Discuss the role of physiotherapists in the management of patients in the ICU.
Physiotherapists are part of the multidisciplinary team providing care to patients in the ICU.
Physiotherapists perform an assessment that includes the respiratory, cardiovascular, neurological, and musculoskeletal systems to formulate treatment plans.
The traditional focus of treatment has been the respiratory management of both intubated and spontaneously breathing patients however emerging evidence of the longstanding physical impairment suffered by survivors of intensive care has resulted in physiotherapists re-evaluating treatment priorities to include exercise rehabilitation as a part of standard clinical practice.
The goals of respiratory physiotherapy management are to promote secretion clearance, and to maintain or recruit lung volume, in both the intubated and spontaneously breathing patient. In the intubated patient, physiotherapists commonly employ manual and ventilator hyperinflation and positioning as treatment techniques whilst in the spontaneously breathing patients there is an emphasis on mobilisation.
Physiotherapists have a role in maintaining joint and muscle function in those who are at risk of contractures, for example in neurological injuries and patients with prolonged paralysis. A trend toward an emphasis on exercise rehabilitation over respiratory management is increasingly evident as survivors of a prolonged ICU stay can suffer deconditioning, muscle atrophy, and weakness that may impact upon quality of life.
Additional roles include the fitting of cervical collars, spinal braces, slings etc. in trauma patients, setting up TENS machines and patient education (exercise, rehab etc.)
This topic merited an entire chapter in Oh's Manual; and therefore we can expect that this question is the college's way of investigating whether or not anybody has read that chapter. Specifically, the chapter begins with a list of the main roles of the physiotherapist in the ICU.
Thus, it is the primary source for the answer below.
A more structure list-like answer would resemble the following:
At some point, the cynical candidate should use a key phrase such as "multidisciplinary team", "collaborative interdisciplinary care" or "shared therapeutic strategy".
Potential risks of physiotherapy:
Oh's Manual (7th ed) Chapter 5 (pp.38) Physiotherapy in intensive care by Fiona H Moffatt and Mandy O Jones
Stiller, Kathy. "Physiotherapy in intensive care: towards an evidence-based practice." CHEST Journal 118.6 (2000): 1801-1813.