Fysiotherapie voor volwassen patiënten met critical illness

Abstract

Samenvattingx x x De Task Force heeft de beschikbare literatuur over de effectiviteit van fysiotherapie bij volwassen patiënten met acute en chronische critical illness. Bewijs uit gerandomiseerde gecontroleerde onderzoeken of meta-analyses is beperkt en de meeste aanbevelingen waren van niveau C (bewijs uit niet-gecontroleerde of niet-gerandomiseerde onderzoeken, of uit observatieonderzoeken) en D (deskundig oordeel). Niettemin werden de volgende problemen als evidence-based doelen voor fysiotherapie vastgesteld: verlies van lichamelijke conditie, atelectase, het voorkómen van intubatie en problemen bij het weanen. Tegenstrijdige en gebrekkige gegevens in klinische onderzoeken over de werkzaamheid van fysiotherapie bevestigen de noodzaak om richtlijnen voor fysiotherapie vast te stellen. De bedoeling is met name patiëntkenmerken te identificeren, zodat behandelingen voor de individuele patiënt op maat gemaakt kunnen worden voorgeschreven en aangepast. Het is nodig het proces van klinisch redeneren en voorlichting te standaardiseren, het professionele profiel van fysiotherapeuten vast te leggen, en zich meer bewust te zijn van de voordelen van preventie en behandeling van immobiliteit en het verlies van lichamelijke conditie bij volwassen patiënten met critical illness.

Functional Recovery Following Physical Training in Tracheotomized and Chronically Ventilated Patients

“…27 Though it seems that early physical training should be helpful in mechanically ventilated patients who are confined to bed, no clear evidence has yet emerged in the literature in favor of early physical training in patients in the ICU setting. 9 A randomized trial in a medical ICU found that only 13% of patients ventilated for Յ 72 hours were eligible for interrupting sedation and participating in whole-body rehabilitation to recover their basic activities. 11 The feasibility of an early training program in the ICU to improve BADL functioning at hospital discharge was been further confirmed in medical and surgical mechanically ventilated patients, 10 even during an episode of acute respiratory failure.…”

“…We excluded patients with persistent altered sensorium, major cardiac arrhythmia, 9 history of underlying neuromuscular disease or acquired polyneuromyopathies, unable to perform physical training due to preexisting joint dysfunction, or with conditions that could have negatively influence the prognosis. We used electromyography to assess for acquired ICU neuropathy and myopathy (Fig.…”

“…7 The role of rehabilitation in critically ill adults remains controversial 8 and not fully addressed. 9 Recent randomized trials in ICU settings showed that early rehabilitation/training of mechanically ventilated patients translates into substantial functional independence at hospital discharge, both in exercise capacity 10 and basic activities of daily living. 11 Few non-randomized studies have addressed the role of physical training in critically ill patients on prolonged mechanical ventilation.…”

Use of thoracic ultrasound by physiotherapists: a scoping review of the literature

“…Accurate diagnosis of respiratory conditions is of paramount importance to physiotherapists 51 to enhance treatment selection and monitor treatment effectiveness [6]. TUS may provide an 52 alternative, and more accurate, imaging option for physiotherapists that can be performed at 53 the bedside and in real-time.…”

Mobilização precoce a prática do fisioterapeuta intensivista: intervenções e barreiras

“…16,19 A força-tarefa da European Respiratory Society and Europen Societyof Intensive Care Medicine, em 2008, e o Departamento de Fisioterapia da Associação de Medicina Intensiva Brasileira, em 2012, descrevem uma hierarquia de atividades de mobilização na UTI seguindo uma sequência de exercícios que se iniciam a partir da mudança de decúbito, com grau de recomendação Nível B para mobilização precoce e ortostatismo. 16,20 Nossos resultados revelam que a sedestação (91,2%) foi a intervenção para MP mais citada pelos participantes. Segundo Hickmann et al 21 , quando acompanhada de exercícios ativos, otimiza a aeração pulmonar e minimiza a hipoxemia.…”