PHYSIOTHERAPY FOR ICU ACQUIRED WEAKNESS

PHYSIOTHERAPY FOR ICU ACQUIRED WEAKNESS: 

Pre and Post ICUAW PT management:

Introduction:

Critically ill patients often develop neuromuscular disorders such as Critical Illness Polyneuropathy and Critical Illness Myopathy called Intensive Care Unit Acquired weakness (ICUAW).

ICUAW causes generalized muscle weakness with more affectation on the limbs and respiratory muscles, leading to delays in mobilization and prolongation of hospitalization.

Physiotherapy Management:

1. Respiratory Muscle Training

Respiratory muscle weakness is a common feature of ICUAW patients. The critically ill patient depends on the mechanical ventilator for a longer period of time, which makes the respiratory muscles weak. 

Inspiratory muscle training when the patient is on a mechanical ventilator and when weaned improves the strength of the respiratory muscle.

Inspiratory muscle training can be achieved by Spontaneous breathing by means of a nonlinear resistor that increases respiratory workload;

Insensitive trigger threshold can be used during assisted mechanical ventilation support;

A threshold device can also be used.

2. Joint mobilization and muscle training regimes:

 Main aim is to increase muscle strength, minimize atrophy, improve muscle mass, and function. 

It can be divided into the ICU admission period when the patient is on a ventilator and post ICU rehabilitation when the patient is weaned. 

Joint mobilization and muscle training for patients with ICUAW during admission includes:

• Passive range of motion treatment sessions

• Passive cycling

• Electrical muscle stimulation (EMS)

Post-ICU Joint mobilization and muscle rehabilitation of a patient with ICUAW is following:

• Strength training program

• Aerobic session such as walking, arm and leg cycling exercises,

• Functional activities therapy regime

• And the provision of self-help manuals and programs…