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What does a physio do in the Intensive Care Unit?

The following blog is written by Michael Wang.

Hi, my name is Michael. I am the Senior Intensive Care Unit (ICU) Physiotherapist at Frankston Hospital, Peninsula Health.

What can a physiotherapist do in Intensive Care you might ask? Every now and then I get the same question from my patients – the ones that are awake anyway.

There is a lot that we do. Using the words of some of our pioneers in the field:

An Intensive Care Physiotherapist is a part of the multidisciplinary team in most intensive care units in Australia (Skinner, 2008).

Physiotherapists are primary contact practitioners and use a comprehensive multisystem assessment that includes the respiratory, cardiovascular, neurological, and musculoskeletal systems to formulate individualized treatment plans (Denehy, 2006).

Physiotherapists provide treatment for respiratory complications including the application of noninvasive ventilation and exercise and rehabilitation for the prevention and management of intensive care acquired weakness (ICUAW) and deconditioning associated with immobility. (Grosselink, 2008)

I wanted to become an Intensive Care Physiotherapist since the first time I stepped into an ICU, as an undergraduate physiotherapy student. I have always been fascinated by how complex our body systems are, how they work so well together in synergy, and how they can spiral out of control in illness. When I saw the work done by my clinical educator and the rapid improvement of the patient’s condition, I knew I wanted to become an ICU physiotherapist.

My passion is to maximise the physical recovery of survivors of critical illness. I am currently undertaking my Ph.D. studies in this area at Monash University.

I am happy to say that my first publication has already changed practice worldwide.

“Historically, patients requiring dialysis via a line in their hip have been restricted to bed rest, while there has been no evidence to suggest the restriction was warranted or beneficial. Our team tested the safety and feasibility of early exercise and mobility in these patients. We found that mobilisation of patients undergoing this dialysis therapy was safe, feasible and possibly improved the delivery of the dialysis therapy.”

This change in evidence was reflected in the international expert consensus of early mobilisation in the critically ill, where dialysis via a catheter in the hip is no longer deemed a barrier to mobilisation and rehabilitation activities.

The next phase of my research will focus on novel ways to identify patients at risk of disability as soon as they are admitted to an intensive care unit.

References:

Skinner E, Berney S, Warrillow S, Denehy L. Rehabilitation and exercise prescription in Australian Intensive Care Units. Physiotherapy. 2008;94:220–229.

Denehy L, Berney S. Physiotherapy in the intensive care unit. Phys Ther Rev. 2006;11:1–8.

Gosselink R, Bott J, Johnson M, 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 Med. 2008;34:1188–1199