Physiotherapy in the Intensive Care Unit

iotherapists are vital members of the multidisciplinary team providing a spectrum of care from acute respiratory to rehabilitation. The education and training of physiotherapists and their role in relation to other health professionals such as nurses and respiratory therapists varies greatly. This withstanding, physiotherapy is reported to be an integral part of patient management in the intensive care unit (ICU) of hospitals in industrialised countries.1 The aims of this review are to present the current evidence for the role of physiotherapists in the adult ICU in relation to respiratory management including non-invasive ventilation (NIV), exercise, and short and longer term rehabilitation of patients. Literature searches were performed using the databases MEDLINE and CINAHL (cumulated index to nursing and allied health literature) with appropriate subject headings including intensive care, rehabilitation, physiotherapy, physical therapy, critical care, critical illness, chest physiotherapy, manual hyperinflation and exercise; searches were limited to English language. The reference lists of extracted articles were also reviewed. Several surveys report on specific physiotherapy practice in the ICU;2–4 generally, these are limited to respiratory management. However, the assessment and management of neurological and musculoskeletal complications form an important part of the physiotherapist’s role.1,5 It is this individualised, multisystem patient assessment and treatment that defines the role of physiotherapists compared with respiratory therapists and nurses. Physiotherapists may be involved with specific patient positioning, suction, mobilisation, exercise, passive movements, manual airway clearance techniques, manual (MH) and ventilator hyperinflation (VH), NIV and weaning.1,6–8 The country of origin of published research reflects differences in types of healthcare professionals employed in the ICU, with research from the US predominately reporting respiratory therapist roles. In the UK, parts of Europe and Canada, South Africa, and Australia, the role of physiotherapists encompasses respiratory as well as neurological and musculoskeletal patient