物理治疗（PT）在ICU英文课件.ppt

1、Physical therapy (PT) in Intensive care unit (ICU), ,Physical therapy in ICU,Rationale for PT in ICU - increase mucus production and decrease mucociliary activity due to artificial airway and inadequate humidifiation - increase risk of nosocomial infectionatelectasis - mechanical ventilated patients

2、 may lead to decrease FRC and CL , V/Q mismatching - immobilized critically ill patients suffer muscle deconditioning, increased risk of DVT, pressure sore ,Goals of PT treatment in ICU,improve / maintain cardiopulmonary function promoting mucociliary clearance , sputum expectoration , alveolar expa

3、nsion maximize musculoskeletal function physical performance joint movement , muscle strength , ADL , ambulation,PT. assessment of the critically ill patients in ICU, concerned with the patients respiratory system analytical assessment must be conducted on the other related system to allow a full ov

4、erview of the patients medical stability and suitability for Rx,Cycle of PT program,Assessment / reassessment,Analysis of findings,Implementation of treatment,Problems identification,Planning of treatment,Complication of retained secretion, atelectasis hypoxemia,Retained secretions,Partially occlude

5、,Uneven distribution of ventilation,V/Q mismatching,Hypoxemia,Complete occlude,Shunting blood,V/Q mismatching, Postural drainage position Percussion Vibration FET ACBT etc.,Airway clearance techniques,Postural drainage position (PD),position that aligns the segmental bronchi with gravity , so the ac

6、cumulated secretions in a bronchopulmonary segment move toward centrally and removed by coughing , then easily expectorated.,Percussion and vibration = external manipulation of thorax, assist secretion mobilization percussion : rapid clapping , cupping or striking of external thorax directly over th

7、e lung segment being drained , with cupped hands or mechanical percussor : the mechanical wave of energy produced are believed to be transmitted through the chest wall to loosen airway mucous (4-5 Hz),vibration : fine tremorous action or fine shaking, manually performed by pressing in the direction

8、that the ribs and soft fissure of chest normally move during exhalation,: PD with percussion and vibration facilitate removal of secretions : Percussion by itself may cause : FEV1 : induced hypoxemia but the adversed effects can be prevented if breathing exercises are incorporated into Rx program,Co

9、mbination of physical therapy treatments,During percussion and vibration : PT must observed patient s facial expression because of pain or uncomfortable The consequences of pain are - muscle splinting - increase work of breath - increase O2 consumption - breath holding - bronchospasm etc.,Secretion

10、removal techniques,Coughing suction huffing. etc.,Breathing exercises (BE) - Muscles of ventilation consist of diaphragmatic muscle and intercostal muscle, act as “pump muscles” to move bony thorax,causing intrathoracic pressure changes that, in turn, produce airflow into the lungs. - Muscles of the

11、 larynx and pharynx act as “valves” that help regulate airflow and maintain airway patency.,Active inspiration Lung expansion in 3 directions - antero posterior - transverse - longitudinal Pump handle movement occurs at upper ribs Bucket handle movement occurs at lower ribs abdominal contents move d

12、ownward,Patterns of BE - Diaphragmatic BE - Costal BE (thoracic expansion exercise) - Pursed lips breathing (PLB) - Sustained maximal inspiration (SMI) - Deep BE etc.,Collateral ventilation,Channels of Martin (interbronchiolar channel) Channels of Lambert (bronchiole-alveolar channel) - Pore of Kohn

13、 (interalveolar channel),Considerations for PT. in ICU Closed observation and continuously monitoring - patient s ability to tolerate PT Rx - ventilated patient / reduced level of consciousness / poor gag reflex aspiration - appropiate care minimize cross-infection - raised airway pressure - high PA

14、P - arrhythmia - vital sign - level of ICP - level of consciousness , sedation etc.,Complexity of patients problems in ICU PT must remember the possible feelings and fears that patients may have in their unnatural surrounding - inability to speak - loss of perception of time - suffer from chronic sleep deprivation,Summary,At the ICU bedside - VS and ventilation parameters should be checked before Rx - Proper physical therapy techniques application - Closed observati