Physiotherapists in the intensive care unit
Who they are, what they do and which devices they use: a research-based profile for recruiting this target group for MedTech and pharma projects.
Overview
Physiotherapists in the intensive care unit treat critically ill patients early to prevent long-term consequences of the ICU stay. Their work divides into respiratory physiotherapy, such as secretion mobilisation and cough support, and movement therapy with mobilisation to the edge of the bed and beyond. Each treatment starts with a handover from physicians and nursing; at the bedside they then assess dyspnoea, pain, ability to cooperate, delirium and function using standardised assessments. Intensity ranges from passive to assisted, active and resistive exercises and depends on stability, alertness and cooperation. Besides direct therapy time, a single treatment includes walking time, set-up time, hygiene measures and conversations with relatives.
Profession by country
Fields of use and typical tasks
Intensivstation
Evidence from: DE, AT, CH
- Physiotherapy treatment usually starting on the day of ICU admission
- Passive mobilisation: assessing joint status and moving arms and legs in supine position or at the edge of the bed
- Respiratory therapy by two therapists to deepen breathing and loosen secretions before suctioning
- Involvement in extubation
- Coordinating treatments with the responsible nurse after the daily team time-out
- Stepwise mobilisation up to respiratory muscle training, training of activities of daily living and walking with or without aids
Specializations
Devices and systems they use
- Intensive care ventilator
- Rehabilitation exercise trainer
- Suction catheter (open/closed)
- Respiratory therapy device (incentive spirometer/PEP device)
- Care / mobilisation chair
- Respiratory muscle strength meter (MIP/MEP)
- Ventilation mask (NIV interface)
- ECMO system
- Ventricular assist device (VAD)
- High-flow nasal oxygen device
- Intra-aortic balloon pump
- Tilt table
- Medication management / CPOE system
- Patient monitor
- Electric hospital/care bed
- Standing frame
Who they work with
- Intensive care physicians (handover and prescription)
- ICU nursing staff
Frequently asked questions
What are the main focuses of physiotherapy in the ICU?
Respiratory physiotherapy with secretion mobilisation and cough support, and movement therapy with mobilisation, for example to the edge of the bed.
Where do physiotherapists get their information before treatment?
From a structured handover by physicians and nurses, followed by their own bedside assessment.
Which assessments do they use?
The source names scales for alertness, delirium and muscle strength, plus an observation-based functional assessment for ICU patients that takes a few minutes.
How long does a treatment take including ancillary time?
In a pilot survey at university hospitals, a single treatment including walking, set-up and hygiene took between 22 and 55 minutes.
When is active training possible?
Training stimuli require medical stability and sufficient cooperation and alertness; rest phases are also part of therapy.
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Related target groups
Same work area
Same specialty
Sources
- Strukturiertes physiotherapeutisches Handeln: befundbezogen und funktionsorientiert, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Zeitschrift DIVI 12 (2) (DE)
- Physiotherapie auf der Intensivstation: sind wir effektiv und effizient?, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Zeitschrift DIVI 12 (2) (DE)
- Hand in Hand für den Erfolg: Wieso Frühmobilisierung für Intensivpatienten so wichtig ist, Universitätsklinikum Münster (DE)
- Mobilisation: der Weg ist das Ziel, Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Zeitschrift DIVI 12 (2) (DE)
- Physiotherapie auf der Intensivstation, Universitätsklinikum Hamburg-Eppendorf (DE)
- Evidenzbasierte Grundlagen des physiotherapeutischen Personalbedarfs auf Intensivstationen (Positionspapier), Physio Austria, Bundesverband der Physiotherapeut:innen Österreichs, Fachliches Netzwerk Intensivmedizin (AT)
- Respiratorische Physiotherapie bei erwachsenen beatmeten Patienten mit Covid-19, Universimed (Fachverlag), Autor:innen aus der kardiorespiratorischen Therapie eines Wiener Krankenhauses (AT)
- Intensivversorgung (Presseinformation), Klinikum Wels-Grieskirchen (AT)
- Early mobilisation and rehabilitation in Swiss intensive care units: a cross-sectional survey, Swiss Medical Weekly (CH)
- Physiotherapie und Mobilisation, Universitätsspital Zürich, Institut für Intensivmedizin (CH)
- CAS Spezialist*in Therapie auf der Intensivstation, Berner Fachhochschule, Departement Gesundheit (CH)
- Three-Fourths of ICU Physical Therapists Report Use of Assistive Equipment and Technology in Practice: Results of an International Survey (Journal of Acute Care Physical Therapy 12(1):21-30), University of Kentucky (Forschungsportal), Studie im Journal of Acute Care Physical Therapy (US)
- Cardiovascular and Pulmonary Physical Therapy Residency Program, Advocate Health, Advocate Christ Medical Center (US)