ICU
DR. MOHAMED SEYAM PHD. PT.
ASSISTANT PROFESSOR OF PHYSICAL THERAPY
INTENSIVE CARE UNIT
 intensive care unit (ICU), critical care unit (CCU), intensive therapy unit, or
intensive treatment unit (ITU): is a specialized department in a hospital that
provides intensive-care medicine.
 Specialized ICU designed and equipped to provide specialized care to patients
with specific conditions. For example, a neuromedical ICU cares for patients with
acute conditions involving the nervous system or patients who have just had
neurosurgical procedures and require equipment for monitoring and assessing
the brain and spinal cord.
 A neonatal ICU is designed and equipped to care for infants who are ill, born
prematurely, or have a condition requiring constant monitoring.
:
Members of the ICU Care Team
Medical staff typically includes intensivists with training in internal medicine,
surgery, anesthesia, or emergency medicine.
Many nurse practitioners and physician assistants with specialized training are
also part of the staff that provides continuity of care for patients.
Staff typically includes specially trained critical care, registered
nurses, registered respiratory therapists, clinical pharmacists,
nutritionists, physical therapists, occupational therapists,
certified nursing assistants, social workers.
TYPES OF ICU
11- Neuro intensive-care unit (NICU)
1- Neonatal intensive-care unit (NICU)
2- Special Care Nursery (SCN)
3- Pediatric intensive-care unit (PICU)
4- Psychiatric intensive-care unit (PICU)
5- Coronary care unit (CCU)
6- Cardiac Surgery intensive-care unit (CSICU)
7- Cardiovascular intensive-care unit (CVICU)
8- Medical intensive-care unit (MICU)
9- Medical Surgical intensive-care unit (MSICU)
10- Surgical intensive-care unit (SICU)
12- Bum wound intensive-care unit (BWICU)
13- Trauma Intensive care Unit (TICU)
14- Surgical Trauma intensive-care unit (STICU)
15- Trauma-Neuro Critical Care (TNCC)
16- Respiratory intensive-care unit (RICU)
17- Geriatric intensive-care unit (GICU)
18- Neuro trauma intensive-care unit (NICU)
Diseases and Injuries that can lead to critical illness.
1.
2.
3.
4.
5.
6.
Problems with the heart and blood vessels
Problems with the lungs
Problems with salts, chemicals, or minerals in the bloodstream
Brain injuries
Severe trauma
Major surgery
Monitoring and Life Support Equipment in
Intensive care Unit
1) Non Invasive Monitoring Equipment's
2) Invasive Monitoring Equipment's
3) Oxygen Delivery Devices
4) Chest Tube
5) Life Support Equipment
1- Patient monitoring equipment
1. Cardiac or heart monitors: are used to monitor the electrical activity of the heart
2. Pulse oximeter : allows us to monitor the saturation of oxygen in the blood.
3. Swan-Ganz catheter: is used to measure the amount of fluid filling the heart as
well as to determine how the heart is functioning
4. Arterial lines : are used for continuous monitoring of blood pressure
2- Tubes & Catheters in the ICU
1. Central venous catheter (CVC)
2. Intravenous (IV)
3. Chest tubes
4. Urinary catheter
5. Endotracheal tubes
If tube in greater than 4-5 days,
perform a tracheotomy.
Surgical
InterventionTracheostomy
Tracheostomy
Surgical procedure
performed when need
for an artificial airway
is expected to be long
term
Endotracheal Tube
3-Life support and emergency
resuscitative equipment
1. Ventilator (also called a respirator):
Controls pulmonary ventilation in patients who cannot breathe on their own.
Ventilators consist of a flexible breathing circuit , gas supply, heating, humidification
mechanism, monitors, and alarms.
They are microprocessor- controlled and programmable, and regulate the volume,
pressure, and flow of patient respiration .
2. Infusion pump: Infusion pumps employ automatic, programmable pumping
mechanisms to deliver continuous anesthesia, drugs, and blood infusions to the
patient.
•Device that delivers fluids intravenously or epidural through a catheter
4- Oxygen Delivery Devices
Oxygen therapy is the administration of oxygen as a medical
intervention, which can be for a variety of purposes in both chronic
and acute patient care.
Oxygen is essential for cell metabolism and essential for all normal
physiological functions.
High blood and tissue levels of oxygen can be helpful or damaging,
depending on circumstances and oxygen therapy should be used to
increasing the supply of oxygen to the lungs and thereby increasing the
availability of oxygen to the body tissues, especially when the patient is
suffering from hypoxia and/or hypoxaemia
Physical Therapy Role In ICU
1- Mobilization inside ICU
Mobilization should be used as a primary means for
•Reducing the effects of immobility and bed rest,
•Enhancing oxygen transport,
•Improving ventilation/perfusion (v/Q) matching,
•Increasing lung volumes,
•Reducing the work of breathing,
•Minimizing the work of the heart and
•Enhancing microciliary clearance in patients with
•Acute pulmonary disease, including patients in the ICU
Factors taken into consideration during positioning
1- If no part of the body remains in contact with a resistant surface for long enough,
pressure necrosis will not occur. But it is important to realize that the length of time which
the tissues can withstand ischemia and recover may be much less in an acutely ill patient
than in a healthy person. In a patient with a new spinal cord injury, less than half an hour of
unrelieved pressure may be sufficient to cause a sore.
