Evidence-Based Physiotherapy in Intensive Care

Critical illness myopathy and polyneuropathy - A challenge for physiotherapists in the intensive care units

The development of critical patient related generalized neuromuscular weakness, referred to as critical illness polyneuropathy (CIP) and critical illness myopathy (CIM), is a major complication in patients admitted to intensive care units (ICU). Both CIP and CIM cause muscle weakness and paresis in critically ill patients during their ICU stay. Early mobilization or kinesiotherapy have shown muscle weakness reversion in critically ill patients providing faster return to function, reducing weaning time, and length of hospitalization. Exercises in the form of passive, active, and resisted forms have proved to improve strength and psychological well being. Clinical trials using neuromuscular electrical stimulation to increase muscle mass, muscle strength and improve blood circulation to the surrounding tissue have proved beneficial. The role of electrical stimulation is unproven as yet. Recent evidence indicates no difference between treated and untreated muscles. Future research is recommended to conduct clinical trials using neuromuscular electrical stimulation, exercises, and early mobilization as a treatment protocol in larger populations of patients in ICU.

Patterns of chest physiotherapy in Australian Intensive Care Units

PURPOSE

The aim of this study was to identify the availability of physiotherapy services in Australian Intensive Care Units (ICUs) and articulate the roles that physiotherapists and nursing staff play in the provision of chest physiotherapy.

MATERIALS AND METHODS

Telephone interviews with 71 clinical nurse managers and 6 physiotherapists of adult public Australian ICUs were undertaken. A structured interview schedule was developed from a review of the literature and a panel of experienced ICU clinicians and researchers to establish the frequency, components and personnel involved in the provision of chest physiotherapy.

RESULTS

Almost 90% (n = 67) of ICUs had physiotherapists available during the week but over 25% (n = 22) had "on-call" service only on weekends. Less than 10% had weekday (n = 7) or weekend (n = 6) evening physiotherapy coverage. While nurses were involved in the provision of all aspects of chest physiotherapy, physiotherapists were primarily involved in airway suctioning, percussions, vibrations, positioning, and mobilization.

CONCLUSIONS

The provision of chest physiotherapy services is often shared between physiotherapists and nurses, however, the actual therapies provided appears to vary depending on the provider. While strong evidence for chest physiotherapy procedures is lacking, the widespread use in the ICU suggests that it is an ideal setting for undertaking clinical research.