Therapies on ICU
Our therapists play a key role on ICU. They focus on the following areas:
Physiotherapists aim to make the best of a patient’s respiratory function in the following ways:
Assessment of ventilated (connected to a ventilator or ‘breathing machine’) and self-ventilating patients, as well as chest and breathing function.
Treatments to improve and prevent deterioration of lung volumes. This is to help patients with chest infections clear their sputum and prevent further infection. Treatments may include positioning, manual techniques, suction, manipulation of ventilation, manual hyperinflation, cough assistance, mobility and strengthening exercises.
Assistance to get the best from mechanical ventilation and weaning the patient from this. Weaning is the process of reducing ventilator support and lessening the reliance on the tube for breathing.
Assistance in the care of tracheotomised patients. A tracheostomy is a procedure to make a hole in the throat and insert a tube, which is connected to the ventilator.
Physiotherapists work closely with occupational therapists and the rest of the ICU team to restore and maintain patients’ physical strength and function following prolonged ventilation, illness, surgery and/or bed rest.
Early rehabilitation has been shown to be safe and effective and may include:
Stretching and mobilising the limbs to maintain range of movement.
Early mobilisation – assessing patient's readiness to move as early as the day after surgery, or while they are still on a ventilator.
Transfer practice to get the patient out of bed as soon as possible.
Patient-centred exercise programmes, including cardiovascular fitness, strength training and balance exercise.
Helping with personal care and restoring the activities of daily living.
Rehabilitation of patients, alongside their respiratory management, aims to improve physical abilities and work towards regaining independence and quality of life.
Bringing the patient off the ventilator
Patients in the ICU sometimes require a tracheostomy. A tracheostomy is a procedure to make a small hole in the front of the throat to insert a tube, which is connected to a ventilator or 'breathing machine'. A tracheostomy may be inserted for a number of reasons, including to:
- provide prolonged mechanical ventilation with the support of a machine
- bypass an upper airway obstruction
- assist in secretion management
- allow reduction of sedation so patients can communicate and participate in rehabilitation
Once the tracheostomy tube is inserted a process called ‘weaning’ will commence. This is the process of reducing ventilator support and reliance on the ventilator tube for breathing. The aim is for the patient to breathe for themselves, so that the process of removing the tracheostomy tube, known as decannulation, can begin.
Both physiotherapists and speech and language therapists, working with the MDT, are involved throughout the process of weaning and decannulation.
Physiotherapists and speech and language therapists will assess respiratory function, swallow function, communication, cough strength and secretion management. These ongoing assessments will be used to create a plan to gradually reduce the amount of ventilator support and increase the times when the patient will breathe on their own. This will begin with small intervals that will gradually become longer.
A ventilator can provide different ways and amounts of mechanical support for a patient’s breathing, depending on what is required. The aim is to reduce the amount of ventilator support and oxygen requirement over time. This enables the patient to regain strength in their breathing muscles.
Alongside weaning from ventilation, the team will try to restore a more natural respiratory function. One way to do this is with the use of one-way valves, or speaking valves. These valves cover the opening of the tracheostomy tube allowing air in when the patient breathes, but close when the patient breathes out, allowing air past the vocal cords and out through the nose and mouth. The patient may be able to speak with the one-way valve in place. The length of time a patient can tolerate a one-way valve will vary.
Once the patient has been weaned from the ventilator and is tolerating an extended period on a one-way valve, decannulation can be considered.
The process of weaning runs alongside ongoing medical care and rehabilitation. These factors are also considered when making a decannulation decision.