ICU protocols for physiotherapists

Oct. 8, 2011 - PRLog -- ICU PRTOCOLS FOR A PHYSICAL THERAPIST
Patient Referral:
All patients should be referred by the attending physician before assessment and treatment. The physical therapist is responsible to see the patient upon receiving the physical therapy referral request or according to standard order.
Patient Assessment:
Patient must be assessed within 3 days of referral or admission .
Primary Cardiopulmonary Dysfunction in the ICU:
1. Respiratory failure
2. Heart Failure
3. Cardiac Surgeries
4. Thoracic Surgeries
Secondary Cardiopulmonary Dysfunction in the ICU:
1. Burns
2. Head Injuries
3. Musculoskeletal Trauma
4. Neuromuscular Dysfunction
5. Acute Spinal Cord Injury
6. Renal Failure
7. Complicated General Surgeries  
PHYSICAL THERAPY GOALS FOR PATIENTS IN THE ICU:
1) Improve / Maintain Normal or Baseline Ventilation and Oxygenation.
a) Clearance of Airways
b) Improve Chest Expansion
c) Improve Breath Sound
d) Improve Cough Effectiveness  
e) Improve Breathing Pattern
2) Improve / Maintain Musculoskeletal System within Functional Limit.
a) Improve ROM
b) Improve Muscle Strength and Endurance
c) Prevent Joint Deformities and Contractures
3) Improve Circulatory System Function  
a) Prevent DVT  
b) Prevent Swelling
4) Improve / Maintain Neurological System and Cognitive Status within Functional Limits.    
5) Improve / Maintain Level of Functional Status within Patient's Tolerance.  
Points to remember:
1.  Monitor physiological responses such as heart rate,blood pressure, respiratory rate and oxygen saturation at all times.
2.  The physical therapist should be aware of effects of positioning and mobility of the patient on the various monitoring devices and their readings.
3.  The physical therapist should always deal with the patient as if he/she were conscious and awake even if the patient appears not to be (talk to him and explain all procedures he is going through, and do not talk about his condition within his hearing). This may help to relax the patient and decrease patient anxiety and possible subsequent increase in muscle tone.
4.  Frequency and intensity of treatment sessions will  be determined by patient condition, but should generally be at least twice a day.  
5.  Treatment should be carried out at least 1 1/2 hrs after feeding time.
6.  The physical therapist must be aware of patient's medication (appendix D), pertinent laboratory test result (appendix E), patient's management by other health care team, and patient's / family concerns.
7.  The physical therapist should be familiar with all  ICU equipment.  
Pulmonary System
(A) INTUBATED PATIENTS: (endotracheal tube or tracheostomy)
Unconscious
1. Pre-treat with bronchodilator if the patient presents with severe bronchospasm (20 min. before treatment).    
2. Modified postural drainage positions, usually with the head of the bed flat unless patient has an increase in intercranial pressure above 30 mmHg, then the head of the bed should be elevated to 30 degrees.    
If there are  no other contraindications (appendix F), then the following should be done by two therapists:
a) Turn patient to both sides and manually hyperventilate the patient using the “ambu bag" and hyperoxygenate using 10-15 L O2; if the patient who can't be taken off ventilator, set the ventilator FIO2 200%
b) Use pulmonary hygiene techniques to mobilize secretions such as vibration, percussion, rib springs and shaking.    
c) Endotracheal suctioning to clear retained secretions using sterile techniques.
3. The best position for relaxation, decreased dyspnea and improved ventilation and oxygenation are with the head of the bed elevated to 30 degrees and lying on well aerated lung. The prone lying position is also proven to be beneficial.

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Kindly check for the complete and downloadable protocol here at :http://www.physioblasts.org/p/forum/forum_viewtopic.php?1...