Currently on my cardiopulmonary placement, I had the opportunity to treat a patient in ICU with APO, cardiovascular instability and obesity (BMI of 43). The patient had been in ICU for over two weeks, and has remained fairly unstable over this period. He has CPAP via a trachy, constant production of sputum that he is unable to clear independently and maintains O2 sats of 94% on O2 therapy. His BP fluctuates throughout the day and with t/f.
When I went to assess this patient, auks findings revealed insp and exp wheeze in the upper lobes, and quiet bibasally. The chest Xray confirmed L lobe pneumonia. He had decreased chest expansion bibasally and the NSG where regularly s/o 2-3 plugs M2P1 secretions. Prior to assessment, I read the patients noted to investigate past physio treatment he has received while on ICU. Over the two weeks, he received the same PT treatment bidaily: TEE’s, +/- vibes, active movement (10 ul and 10LL exs) followed by a s/o.
To me, this treatment sounded fine- TEE’s to increase FRC and Vt, vibes to aid in shearing secretions active movement to encourage increase in exp flow. All aimed at improving gas exchange, air way clearance and reduced lung vol. But the more I thought about this repetitive treatment, I began to think how effective 4*4 deep breaths and 20 active movements twice a day could really be for a patient this debilitated?? If the nursing staff are already suctioning, wouldn’t it be more beneficial to encourage active movement and set goals with a more functional outcome ie passive movements program to active assisted to active?
This experience taught me that it is important to understand the rationale behind treatment techniques and to not just follow a recipe when treating patients in an acute setting. Functional goals are just as important for the critically unwell as those in other stages of recovery,
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