2- Individuals who are 'at risk' of pressure ulcer development should be repositioned and
the frequency of reposition determined by the results of skin inspection and individual
needs not by a ritualistic schedule. Routinely, turning is done eveiy two hours, day and night.
3- The most susceptible areas, that is, where bony points are close to the skin, must be kept
free of any pressure by adjusting the pillows
accordingly.
4- At each turn, all areas need to be inspected, the skin is checked and all wrinkles and
debris are removed from the bed linen.
5- Any evidence of local pressure, however minor, is an urgent warning. Redness, which
does not fade on pressure, septic spots, bruising, swelling, induration or grazing
indicate an impending pressure sore. All pressure must be relieved from any area thus
affected until it is healed.
6- Reduce shear and friction. Avoid dragging the person across the bed sheets. Either
lift the person or have the person use an overhead trapeze to briefly raise his or her
body. Keep the bed free from crumbs and other particles that can rub and irritate the
skin. Do not raise thehead of the bed more than 30 degrees, unless your doctor tells
you otherwise. Use sheepskin boots and elbow pads to reduce friction on heels and
elbows.
7- Repositioning should take into consideration other aspects of an individual's
condition for example, medical condition, comfort,
overall plan of care i.e. how it fits into their overall plan of care (for example in relation
to other activities such as physiotherapy or occupational therapy, meal times,
attending to personal hygiene) and the surface they may be lying or sitting on.
8- Individuals who are considered to be acutely 'at risk' of developing pressure ulcers should
sit out of bed for less than two hours.
9- Positioning of patients should ensure that: prolonged pressure on bony prominences is
minimized; bony prominences are kept from direct contact with one another and friction and
shear damage is minimized.
10-A written/recorded re-positioning schedule agreed with the
individual, should be established for each person 'at risk'. This
record should also include actual position changes.
11-Individuals/carers who are willing and able should be taught
to redistribute their own weight.
12-Manual handling devices should be used correctly in order to
minimize shear and friction damage.
13-After maneuvering, slings, sleeves or other parts of the
handling equipment should not be left underneath individuals.
14-Correct lifting and handling techniques will also reduce the
risk to carers' backs.
2- Stretching:
Stretching to improve range of motion is an important method to improve the
patient's mobility.
It is particularly helpful in post operative cases who are hesitant to move their trunk
and extremities, as a result they are susceptible to develop muscle shortening and
deformities
3-Range of motion exercises (ROM):
They may be performed with ICU patients with the aim of
maintaining or improving joint range of motion,
soft-tissue length,
muscle strength and function,
and decreasing the risk of thromboembolism.
In addition to improving ROM, these exercises improve muscular strength
and endurance and may diminish the need for further chest
physiotherapy.
Types of ROM exercises:
1)
2)
3)
4)
Passive movement (CPM can be applied in ICU).
Active assistive exercises
Active free exercises
Active resistive exercises.
Active
Assisted
Exercises
4- Standing and ambulation:
When allowed, standing and ambulation should be
encouraged.
Early ambulation of ICU patients diminishes the need for
vigorous chest physiotherapy .
Sitting and standing balance are prerequisites for (independent
ambulation.
 For patients who can not bear full weight on one lower
extremity a walker or crutches may be used
5- Kinetic therapy
This therapy uses specific respiratory therapy products such as special beds.
These work by facilitating gas exchange using rotation movements, to prevent
'pooling' of secretions
It may be useful for preventing and treating respiratory complications in selected
critically ill patients receiving mechanical ventilation.
The rotation of the patient on a bed is hypothesized to improve drainage of
secretions within the lung and lower airways, to increase functional residual
capacity by providing an increased critical opening pressure to the independent
lung, and to reduce the risk of venous thrombosis and associated pulmonary
embolism.
Tilting table
6- Breathing Techniques
A variety of breathing techniques have been developed that
enhance cephalic airflow bias to improve secretion mobilization.
Directed cough with FET and ACBT is as effective in mobilizing
secretions and increasing lung volumes as is postural drainage
with percussion and vibration.
7-Forced Expiratory Technique
FET was first described in 1968 by Thompson and Thomps.
They described the use of 1 or 2 huffs from middle to low lung
volumes, with the glottis open, preceded and followed by a
period of relaxed, controlled diaphragmatic breathing, with slow
deep breaths.
Secretions mobilized from the lower to upper airways were
expectorated, and the process was repeated
8- Active Cycle of Breathing Techniques
The ACBTs are combinations of
1- Breathing Control,
2- Thoracic Expansion Control, And
3- Forced expiratory technique (FET)
Breathing control has been referred to as diaphragmatic breathing, or as gentle
breathing with the lower chest.
Thoracic expansion exercises are simply active inspirations with larger-than-normal
breaths.
The FET consists of 1 or 2 forced expirations or huffs, combined with a
period of controlled breathing.
Pneumatic
Compression
pump or
Vacuum
therapy to
prevent DVT
and improve
peripheral