Current physiotherapy approaches in intensive care units

Yıl 2011, Cilt: 1 Sayı: 3, 196 - 201, 31.01.2014

S. Ufuk Yurdalan

Öz

Physiotherapy is a part of the multidisciplinary treatment in different intensive care units. Respiratory, cardiovascular and neuromusculoskeletal- focused physiotherapy programmes and prevention of the respiratory, neuromuscular complications which may be possible, developing the exercise capacity related to inspiratory muscle function in critically patients internalized and postoperative cases in intensive care unit are clinical targets. It is known that physiotherapy initiated early is reliable, practicable, cost effective to shorten the length of stay in intensive care and hospital. Besides, physiotherapy improves the effects of the medical treatments. Intensive care unit and patient type, available technology, acute or chronic prognosis of the disease, consciousness and expected benefit from physiotherapy are determinants of selecting physiotherapy approaches used in intensive care unit. Standard physiotherapy protocol consists of pulmonary physiotherapy, mobilization, ambulation and instrumental physiotherapy and current approaches vary associated with needs of case. Manual hyperinflation, prophylactic continuous lateral rotation, expiratuar flow increase technic (EFIT), supported arm exercise training, kinetic therapy, tilt table treatment, skeletal and pulmonary muscle training, bedside bisergo, and neromuscular electrical stimulation may be preferred by developing the programme. In some cases, approaches are need to be combined or modified within the limitations of the disease. Physiotherapy changes depending on the patient being conscious or unconscious, oriented or disoriented, sedatized or agitated status in intensive care unit. Rearranging the treatment by following symptomatic and functional recovery carefully and maintaining the approaches in preventive applications continuously are significant. Effectiveness and effects of physiotherapy are maximized by explaining the physiotherapy to the patient.

Key words: Intensive care, physiotherapy, length of stay

Anahtar Kelimeler

-

Yoğun bakım ünitelerinde güncel fizyoterapi yaklaşımları

Öz

Farklı yoğun bakım ünitelerindeki (YBÜ) multidisipliner tedavinin bir bölümü de fizyoterapidir. YBÜ’nde interne edilen kritik hastalarda ve postoperatif olgularda; solunumsal, kardiyovasküler ve nöromuskuloskeletal odaklı fizyoterapi programlarıyla olası respiratuar ve nöromuskuler komplikasyonların önlenmesi, inspiratuar kas fonksiyonuyla ilişkili egzersiz kapasitesinin geliştirilmesi klinik hedeflerdendir. Erken başlatılan fizyoterapinin uygulanabilir, güvenli, maliyet etkin ve YBÜ ile hastanede kalış sürelerini kısalttığı bilinmektedir. Yanısıra fizyoterapi YBÜ’de uygulanan diğer tedavilerin (tıbbi, ağrı sağaltımı vb) etkilerini geliştirebilmektedir. YBÜ’de kullanılacak fizyoterapi yaklaşımlarının seçiminde YBÜ ve hasta tipi, varolan teknolojisi, hastalığın akut veya kronik seyri, bilinç açıklığı ile fizyoterapiden beklenen yarar belirleyicidir. Standart fizyoterapi protokolü solunum fizyoterapisi, mobilizasyon, ambulasyon ve donanımsal fizyoterapiden oluşurken; güncel yaklaşımlar olgunun gereksinimleriyle ilişkili çeşitlenmektedir. Program genişletilirken manuel hiperinflasyon, profilaktik sürekli lateral rotasyon, ekspiratuar akım arttırıcı teknik (EFIT), destekli kol egzersizi, kinetik terapi, tilt table tedavisi, iskelet ve solunum kas egzersizi, yatakbaşı bisergo ve nöromuskuler elektrik stimulasyonu tercih edilebilir. Bazı durumlarda yaklaşımların kombine edilmesi veya hastalığın sınırları içinde modifiye edilmesi gerekebilir. Fizyoterapi yoğun bakım hastasının bilincinin açık veya kapalı, oryante veya disoryante, sedatize veya ajite olmasıyla da değişir. Tedavinin, semptomatik ve fonksiyonel iyileşme dikkatle izlenerek her bir seansta yeniden düzenlenmesi, koruyucu uygulamalarda yaklaşımların aralıksız sürdürülmesi önemlidir. Fizyoterapinin hastaya açıklanarak egzersize aktif katılımının sağlanmasıyla da etkileri ve etkinliği maksimize edilir.

