Chest
Critical Care ReviewsPhysiotherapy in Intensive Care: Towards an Evidence-Based Practice
Section snippets
Positioning
Positioning in this context describes the use of body positionas a specific treatment technique. Positioning for ICU patients can beused with the physiologic aims of optimizing oxygen transport throughits effects of improving ventilation/perfusion (V/Q)matching, increasing lung volumes, reducing the work of breathing, minimizing the work of the heart, and enhancing mucociliaryclearance.8910 Rather than considering postural drainageas a separate technique, it is considered herein as one example
The Effect of Physiotherapy on Pulmonary Function
Many studies have investigated the short-term effect ofmultimodality respiratory physiotherapy (eg, positioning, percussion, vibrations, MH, and suction) on the pulmonary function ofintubated ICU patients receiving mechanicalventilation.17323334353637
Mackenzie and Shin,32 in a study typical of thoseconducted in this area, examined the effect of a physiotherapytreatment (consisting of postural drainage, percussion, vibrations, andsuction) administered to each of 19 patients receiving
Summary of Evidence
Table 1summarizes the evidence concerning physiotherapy for intubated ICUpatients receiving mechanical ventilation. There are data demonstratingthat multimodality physiotherapy may result in short-term improvementsin the pulmonary function of ICU patients. However, it has also beenshown that these techniques may have deleterious effects on hemodynamicand metabolic variables, particularly if used inappropriately. There isevidence from one study that twice-daily physiotherapy, in addition
Recommendations for Evidence-Based Practice
Based on the research available, what recommendations can be maderegarding evidence-based practice for physiotherapy in the ICU (Table 1)?
Areas for Future Research
It is clear that virtually every aspect of the physiotherapymanagement of intubated ICU patients receiving mechanical ventilationrequires validation. Further study to investigate the short-term effectof physiotherapy treatments on pulmonary and hemodynamic variables, preferably with the inclusion of control groups, will be of value. However, the role of physiotherapy in the ICU will continue to bequestioned until it has been shown to have a favorable impact onbroader outcomes of ICU patients.
Conclusion
Although physiotherapy is seen as an integral part of themultidisciplinary team in most ICUs, there is only limited evidenceconcerning the effectiveness of physiotherapy in this setting. Physiotherapy may have short-term beneficial effects on pulmonaryfunction, but it may also adversely affect the hemodynamic andmetabolic status of intubated patients receiving mechanicalventilation. Physiotherapy has been shown to be effective in thetreatment of acute lobar atelectasis but, in one study, did
References (82)
- et al.
Role of the physiotherapist in the intensive care unit
Intensive Care Nurs
(1987) - et al.
Hemodynamic effects of manual hyperinflation in critically ill mechanically ventilated patients
Chest
(1994) - et al.
A survey of manual hyperinflation in Australian hospitals
Aust J Physiother
(1999) - et al.
Discordance between cardiopulmonary physiology and physical therapy: toward a rational basis for practice
Chest
(1992) Haemodynamic stability of the ventilated intensive care patient: a review
Aust J Physiother
(1992)- et al.
Body position and ventilation-perfusion relationships in unilateral pulmonary disease
Chest
(1987) - et al.
The prone position in ARDS patients
Chest
(1988) - et al.
Influence of positioning on ventilation-perfusion relationships in severe adult respiratory distress syndrome
Chest
(1994) - et al.
Peak expiratory flow rates produced with the Laerdal and Mapleson-C bagging circuits
Aust J Physiother
(1992) - et al.
A survey on manual hyperinflation as a physiotherapy technique in intensive care units
Physiotherapy
(1992)