Week 4 - Physio in ICU

Question 1

What treatment options do you have for reduced lung volumes in ICU?

2 points

Answer 1

-Positioning
Intubuated versions of deep breathing e.g.
-MHI
-VHI
-REcruitment manouvres??

Question 2

What are your treatments options to manage excess secretions in ICU?

4 points

Answer 2

Facilitate secretion movement (drainage, MHI, VHI)
Manual techniques (percussion, vibes)
Extra humidification (saline plus suction)
Suction

Question 3

What are some precautions to suction?

4 points

Answer 3

Severe hypoxemia
Unstable CV system
Bleeding disorders
Bronchial stump

Question 4

What methods are used for weaning?

3 points

Answer 4

Step down assistance
T-piece
NIV

Question 5

Why might patients fail to wean?

5 points

Answer 5

Cannot manage secretions (excess sputum, ineffective cough)
Cannot move enough air for ventialory needs (and insufficient spontanous effort)
Underlying problem not resolved (e.g. CV problems)
Diaphragm stealing theory
Can’t respond to commands

Question 6

What is the role of the physiotherapist in weaning?

6 points

Answer 6

• Minimise airway resistance
• maximise lung compliance
• optimise respiratory mechanics
• Prevent peripheral deconditioning
• Reassure and minimise demand during weaning trials
• Respiratory muscle training

Question 7

What are the causes of ICU acquired weakness?

2

Answer 7

Prolonged bed rest leads to catabolism, decreased protein synthesis and wasting.
Insulin resistance can injure muscles and nerves

Question 8

What can the physio do about ICU acquired weakness?

3 points

Answer 8

Early mobilisation
Bed exercises
Guide functional rehabilitation

Question 9

What is the innervation of the muscles of respiration?

Answer 9

C3,4,5 Diaphragm
T1-11 intercostals
T5-12 abdo

Question 10

What are the effects of SCI on respiration?

4

Answer 10

Respiratory fatigue
chest infections
loss of volume
can’t clear secretions

Question 11

How would you treat some of the effects of SCI on respiration?

Answer 11

Loss of volume:
Position, positive pressure (bird, BiPAP, MHI), manual techniques, incentive spirometry

secretions:
abct, positioning, positive pressure, cough assist, manual techniques, suction

fatigue:
positioning, NIV or vent. support, ICU if needed

Question 12

What are the treatments for sleep disordered breathing?

OSA
CSA
Nocturnal hypoventilation
Secretions

Answer 12

OSA: CPAP
CSA: CPAP or adaptive servoventilation
Nocturnal hypo: NIV or Bilevel
Secretions: mechanically assisted cough or cough-assist

Question 13

What is the difference between ARDS and ALI?

Answer 13

ARDS PaO2/FiO2