Question 24 from the second paper of 2013 waned to discuss the role of physiotherapists in intensive care, whereas Question 16 from the first paper of 2006 asked specifically what were the risks and benefits of physiotherapy in the ICU. This recalls the chest physiotherapy related Question 12 from the second paper of 2001, where the college asked the candidates to not only recall some details as to the role of chest physiotherapy in the ICU, but to list the manoeuvres and provide the rationale for them. In view of that fact that the manoeuvres are well covered in the Chest Physiotherapy chapter, they will not be re-examined here. The best resource for answering such questions would have to be the Oh's Chapter by Moffat and Jones (Physiotherapy in intensive care, p. 38). If for whatever reason one requires a non-Ohs source, Kathy Stiller's review article from CHEST (2000) is the next most useful piece of reading. The most important society statement to become familiar with is the ERS/ESICM Guidelines Statement from 2008.
The best way to approach this topic is by way of the "critically evaluate" answer format.
This would have to be a brief fluffy motherhood statement. On offer is the college's own model answer introduction from Question 24:
Physiotherapists are part of the multidisciplinary team providing care to patients in the ICU.
Note how the first line of the model answer includes both the word care and the word multidisciplinary, both of which are important keywords for the examiner's intracranial SEO. Appropriate triggers are important. Marks are earned in this way.
A more structured list-like answer would resemble the following:
Specific techniques are well discussed in the excellent recent article by Sommers et al (2015). I paraphrase their Table 2 in the following list:
The ERS/ESICM Guidelines Statement from 2008 makes the following recommendations. Most of them were Level C, because at this stage there were few clinical trials available. Subsequent trials have actually retrospectively supported many of these recommendations.
Mind you there is a massive amount of literature out there. A meta-analysis by Kaymabu et al (2013) identified 10 RCTs. In brief, physiotherapy was found to confer "significant benefit in improving quality of life, physical function, peripheral and respiratory muscle strength, increasing ventilator-free days, and decreasing hospital and ICU stay". There was no benefit in mortality. A good representative trial is by Burtin et al (2009) - single centre RCT, 90 patients got on to an exercise cycle ergometer as soon as their condition permitted. At intensive care unit discharge, quadriceps force and functional status were not different between groups, but at hospital discharge the 6-minute walking distance, isometric quadriceps force, and the subjective feeling of functional well-being were significantly higher in the treatment group.
Some of the mor recent trials which were not included in this review. Weirdly, these more recent trials are all negative studies.
ACT-ICU trial, Brunnel et al (2014) - 87 patients
Goll et al (2015) - 50 ICU patients subjected to electro-torture to investigate the effects of daily EMS-therapy on muscular strength.
Kayambu et al (2015) - 50 patients with sepsis, randomised to either early physical rehab or routine care.
EPICC trial, Thomas et al (2015) - still in recruitment phase; 308 patients to be randomised to receive one of two different intensities 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.
Thomas, Kirsty, et al. "Extra Physiotherapy in Critical Care (EPICC) Trial Protocol: a randomised controlled trial of intensive versus standard physical rehabilitation therapy in the critically ill." BMJ open 5.5 (2015): e008035.
Sommers, Juultje, et al. "Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations." Clinical rehabilitation (2015): 0269215514567156.
van der Schaaf, Marike, et al. "Poor functional recovery after a critical illness: a longitudinal study." Journal of rehabilitation medicine 41.13 (2009): 1041-1048.
Burtin, Chris, et al. "Early exercise in critically ill patients enhances short-term functional recovery*." Critical care medicine 37.9 (2009): 2499-2505.
Gosselink, Rik, et al. "Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on physiotherapy for critically ill patients." Intensive care medicine 34.7 (2008): 1188-1199.
Kayambu, Geetha, Robert Boots, and Jennifer Paratz. "Physical Therapy for the Critically Ill in the ICU: A Systematic Review and Meta-Analysis*." Critical care medicine 41.6 (2013): 1543-1554.
Kayambu, Geetha, Robert Boots, and Jennifer Paratz. "Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial." Intensive care medicine 41.5 (2015): 865-874.
Goll, M., et al. "Randomised controlled trial using daily electrical muscle stimulation (EMS) in critically ill patients to prevent intensive care unit (icu) acquired weakness (ICUAW)." Intensive Care Medicine Experimental 3.Suppl 1 (2015): A809.
Brummel, N. E., et al. "Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial." Intensive care medicine 40.3 (2014): 370-379.
Templeton, Maie, and Mark GA Palazzo. "Chest physiotherapy prolongs duration of ventilation in the critically ill ventilated for more than 48 hours." Intensive care medicine 33.11 (2007): 1938-1945.