement varied significantly with the clinical scenarios (highest 71.2% status cerebrovascular accident, lowest 3.8% myocardial infarction, P < 0.001). The most preferred PT treatment was chest PT (53.8%) and positioning (21.2%) while least preferred was therapeutic exercise (3.8%) irrespective of clinical scenarios.Conclusions:There is a lack of regular PT service during weekends in ICUs of Nepal. Most of the cases are treated by physiotherapists only after physician's referral. The preferred intervention seems to be limited only to chest PT and physiotherapists are not practicing therapeutic exercise and functional mobility training to a great extent.

Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units

ObjectivesTo compare the physiotherapy service provided when therapists’ decisions are guided by an evidence-based protocol with usual care (i.e. patient management based on therapists’ clinical decisions). DesignExploratory, controlled, pragmatic sequential time block clinical trial. SettingLevel 3 surgical unit in a tertiary hospital in South Africa. ParticipantsAll patients admitted consecutively to the surgical unit over a 3-month period were allocated to usual or protocol care based on date of admission. InterventionsUsual care was provided by clinicians from the hospital department, and non-specialised physiotherapists were appointed as locum tenens to provide evidence-based protocol care. Main outcome measuresPatient waiting time, frequency of treatment sessions, tasks performed and adverse events. ResultsDuring protocol-care periods, treatment sessions were provided more frequently (P<0.001) and with a shorter waiting period (P<0.001). It was more likely for a rehabilitation management option to be included in a treatment session during protocol-care periods (odds ratio 2.34, 95% confidence interval 1.66 to 3.43; P<0.001). No difference in the risk of an adverse event was found between protocol-care and usual-care periods (P=0.34). ConclusionsPhysiotherapy services provided in intensive care units (ICUs) when the decisions of non-specialised therapists are guided by an evidence-based protocol are safe, differ from usual care, and reflect international consensus on current best evidence for physiotherapy in ICUs. Non-specialised therapists can use this protocol to provide evidence-based physiotherapy services to their patients. Future trials are needed to establish whether or not this will improve patient outcome.

Staff-Perceived Barriers and Facilitators

Staff-Perceived Barriers and Facilitators