The role of the physiotherapist in Critical Care

The physiotherapist plays an important role in a patient’s recovery on the Critical Care Unit (CCU).

What is the role of the physiotherapist on CCU?

The role of the physiotherapist can be divided into two areas:

• respiratory physiotherapy, and

• rehabilitation.

Both areas involve important strengthening exercises. This is important in the recovery of some patients during their time on CCU. Each treatment program will depend on the patient's individual needs.

What does respiratory physiotherapy involve?

It is normal for our lungs to create sputum every day. Sputum collects dust and dirt particles, and is usually coughed and cleared throughout the day.

Some CCU patients need mechanical ventilation to help with their breathing. Ventilation is important for recovery, but can:

• stop patients coughing and clearing their sputum as normal, and

• lead to weakness of the chest muscles, which usually do not need this extra help.

If a patient has a chest infection or pneumonia, they will produce more sputum. Physiotherapists help patients to manage their daily sputum with different techniques, including:

• breathing exercises, and

• early movement (such as sitting out in a chair).

These exercises and movement help maintain muscle and cough strength. Strength is important when helping patients to “wean” off the ventilator. Physiotherapists have a key role in this process.

The physiotherapist will often arrange a structured “weaning plan” for the patient. This plan allows patients to have time breathing without the ventilator, leading to independent breathing (breathing on their own).

Most mechanically ventilated patients are referred to Physiotherapy. These patients are treated, and can see the benefits of working with a physiotherapist even when sedated.

What does rehabilitation involve?

Patients on CCU can become weak very quickly. The longer they stay in bed, the tighter and weaker their muscles become, and the stiffer their joints are.

If necessary, physiotherapists will review and monitor the patient's functional progress throughout their time on CCU. Evidence suggests it helps patients on CCU to begin moving around early on. As soon as possible, the physiotherapist may progress patients to:

• sitting up

• standing

• sitting out on a chair, and

• moving.

This will help the patient physically and mentally, and should improve their recovery.

What other treatments may I see on CCU?

The following are treatments you may see other patients having in CCU. Some treatments are not suitable for all patients. The physiotherapist assesses each patient, and gives them their own treatment plan.

• Bed and breathing exercises.

• Stretches or splints for hands or feet, to prevent muscle and joint stiffness.

• Early activity, such as getting into a chair or walking (even if still on the ventilator). Early activity encourages deep breaths and coughing.

• Positioning patients to allow gravity to help sputum drain from their lungs and encourage deeper breaths.

• Manual techniques, such as percussion and vibrations applied to the patient’s ribs. These techniques include “patting” to try to loosen and clear sputum.

• The “Cough Assist” device.

• Placing a small tube into a patient's lungs to suck out excess sputum. This is very important for patients who are:

  • too weak to cough properly, or

  • relying on mechanical ventilation for their breathing.

The Physiotherapy Team

Physiotherapists work with the rest of the CCU team. There are a team of physiotherapists available throughout the week in CCU. Your physiotherapist will visit at least once a day, but will visit more if needed.

This leaflet explains the role of the physiotherapist on Critical Care. If you have any questions, please speak to a member of Critical Care staff or a member of the Physiotherapy team.

Contact details

• Kent and Canterbury Hospital, Canterbury:

• Queen Elizabeth the Queen Mother (QEQM) Hospital, Margate:

• William Harvey Hospital, Ashford: