Chest
Volume 118, Issue 6, December 2000, Pages 1801-1813
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Critical Care Reviews
Physiotherapy in Intensive Care: Towards an Evidence-Based Practice

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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

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