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  • Writer's picturePhysical Therapy International Service

Physical Therapy in the Intensive Care Unit (ICU)


What is the ICU and who will you see working there?


The intensive care unit (ICU) is a specialized unit in the hospital where a team of highly trained specialists and health professionals, called the critical care team, provide 24-hour care to people with life-threatening conditions, serious illnesses, or injuries. ICU patients are in critical condition and require around-the-clock monitoring and life support.


There are four types of intensive care units: medical, surgical, neonatal pediatric, and medical-surgical. ICU patients typically have breathing or heart problems, serious head or traumatic injuries, and uncontrolled infections. Many patients are admitted to the ICU from the emergency room for extended critical care. Each patient in the ICU has a larger team of professionals dedicated to their care, including intensivists, critical care nurses, pharmacists, physical therapists, occupational therapists, physician assistants, and child life specialists. The collaboration of health care professionals, especially in the ICU, is critical for positive patient outcomes and recovery.


What is the physical therapist's role in ICU?


Physical therapists play a critical role in acute care but can especially contribute to the ICU critical care team. The main goal for physical therapists within this setting is to work towards early mobility and work safely to ensure the patient is progressing out of their critical medical state. Physical therapy for critically ill patients can be important in reducing the consequences associated with immobilization periods such as swelling, muscular weakness or atrophy, bed sores, or bone degeneration. Physical therapists in the ICU use chart review, patient interviewing, and therapy session information to decide when to discharge the patient to the step-down unit where both therapy and medical care will be used to monitor patient progress.


Mobility and exercise in the ICU


Extended periods of immobility are known to lead to physical deconditioning, fatigue, and a decline in functionality. Previous research indicates that initiating rehabilitation early in the ICU setting can lower the incidence of intensive care unit-acquired weakness. Advancing patient mobility is crucial to minimize complications, such as excessive pain and exacerbation of wounds. Goals for patients in the ICU include periodic changes in positions, such as rolling, sitting in bed, hanging legs off the bed, and occasional standing.


Determining appropriate mobility levels requires consideration of patient-related barriers, necessitating healthcare professionals, including doctors, nurses, therapists, and medical technicians, to possess comprehensive knowledge of each patient's deficits. Protocols have been established to guide the adequate mobilization of each patient, ensuring a personalized and effective approach to their care.


“Red flags” that could delay rehabilitation?


Where the integration of physical therapy in the ICU is paramount for patient recovery, recognizing "red flags" is essential to navigate the complexities of critical care. Delving into specifics, anomalies in crucial test results and lab work can act as significant deterrents to timely therapy initiation. For instance, elevated levels of creatinine or abnormal kidney function tests may signal compromised renal health, necessitating a pause in physical therapy to prevent further strain on the kidneys. Similarly, abnormal blood gas values, indicative of respiratory distress, might prompt therapists to reconsider exercise intensity to avoid exacerbating respiratory compromise. In cases where coagulation parameters like prothrombin time (PT) or activated partial thromboplastin time (aPTT) are deranged, caution is warranted to minimize the risk of bleeding complications during therapeutic activities. These examples underscore the nuanced approach required by physical therapists in the ICU, where a thoughtful evaluation of specific test results and lab work becomes integral to ensuring the safety and efficacy of rehabilitation interventions.


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