Anahtar Kelimeler : Yoğun bakım, fizyoterapi, kalış süresi

Anahtar Kelimeler

Yoğun bakım, fizyoterapi, kalış süresi

Kaynakça

• Stiller K. Physiotherapy in intensive care:towards an evidence-based practise. Chest. 2000;118 (6):1801-1813.
• Zeppos L, Patman S, Bemey S, Adsett JA, Bridson JM, Paratz JD. Physiotherapy in intensive care: as an observational study. Aust J Physiother. 2007;53(4): 279-283.
• Hanekom SD, Faure M, Coetzee A. Outcomes research in the ICU: an aid in defining the role of physiotherapy. Physiother Theory Pract. 2007;23(3): 125-135.
• Fan E, Zanni J, Dennison C, Lepre S, Needham D. Critical illness neuromyopathy and muscle weakness in patients in the intensive care unit. AACN Adv Crit Care. 2009;20(3): 243-253.
• Dusing SC, Murray T, Stern M. Parent preferences for motor development education in the neonatal intensive care unit (NICU). Pediatr Phys Ther. 2008;20(4): 363-368.
• Arcencio L, Souza MD, Bortolin BS, Fernandes ACM, Rodrigues AJ, Evora PRB. Pre-and postoperative care in cardiothorasic surgery:a physiotherapeutic approach. Rev Bras Cir Cardiovasc. 2008;23(3): 400-410.
• Şenduran M, Yurdalan SU, Karadibak D, Günerli A. Haemodynamic effects of physiotherapy programme in intensive care unit after liver transplantation. Disabil Rehabil. 2010;32(17): 1461-1466.
• Hodgin KE, Nordon-Craft A, McFann KK, Mealer ML, Moss M. Physical therapy utilization in intensive care units: results from a national survey. Crit Care Med. 2009;37(2): 561-566.
• Smyth A, Merkus P. Respiratory medicines for children: current evidence, unlicensed use and research priorities. DOI:10.1183/09031936.00139508.
• Sweeney JK, Heriza CB, Blanchard Y, American Physical Therapy Association. Neonatal physical therapy. Part I: clinical competencies and neonatal intensive care unit clinical training models. Pediatr Phys Ther. 2009;21(4): 296-307.
• Polat MG. Yoğun bakımda fizyoterapi uygulamaları. Turkish J of Intensive Care Med. 2007;7 (3): 359-361.
• Sweeney JK, Heriza CB, Blanchard Y, Dusing SC. Neonatal physical therapy. Part II: Practice frameworks and evidence-based practice guidelines. Pediatr Phys Ther. 2010;22(1): 2-16.
• Mahoney MC, Cohen MI. Effectiveness of developmental intervention in the neonatal intensive care unit: implications for neonatal physical therapy. Pediatr Phy Ther. 2005;17(3): 194-208.
• Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36(8): 2238-2243.
• Kress JP. Clinical trials of early mobilization of critically ill patients. Crit Care Med. 2009;37(10): 442-447.
• Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M. Early physical and occupational therapy in mechanically ventilated, critically ill patients:a randomised controlled trial. Lancet 2009;373(9678): 1874- 1882.
• Malkoç M, Karadibak D, Yıldırım Y. The effect physiotherapy on ventilatory dependency and the length of stay in an intensive care unit. Int J of Rehab Research. 2009;32(1): 85-88.
• JiYeon C, Frederick JT, Leslie AH. Mobility interventions to improve outcomes in patients undergoing prolonged mechanical ventilation: a review of literature. Biol Res Nurs. 2008;10(1): 21-33.
• Padhye NS, Hamlin S, Brazdeikis A, Hanneman SK. Cardiovascular impact of manual and automated turns in ICU. Conf Proc IEEE Eng Med Biol Soc. 2009: 1844-1847.
• Peter JT, Jennifer DP, Warren RS, Renae D, Jeffrey L. Positioning practices for ventilated intensive care patients: current practice, indications and contraindications. Austr Crit Care. 2006;19 (4): 122- 132.
• Winkelman C, Higgins PA, Chen Yea-Jyh Kathy. Activity in the Chronically Critically Ill. Dimens Crit Care Nurs. 2005:24(6): 281-290.
