Flashcards in Physiotherapy Treatment in ICU [Lecture Notes] Deck (10)
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
Respiratory muscle weakness in ICU caused by:
Disuse atrophy (following MV)
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