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Physiotherapy in critically ill patients 

Physiotherapy in critically ill patients
Chapter:
Physiotherapy in critically ill patients
Author(s):

R Gosselink

and J Roeseler

DOI:
10.1093/med/9780199687039.003.0033_update_001

February 22, 2018: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Minor updates to the text and references

Updated on 27 July 2017. The previous version of this content can be found here.
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date: 16 October 2019

Physiotherapists are involved in the management of patients with critical illness. Physiotherapy assessment of critically ill patients is less driven by medical diagnosis; instead, there is a strong focus on deficiencies at a pathophysiological and functional level. An accurate and valid assessment of respiratory conditions (retained airway secretions, atelectasis, and respiratory muscle weakness), physical deconditioning, and related problems (muscle weakness, joint stiffness, impaired functional exercise capacity, physical inactivity, and emotional function) allows the identifying of targets for physiotherapy. Evidence-based targets for physiotherapy are deconditioning, impaired airway clearance, atelectasis, (re-)intubation avoidance, and weaning failure. Early physical activity and mobility are key in the prevention, attenuation, or reversion of physical deconditioning related to critical illness. A variety of modalities for exercise training and early mobility are evidence-based and are implemented, depending on the stage of critical illness, comorbid conditions, and cooperation of the patient. The physiotherapist should be responsible for implementing mobilization plans and exercise prescription and make recommendations for their progression, jointly with medical and nursing staff.

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