An Intensive Care Unit (ICU) is concerned with the management of the patient with acute life threatening condition within the specialised environment of ICU.
Thus ICU can be defined as the services for the patient with recoverable diseases who can benefit from a detailed observation and treatment than is generally available in the standard ward and department.
Critically patient in ICU suffer long-term physical and psychological complications. They are on long term mechanical ventilation, which leads to the 90% of long-term ICU survivors will have significantly muscle weakness. Prolonged stay in ICU are also associated with impaired quality of life, functional decline, cost of care, etc.
Therefore, they require a multidisciplinary team to work with the assessment and management of respiratory complications, physical deconditioning, neuromuscular and musculoskeletal conditions.
Physiotherapy is an important part of this multidisciplinary team to promote lung function, reducing the incidence of ventilator-associated pneumonia, facilitating weaning off and promoting early discharge from the ICU.
ICU APPARATUS
The ICU should have the following equipments in case of emergency:- tracheal incubator,difibrilator, bronchoscopy, chest drainer, IABP (Intra Aortic Balloon Pumping), Invasive haemodynamic monitoring, Suctioning equipment, pharyngeal airways(artificial), mechanical ventilator, Ambubag, etc.
ICU STAFF
A 1:1 nurse: patient ratio is required i.e. 1 nurse is available for one patient 24 hours.
Medical doctor who is also known as RESIDENT.
Senior resident (SR)
administrative staff
Other health care professionals like Physiotherapist, Dietician, Pharmacist, Lab technician, Social workers, etc.
PATIENT SELECTION AND LIMITING TREATMENT
Patient selection is important to ensure a human approach to manage the critical ill patient and to use the limited resources appropriately.
The decision is done on some ethical principle:-
--The first objective is to preserve life.
-- Do not harm
-- Respect autonomy of the patient.
-- Allocate medical resources carefully
-- Tell the truth
DOCUMENTATION IN ICU
Regular systemic clinical assessment of the patient is recorded.
It includes-- vital signs, haematological, biochemical and microbiological investigation, treatment plan, drug regime, clinical signs, etc.
PRIMARY CONCERN IN ICU
-- Acid- base balance
--fluid electrolyte status
-- haemodynamic status
--ECG monitoring
-- ventilator monitoring
-- EEG and ICP monitoring, etc.
SECONDARY CONCERN IN ICU
-- Arterial B.P.
-- Systolic B.P and Diastolic B.P.
-- Mean pressure ( difference between diastolic and systolic B.P., should not exceed 40)
-- Temperature
-- Heamoglobin concentration
-- Urine output
-- Blood volume, plasma volume, red blood cell count
-- Central venous pressure (CVP)
-- Pulmonary artery pressure and pulmonary capillary wedge pressure
-- Cardiac output
--Transcutaneous oxygen and carbon dioxide tension.
--Pulse oximetry, etc.
COMPLICATIONS IN ICU
COMPLICATION OF ARTIFICIAL AIRWAYS:-
👉 Damage to the nasal passage or lips- During insertion, facial trauma or trauma to the nasal structure or lips may occur. While in place, lip ulceration,necrosis of soft tissues, erosion of the nasal septum, increase resistence from the smaller tubes.
👉Damage to the Oropharynx- Soft tissue damage to the Oropharyngeal, retropharyngeal and hypopharyngeal may occur.
👉Damage to the larynx and trachea Soft tissue damage, laryngospasm, laryngeal muscles inflammation and tracheal injury, tracheal dilation may occur.
COMPLICATIONS OF PROLONGED IMMOBILISATION:-
The immediate effect of immobility are associated with cardio-pulmonary and musculo-skeletal changes in 24-48 hours.
The systemic effects are more pronounced in premature infants, young and older people, smokers, obese, etc.
👉 The changes in cardiovascular system are-
Fluid volume redistribution
Decrease in total heart and left ventricular volume.
Increase in haemocryte and haemoglobin.
Venous stasis
Increased chances of venous thrombosis, thrombo-embolism
decreased hydrostatic tolerence
decreased VO₂ max.
👉 The changes in musculo-skeletal system are-
muscle inactivity
loss of muscle mass
loss of muscle endurance
loss of muscle strength.
PSYCHOLOGICAL COMPLICATION IN ICU:-
Confusion, lethargy, less responsiveness, sleep disturbance, loss of privacy, mobility, speech difficulty, disorientation of time and place, etc.
NUTRITIONAL COMPLICATIONS IN ICU:-
In ICU, patient does not receive proper diet hence can have some nutritional deficiency.
SKIN COMPLICATION IN ICU:-
Pressure sores, ulcers, gangrene, etc
Other complications:-
Pulmonary aspiration, barotrauma, cardiopulmonary arrest, hypoxemia, cardiac arrhythmia, cervical spinal cord injury, communication problems, decreases mucous transport, ineffective cough, etc.
SHORT-TERM GOALS OF PHYSIOTHERAPY
👉Both passive and active exercises to maintain the muscular integrity.
👉 Positioning of patient is done to allow gravity to help in draining the sputum from the lungs.
👉 Manual techniques like shaking and vibration to loosen and clearance the secretion of lungs.
👉 Suctioning is done to clear the secretion.
LONG-TERM GOAL OF PHYSIOTHERAPY
Physiotherapist plan an extensive rehabilitation program to integrate and re-initiate the patient in the society.
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