• Thomas PJ, Paratz JD, Lipman J, Stanton WR. Lateral positioning of ventilated intensive care patients: a study of oxygenation, respiratory mechanics, hemodynamics, and adverse events. Heart Lung. 2007:36(4): 277-286.
• Staudinger T, Bojic A, Holzinger U, Meyer B, Rohwer M, Mallner F, Schellongowski P, Robak O, Laczika K, Frass M, Locker GJ. Continuous lateral rotation therapy to prevent ventilator-associated pneumonia. Crit Care Med. 2010:38(2): 486-490.
• Schultz TR, Lin R, Francis BA, Hales RL, Colborn S, Napoli LA, Helfaer MA. Kinetic therapy improves oxygenation in critically ill pediatric patients. Pediatr Crit Care Med. 2005;6 (4): 428-434.
• Browning L, Denehy L, Scholes RL. The quantity of early upright mobilisation performed after upper abdominal surgery is low: an observational study. Australian J of Physiotherapy.2007;53(1) : 47-52.
• Unoki T, Kawasaki Y, Mizutani T, Fujino Y, Yanagisawa Y, Ishimatsu S, Tamura F, Toyooka H. Effects of expiratory rib-cage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation. Respir Care. 2005;50(11): 1430- 1437.
• Cirio S, Piaggi GC, De Mattia E, Nava S. Muscle retraining in ICU patients. Monaldi Arch Chest Dis. 2003; 59(4): 300-303.
• Griffiths RD, Hall JB. Intensive care unit-acquired weakness. Crit Care Med. 2010; 38(3):779-787.
• Fan Eddy; Zanni Jennifer M; Dennison Cheryl R; Lepre Scott J; Needham Dale M. Critical illness neuromyopathy and muscle weakness in patients in the intensive care unit. AACN Adv Crit Care. 2009;20(3): 243-253.
• Green DM. Weakness in the ICU: Quillian-Barre syndrome, myastania gravis, and critical İllness polynerupathy / myopathy. The Neurologist.2005; 11(6): 338- 347.
• Kress JP. Clinical trials of early mobilization of critically ill patients. Crit Care Med. 2009;37(6): S442-447.
• Needham DM, Truong AD, Fan E. Technology to enhance physical rehabilitation of critically ill patients. Crit Care Med. 2009; 37(10 Suppl): S436-441.
• Janadius-Ferreira T, Hill K, Goldstein R, Wadell K, Brooks D. Arm exercise training in patients with chronic obstructive pulmonary disease: a systematic review. J Cardiopulm Rehabil. 2009;29 (5): 277- 283.
• Margaret SH. Mobile, awake and critically ill. CMAJ. 2008;178(6): 691- 697.
• Biais M, Vidil L, Sarrabay P, Cottenceau V, Revel P, Sztark F. Changes in stroke volume induced by passive leg raising in spontaneously breathing patients: comparison between echocardiography and Vigileo/FloTrac device. Crit Care. 2009;13(6): R195.
• Topp R, Ditmyer M, King K, Doherty K, Hornyak J. The effect of bed rest and potential of prehabilitation on patients in the intensive care unit. AACN Clin Issues. 2002;13(2): 263-276.
• Hulzebos EH, Helders PJ, Favié NJ, De Bie RA, Brutel de la Riviere A, Van Meeteren NL. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA. 2006; 296 (15): 1851-1857.
• http://www.toraks.org.tr/mse11-ppt-pdf/s_savcit%20toraks%20icu.ppt
• Samuel SS, Phillip DH. Use of inspiratory strength training to wean six patients who were ventilator-dependent. Phys Ther. 2003;83: 171- 181.
• Platon B, Andréll P, Raner C, Rudolph M, Dvoretsky A, Mannheimer C. High-frequency, high-intensity transcutaneous electrical nerve stimulation as treatment of pain after surgical abortion. Pain. 2010; 148 (1): 114-119.
• Perme CS, Southard RE, Joyce DL, Noon GP, Loebe M. Early mobilization of LVAD recipients who require prolonged mechanical ventilation. Tex Heart Inst J. 2006; 33 (2): 130-133.
• Byrnes MC, Schuerer DJE, Schallom ME, Sona CS, Mazuski JE, Taylor BE, McKenzie W, Thomas JM, Emerson JS, Nemeth JL, Bailey RA, Boyle WA, Buchman TG, Coopersmith CM. Implementation of a mandatory checklist of protocols and objectives improve compliance with a wide range of evidence-based intensive care unit practices. Crit Care Med. 2009;37(10): 2775-2781.