ROLE OF PT IN ICU
Goals of PT in ICU
1. Improve / maintain normal or baseline
ventilation and oxygenation
2. Improve / maintain musculoskeletal system
within functional limit
- Improve range of motion
- Improve muscle strength and endurance
- Prevent joint deformities and
contractures
Goals-contd...
3. Improve circulatory system function
4. Improve / maintain neurological system and
cognitive status within the functional limits.
5. Improve / maintain level of functional status
within patient tolerance
Assessment
• Cardiovascular system
• Respiratory system
• Neurological system
• Renal system
• Hematological system
• Gastrointestinal system
Cardiovascular system
• Heart rate and rhythm
• Arterial BP
• Central Venous pressure
• Pulmonary Artery pressure (PAP)
Neurological system
• Level of consciousness (Glascow coma scale)
• Pupils
– Size
– Reactivity
– Equality
• Cerebral perfusion pressure (>70mmHg)
CPP = MAP- ICP (Mean arterial pressure-Intra
cranial pressure)
• Intracranial pressure (<10mmHg)
Intracranial pressure measurement
Renal system
• Assessment of fluid balance
– Measure of Intravascular volumes
– Urine output
– Serum electrolytes
– ABG
Gastrointestinal system
• Nutritional support
– Routes of administration
– Enteral ( Ryles tube)
– Parentral ( Venous line)
– Oral
CARDIO PULMONARY
DYSFUNCTION
1. PRIMARY
- Respiratory failure
- Heart failure
- Cardiac surgeries
- Thoracic surgeries
2. SECONDARY
- Burns
- Head injuries
- Musculoskeletal trauma
- Neuro muscular dysfunctions
- Acute spinal cord injuries
- Renal failure
- Complicated general surgeries
Respiratory system
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Auscultation
Percussion
Expansion
Chest X-ray
Mode of ventilation
Humidification
Oxygen therapy
Respiratory rate
Airway pressures
ABG
Sputum
Assessment
General Observation
 Patient Position
 Respiration
- Airway Endo Tracheal / Tracheostomy
Ventillator Mode & FiO2
 Vital Signs – Temperature, BP, RR, HR SpO2,GCS, ICP
 Tubes - CV line, Peripheral line, Chest tubes, Catheters
 Drugs
Examination
 Auscultations
 Respiratory pattern
 Cyanosis
 Clubbing
 Radiograph
Goals
• Prevent accumulation of secretions
• Improve mobilization and drainage of
secretions
• Promote relaxation to improve breathing
patterns
• Promote improved respiratory function
• Improve cardio-pulmonary exercise tolerance
Precautions
• Untreated tension pneumothorax
• Status asthmaticus
• Immediately following intra cranial surgery
• Head injury with raised ICP
• Osteoporotic bones
• Recent acute myocardial infarction, unstable vitals
• Sutures and Intercostal drainage
Physiotherapy Techniques
• Gravity-assisted Positioning
• Manual techniques
• Manual hyperinflation
• Airway suctioning
• Chest Mobilization
Physiological effects of Positioning
• Optimizes oxygen transport by improving V/Q mismatch
• Increases lung volumes
• Reduces the work of breathing
• Minimizes the work of heart
• Enhances mucociliary clearance (postural drainage)
Chest Mobilization
• Chest Vibrations
• Chest Percussion/Clapping
• Postural drainage
Chest Percussion / Vibration
PERCUSSION consists of rhythmic clapping on the chest
with loose wrist & cupped hand.
• Effect : Dislodges & loosens secretions from the lung
VIBRATIONS consists of a fine oscillation of the hands
directed inwards against the chest, performed on exhalation
after deep inhalation.
• Effects: Helpful in moving loosened mucous plugs towards
larger airway
Manual Hyperinflation (MH)
• This is inflating the lungs with oxygen and manual compression to a
tidal volume.
Indications
• To aid removal of secretions
• To aid reinflation of atelectatic segments
• To assess lung compliance
• To improve lung compliance
Hazards of Manual Hyperinflation
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Reduction in blood pressure
Reduced saturation
Raised intracranial pressure
Reduced respiratory drive
Hemodynamic and metabolic upset
Risk of barotrauma
Discomfort and anxiety
Contraindications
• Undrained Pneumothorax
• Severe bronchospasm
• Cardiac arrhythmias
• Unexplained Hemoptysis
• Patient on High PEEP (Positive end expiratory
pressure)
Advantages of MH
• Reverses atelectasis
• Improves oxygen saturation and lung compliance
• Improves sputum clearance
Suctioning
• Suctioning is the mechanical aspiration of pulmonary secretions from a
patient with an artificial airway in place.
• Indications
– Inability to cough effectively
– Sputum plugging
– To assess tube patency
Contraindication
• Frank hemoptysis
• Severe brochospasm
• Undrained pneumothorax
• The suction catheter used must be less than
half the diameter of endotracheal tube.
• The vacuum pressure should be as low as
possible. (60-150mmHg)
• Suction should never be routine, only when
there is an indication
Hazards of suctioning
• Mucosal trauma
• Cardiac arrhythmias
• Hypoxia
• Raised intracranial pressure
ROUTE OF SUCTION
• Nasal and oral suction
• Endotracheal suction
• Tracheostomy suction
Mobilisation
• Critically ill
(Frequent Position changes, Kinetic & Kinematic Therapy)
• Stable
(Progressive tilting & Ambulation)
Mobilization
• ICU rehabilitation has been shown to accelerate
recovery
• Early mobilization for unconscious patients
starts right from turning the patient every two
hours.
• Graded exercises can be started as soon as the
patient regains consciousness.
• Activity is required to maintain sensory input,
comfort, joint mobility and healing ability.
• Activity minimizes the weakness caused by
loss of muscle mass
• Graded ambulation can be started depending
on patients condition