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The coronavirus outbreak has meant that many Intensive Care Units are much, much busier than normal. Many Intensive Care Units will have had to completely reorganise how they provide care, so that they can increase the number of beds available, and also provide separate Units for patients who do and don't have coronavirus. All of this means that many more physiotherapists are needed. Many Units have had to bring in ("redeploy") physiotherapists from other areas who don't normally work in Intensive Care.These staff receive rapid training and support from Intensive Care staff, so that they can safely provide care. They will be carefully supervised by staff who normally work in Intensive Care. 

What do physiotherapists do in Intensive Care?

Physiotherapy has a very important role for patients in Intensive Care. Their role is particularly important for patients with COVID-19, who may spend longer in Intensive Care, and are therefore more prone to muscle wasting and joint stiffness. There are two main things that the physiotherapist can help with; breathing and exercises.

Help with breathing

Many patients in Intensive Care need help with their breathing, even if they're not connected to a ventilator or breathing machine. Many patients with COVID-19 will receive support with their breathing using a tight-fitting masked called a CPAP mask (Continuous Positive Airway Pressure, "see pap"). Patients who are not connected to a ventilator or breathing machine may struggle to breathe deeply enough, may have an uncomfortable breathing pattern or may not be able to cough strongly enough to clear phlegm or secretions from their chest. Physiotherapy can sometimes help prevent the need to connect patients to a ventilator or breathing machine.

Regardless of whether or not the patient is connected to a ventilator or breathing machine, the physiotherapist can help with making the pattern of breathing more effective; improving lung and chest expansion (helping to increase the size of each breath that the patient is able to take); clearing phlegm or secretions from the chest, and improving the strength of the patient's cough (so that he or she is able to clear phlegm or secretions).

Help with exercises

Patients are often immobile (lying still) for much of their time in Intensive Care. They often lose muscle due to the severity of their illness, resulting in general weakness, tiredness and joint problems. This can mean that patients may struggle to move without help, can become tired or short of breath when gently moving around (e.g. being helped to sit on the edge of the bed or out in a chair) or may have painful muscles or stiff joints. The longer a patient is in Intensive Care, the more likely they are to have these problems. An equally important part of the physiotherapist's job is therefore to help maintain and improve muscle strength and prevent joint stiffness.

Exercises for patients who spend longer in Intensive Care     

Help with exercises is very important in patients who spend a little longer in Intensive Care, because they are at more risk of muscle loss and joint stiffness. These patients tend to be a little more awake and can take part in gentle exercise, which can be slowly built up over time. These include: exercises in bed or chair to strengthen the arm, chest and leg muscles; balance exercises (either sitting on the edge of the bed or standing next to the bed); help with starting to walk and the use of splints if the patient's joints are becoming stiff or at risk of tightening.

How often does the physiotherapist see patients in Intensive Care?

A physiotherapist will normally see the patient at least once a day. He or she will not treat the patient if they are too unwell, as the heart and lungs may not be able to cope with an increase in activity. He or she might not treat patients who are recovering very quickly, as they are much less at risk of the problems that physiotherapy can help with. This might include, for example, patients who were previously well and spend a very short time in Intensive Care after an operation.

What happens after patients are transferred to the wards?

The physiotherapists in Intensive Care will normally continue to see patients who are discharged to surgical wards. Patients transferred to medical wards will normally be seen by a different team, but the Intensive Care physiotherapist will let the new team know about the patient's time in Intensive Care and what kind of help they need.



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