Chest physical therapy in icu

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Chest physical therapy in icu 

Physiotherapy in the ICU

For patients with mechanical ventilation, early physiotherapy has been shown to improve quality of life and prevent ICU-related complications such as deconditioning, ventilator dependence, and respiratory conditions.

Despite the latest advances in medical care and mechanical ventilation (MV), critical illness in the intensive care unit (ICU) is still associated with a high mortality rate. 1 Furthermore, ICU victims may suffer from muscle weakness, physical disability, and long-standing cognitive problems. up to 5 years.2-5 These critically ill patients may show muscle wasting in the first week of the disease, with greater severity in patients with multiorgan failure compared to those who experience single organ failure.

Physiotherapy has been recommended by the scientific community as a major component in the management of patients with critical illnesses.7,8 The proposed strategy includes patient mobilization based on progressive sequences of activities such as changes in pressure sores and functional positions; passive, active and active mobilization; cycling and sitting in bed; and stand up, walk static, move from bed to chair, and walk. Early physiotherapy is intended to improve the quality of life of patients and prevent ICU-related complications such as deconditioning, ventilator dependence, and respiratory conditions. It has been proven that it is feasible and useful, even in patients who require extracorporeal membrane oxygenation (ECMO). 7-12 In addition, a pilot study shows that early rehabilitation can be extended beyond physical therapy to include cognitive therapy.

Weakness Acquired by ICU

Ambrosino-table1 Weaknesses obtained by the intensive care unit (ICUAW) were observed in the majority of patients who received MV for more than 1 week in the ICU. 6, 14-16 Etiology includes decondition and atrophy that are not used because of long rest and immobility. and critical illness polyneuropathy and / or myopathy, known as critical disease neuromyopathy. 17 Other risk factors for ICUAW include systemic inflammatory response syndrome, sepsis, and multiple organ dysfunction syndromes; hyperglycemia; and drugs, such as corticosteroid use and neuromuscular blocking agents. 18 As a consequence, recommendations for avoiding these risk factors have been suggested.

Implementation of early mobilization programs is feasible in most ICUs and provides benefits if initiated no later than 1 or 2 days after the initiation of MV. 9-11,15,20 Such programs should be given after cardiorespiratory and neurological stabilization.20-23 This approach, along with certain muscle training, can improve functional results and cognitive and respiratory conditions.

Rotation Therapy

Continuous rotation therapy uses a special bed to change patients along the longitudinal axis of up to 60 ° on each side, with a predetermined degree and rotational speed. It has been hypothesized that this modality can reduce the risk of sequential airway closure and pulmonary atelectasis, resulting in a reduction in the incidence of lower respiratory tract infections and pneumonia, and the duration of endotracheal intubation and length of hospital stay.

Chest physical therapy in icu  ahs.us.edu

Initial Mobilization

Ambrosino_Figure1 Initial mobilization can also be performed in unconscious or anesthetized patients.11 The protocol includes semirecumbent positioning with the head of the bed positioned at 45 °, frequent changes in body position, daily passive joint movement sessions and passive sleep cycles and electrical stimulation.

Many studies have concluded that early mobilization of critically ill patients can be carried out with a low risk in patients. Algorithms have been proposed as a guide in selecting patients suitable for mobilization and providing appropriate treatment strategies designed for each patient.8,11 Although the short-term effectiveness of early physiotherapy has been shown, more studies are needed to confirm the long-term responsiveness of survivors ICU for physiotherapy. In addition, even though it was acknowledged the benefits of early mobilization, only a small proportion of ICUs were able to provide full-time physiotherapy to these patients. As a consequence, we need to improve the ICU organization and team to provide early physiotherapy.26-29 Indeed, financial models, based on actual experience and published data, projects that invest in early ICU rehabilitation programs can result in net financial savings for the US. hospitals and even more clinical improvements for patients.

Airway Secretion Management

Patients with mechanical ventilation in the ICU can suffer from restrained secretions due to many causes. The mucociliary system can be disrupted by endotracheal intubation, with increased susceptibility to infection and volume and tenacity of mucus.

In addition, immovable patients can suffer from atelectasis, disruption of the cough mechanism, and associated inability to secrete secretions. Expiratory muscle weakness associated with lowering cough strength; in addition, fluid restriction contributes to secretion retention. 31,32. Helping airway cleaning in patients under the MV includes different techniques.

Postural drainage. Postural drainage traditionally includes a position that is aided by gravity, deep breathing exercises, chest claps, shock or vibration, and coughing with incentives to move airway secretion towards the upper airways.

Chest physical therapy in icu  ahs.uic.com

Chen et al conducted a randomized study in patients with mechanical ventilation in the ICU. The results show that percussion and postural drainage can increase lung collapse. Ntoumenopoulos et al37 suggested that chest physiotherapy might be useful in preventing ventilator-related pneumonia. Lemyze et al38 suggested that in critically obese patients under MV, continuous sitting position and significantly alleviating the limitations of expiratory flow and the final pressure of intrinsic-positive expiration (PEEPi) resulted in a dramatic decrease in alveolar pressure. Combining sitting positions and applying PEEP may be the best strategy in these patients.

Intrapulmonary percussion ventilation. Intrapulmonary percussive ventilation (IPV) is a high frequency ventilation modality that can be superimposed on spontaneous breathing. Intrapulmonary percussion ventilation can reduce the burden of respiratory muscles and help move airway secretions. This tool creates a percussive effect on the airways, thereby increasing the clearance of mucus through direct high-frequency oscillating vents that can help alveolar recruitment. The positive effects of this technique have been shown in patients with respiratory disorders, neuromuscular disease, and pulmonary atelectasis.

The physiological effects of IPV were studied by Vargas et al42 in patients with intubated COPD. Intrapulmonary percussion ventilation increases the reduction of the flow of restriction expiration and gas exchange. Dimassi et al conducted a prospective study to assess the short-term effects of IPV in high-risk patients for extubation failure who received noninvasive ventilation after extubation. The study concluded that noninvasive ventilation and IPV reduce respiratory rate and respiratory work. Clini et al44 conducted a multicenter trial randomly concluded that the addition of IPV increased gas exchange and expiratory muscle performance and reduced the incidence of pneumonia.

Positive expiratory pressure. Positive expiratory pressure (PEP), first introduced in the 1970s, consists of a one-way valve through a mask or funnel connected to one or several small exit holes and expiratory resistors that can be adjusted to enhance and promote the discharge of secretions with airway stenting , increase intrathoracic pressure, or increase functional residual capacity. 45 The benefits of PEP are still deep investigation. Systematic reviews assess the effectiveness of PEP in patients after thoracoabdominal surgery. Six randomized controlled trials were included comparing PEP with other breathing techniques or in addition to routine chest physiotherapy treatments. Only 1 in 6 trials showed a positive effect of PEP compared to other physiotherapy techniques.

Ambrosino_Figure2A new modality for providing low-level PEP in the mouth during spontaneous breathing is called temporary PEP, which has recently been proposed to treat patients with chronic mucous hypersecretion. This modality results in an increase of 1 cm H2O in airway pressure throughout the respiratory cycle until immediately before the end of expiration.