Nowadays physiotherapists are an integral part of a multidisciplinary team in most of the intensive care units (ICU) in Bangladesh. Doctors and hospital management realising the importance of physiotherapy management in ICU.
According to WCPT (World Confederation for Physical Therapy), Physiotherapy in ICU helps to reduce patient morbidity and mortality and prevent increased length of ICU and hospital stay. The focus of physiotherapy treatment in ICU is respiratory physiotherapy and physical rehabilitation.
Every day our lungs produce fluid called sputum. Sputum traps the dirt particles that we breathe in and to clean the lungs this is normally coughed and cleared. Patients in ICU may require mechanical ventilation that helps for breathing but it stops patients from coughing and clearing the daily sputum load that causes sputum retention, chest infection or other complications.
Importance of respiratory physiotherapy in ICU:
* Reduce sputum retention, atelectasis and pneumonia
* Maintain lung volume
* Reduce airway resistance and work of breathing
* Optimise oxygenation and ventilation
* Improve respiratory muscle strength
* Improve ventilation/perfusion mismatch
* Minimise postoperative complications
* Decrease patient’s dependency on the ventilator.
Prolonged immobility or inactivity is a contributing factor of muscle weakness in ICU patients. According to The Chartered Society of Physiotherapy (CSP)-UK, patients who are mechanically ventilated for more than 7 days, 25% display significant muscle weakness, and approximately 90% of long-term ICU survivors will have ongoing muscle weakness. They can also experience joint stiffness, muscle tightness and reduce overall fitness. Physiotherapy rehabilitation programme plays an integral role in the treatment and prevention of these complications.
Importance of physical rehabilitation in ICU:
* Maintain joint range of movement
* Maintain muscle strength
* Help to improve cardio respiratory fitness
* Reduce venous stasis and risk of deep-vein thrombosis
* Maintain and improve exercise tolerance
* Maintain bone density
* Provide positive psychological benefits
* Aid to return to function and daily life
Physiotherapy in the ICU improves patient’s physical wellbeing, facilitating weaning and promoting safe and early discharge from the intensive care unit. Early mobilisation results in decreased length of stay in ICU as well as overall hospital stay. ICU related complications such as deconditioning, muscle weakness, respiratory infections and contractures, can be prevented by early physiotherapy intervention.
The writer is a neurodynamic specialist and clinical physiotherapist by
Zahid Bin Sultan
Center for Physiotherapy & Mobility