Physiotherapy management of ICU acquired weakness
Physiotherapy might not be your first thought if you find yourself in the intensive care unit but a recent review of high-quality evidence on the subject shows that physiotherapists have much to offer this group of patients. Weakness develops extremely commonly and quickly when acutely ill patients are ventilated in intensive care. The weakness affects the muscles of the limbs and trunk, but also the muscles responsible for breathing. There is a range of interventions that physiotherapists can use to combat the weakness - and these interventions start early.
Exercise-based rehabilitation is very effective but it should be commenced within 3 days of admission to the intensive care unit and continued after discharge from the unit. The respiratory muscles can also be trained by applying controlled resistance to the airway, as well as strengthening the respiratory muscles, this intervention improves the likelihood that patients will be able to continue to breathe for themselves after coming off the ventilator (as opposed to requiring some breathing assistance or returning to the ventilator).
A cycle ergometer allows patients to receive passive, active-assisted, and active-resistive exercise. In the intensive care unit, cycle ergometry may be used with sedated, immobile, or awake patients to provide range of motion and muscle strength training whilst patients are in bed. Electrical muscle stimulation has been investigated as a treatment for the prevention of weakness. It involves placing electrodes over the skin, which activate the underlying nerves to produce an muscle contraction. The treatment involves minimal joint movement and does not require patient interaction. Electrical muscle stimulation might be an attractive intervention for critically ill patients and it may have the ability to maintain muscle mass and strength in the ICU setting, particularly in long-stay patients.
With hundreds of papers published on this broad-ranging topic, the evidence has to be navigated carefully. Precautions to exercise and other physiotherapy interventions need to be considered.
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> From: Hodgson et al., J Physiother 63 (2017) 4-10. All rights reserved to Elsevier B.V. Click here for the online summary.