INTRODUCTION TO ICU &

ROLE OF PHYSIOTHERAPY IN
ICU

Simran Kaur
 What is ICU ?
It is highly specified & sophisticated area of a
hospital which is specifically designed, staff, located
furnished and equipped, dedicated to management
of critically sick patient, injuries or complications.

It is a department with dedicated medical, nursing

and allied staff.

It has its own team of doctors, nurses and other staff

who are trained to requirement. The design of ICU, or
the modification of existing units, requires not only a
knowledge of regulatory agency standards but also
the expertise of critical care practitioners who are
families with special needs of this patient population
ICU EQUIPMENTS
BEDSIDE MONITOR
1.Temperature (98.6 F or 37.3 C)
Temperature is continuously monitored by means of an oesophageal or rectal
probe. This determines core temperature, which is usually at least 1°C higher
than axillary temperature
2.Heart rate (60-100 bpm)
Heart rate is measured from the electrocardiogram (ECG) trace.Artefacts are
common. Interference (usually from patient movement or a warming blanket)
may confuse the monitor into showing the presence of a tachycardia or
arrhythmia, while small complexes may be interpreted as asystole.
Physiotherapy may also cause movement artefacts.
3.Respiratory rate (12-18 bpm)
Respiratory rate may be measured by making use of the changing impedance
across the chest wall as it moves with respiration. In systems which offer this
parameter, the sensors are built into the ECG leads.Appropriate (e.g. for lobar
lung collapse) may reduce a rapid respiratory rate, but it must be emphasized
that an already tachypnoeic patient should not be allowed to become
exhausted during treatment as he may rapidly decompensate
4.Blood pressure (12o/80 mm Hg)
Blood pressure is monitored with a pressure cuff around the upper arm. An
oscillometric method is used to measure blood pressure, with automatic cuff
inflation and deflation .Non-invasive blood pressure monitoring is performed
intermittently, but the interval between readings may be as short as 1 minute.
Physiotherapy treatment may cause a patient to become hypertensive,
especially if the treatment causes pain or anxiety. The hypotensive patient may
occasionally become more unstable, and here the risks and benefits of
treatment need to be carefully balanced.
5.Oxygen saturation (95-100%)
Oxygen saturation is continuously measured by a pulse oximeter with a probe
on a finger or ear lobe. Hypoxaemia has been shown to occur both during and
after chest physiotherapy.
 IV
LI
An IV line, or intravenous line, is NE
a flexible tube that's inserted into a vein to
deliver fluids, medications, or other therapies directly into the bloodstream

In the acute care setting, intravenous (IV) lines have

varied functions:
1. to infuse fluids, nutrients, electrolytes, and medication
2. to obtain venous blood samples

3. to insert catheters into the central circulatory system

Common areas of placement are in the forearm or back of

the hand.
It allows the nurse to see the blood pressure continuously and also allows the nurse to
take bloods when required. It is a red line that usually goes into a patients arm and is
connected up to the cardiac monitor and shows a the blood pressure constantly.
Non invasive
Ventilation
Non Invasive Ventilation means the patient
would be helped to breath, without any
OXYGEN MASK
tubes going into their mouth. “Non
invasive” meaning nothing going in.
A tight mask usually covers the nose and
mouth, and it is connected to a small
machine which will give extra oxygen or
support with every breath.
The mask is secured tightly in order to
function, there cannot be any air leaks. It
usually helps increase blood oxygen levels
and reduced carbon
dioxide levels. The NIV would only be used
on a conscious patient, as you have to
make
every breath yourself. Sometimes it is used
to try and prevent needing a ventilator, and
sometimes it might be needed with the
patient comes off the ventilator.
Mechanical Ventilator

Mechanical ventilators are machines that act as bellows to move air in and out of your lungs.
Here the ventilator is to control how often it pushes air into your lungs and how much air you
get.

Principle : The ventilator pushes a mixture of air and oxygen into the patient's
lungs to get oxygen into the body. The ventilator can also hold a constant amount of
low pressure, called positive end-expiratory pressure (PEEP), in order to keep the air sacs
in the lung from collapsing.
Working : When a person needs to be on a ventilator, a healthcare provider will insert an
Endotracheal tube (ET tube) through the patient’s nose or mouth and into their
windpipe (trachea). This tube is then connected to the ventilator. The endotracheal tube
and ventilator do a variety of jobs. The ventilator pushes a mixture of air and oxygen into
the patient’s lungs to get oxygen into the body. The ventilator can also hold a constant
amount of low pressure, called positive end-expiratory pressure (PEEP), in order to
keep the air sacs in the lung from collapsing.
Mechanical ventilators work via a tube
in a person’s throat, pumping air into
the lungs and transporting carbon
dioxide away.
A ventilator unit regulates the
pressure, humidity, volume, and
temperature of the air, depending on
the controls that a doctor or
respiratory therapist places. This
allows healthcare professionals to
control a person’s breathing and
oxygen levels.
 Suction is used to clear retained or excessive
lower respiratory tract secretions in patients who are unable

to do so effectively for themselves. This could be

due to the presence of an artificial airway, such as
an endotracheal or tracheostomy tube, or in patients who
have a poor cough due to an array of reasons such
as excessive sedation, unconsciousness, or
neurological involvement.

It monitors for infection such as signs of

infection include: redness, tenderness at
the drain site, warmth at site, increased
ooze, or a change in collection fluid to
purulent, or if the patient is febrile.
 A chest drainage device helps
with breathing by allowing the
lungs to expand and restoring
negative pressure in the thoracic
cavity. The device is usually
connected to a drainage system
that collects fluid and allows air to
escape

A clip-like device called a probe is

placed on a body part, such as a
finger or ear lobe. The probe uses
light to measure how much oxygen
is in the blood. This information
helps the healthcare provider decide
if a person needs extra oxygen.
It is used in the ICU for patients who are having difficulty
breathing because of a lung problem, or for patients who are
not awake enough to breathe for themselves. The ET Tube is
connected to tubing which is connected to a ventilator.
INFUSION PUMPS
These are pumps that you will see beside
the patient and they control the amount of
medication or fluid that a patient receives
and how fast or slow it can be given. You will
see fluids and bags of medication hanging
over these on a pole. The fluid or medication
flows through plastic lines and passes
through the pump and into the patient.
High-risk medications for cancer,
anesthesia, and diabetes (insulin), among
others can thus be safely delivered using
infusion pumps. A variety of infusion pumps
are available in the market including
ambulatory pumps, volumetric pumps,
syringe pumps, enteral pumps, insulin
pumps, and implantable pumps.
Manual
Hyperinflation

Manual hyperinflation also known

as bagging, is a technique used by
respiratory physiotherapist in the
management of ventilated patients
to increase lung volumes and aid
secretion clearance. It involves use
of manual resuscitation bag
connected to oxygen to provide
deep, slow inspiratory breath
followed by inspiratory pause of 1-
2 seconds and a rapid release of
resuscitation bag.
The use of indwelling catheters in
the Critical Care Units (CCUs) has
a major role in determining the
incidence and the morbidity as
well as mortality from hospital-
acquired urinary tract infections
(UTIs)In the ICU, a patient may
have a urinary catheter put in
place to monitor an hourly output.
T

This allows us to calculate how

much fluid is going in, versus how
much is coming out. We can get
ensure that we prevent patients
becoming fluid overloaded, or
dehydrated. The
Renal team may need to become
involved and some patients may
need dialysis.
 ICU
Medicine
BED
trolley
Role of Physiotherapy in
ICU
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