This paper is intended to introduce...

This paper is intended to introduce physical therapists in facility based practice to the paraphernalia they may assault when treating patients in the intensive care unit (ICU). The chiefly common lines, tubes, catheters, and physiologic monitoring equipment are discussed. The diagnostic indications for placement of tracheal tubes, chest tubes, arterial lines, central venous compressing and pulmonary artery catheters as well as their function in the medical management of the patient are described. Monitoring devices seen in the neurological intensive care unit are discussed in detail. Finally, the therapist is introduced to the rationale for administering continuous hemodialysis, peritoneal dialysis, and the intraaortic balloon cross-question Physical therapy implications for each device are included. Although complications directly related to physical therapy interventions in the ICU are rare, therapists are urg to have haunt and timely communication with all team members. Physical therapists are encouraged to establish comprehensive orientation programs. Periodic assessments are recommended to assure patient safety and minimize complications that may be associated with routine physical therapy transactions

Key Words: Physical therapy, hemodynamic monitoring devices, physiologic monitoring

Sophisticated hemodynamic and laboratory techniques and critical care as a medical/nursing specialty evolv in the 1960 In the 1970 physical therapists began practicing in the Intensive Care Unit (ICU).1 Critical Care physical therapy was primarily limited to academic medical center with a staff specially trained and committed to the care of critically ill patients. More lately advanced medical technology and training have expanded to community hospitals with sophisticated intensive care units; patients previously triaged to academic medical center are many times treated in intensive care units in community hospitals. The Society of Critical Care Medicine includes physical therapists as an essential part of the health care team for all critical care units.2 Therefore, knowledge of the placement and function of lines, tubes, hemodynamic monitoring, and critical care equipment necessary to sustain life is crucial for physical therapists entering practice in principally acute care environments.

Chest physical therapy in the ICU, which includes postural drainage, manual techniques, breathing exercises, and airway suctioning, is as effective as therapeutic bronchoscopy for treatment of atelectasis resulting from pulmonary secretion retention and may increase PaO^sub 2^(34) Limited studies demonstrate the importance of early physical therapy intervention to improve functional issue decrease hospital stay, and rehabilitation time.5-7 Clearly, getting patients disclosed of bed while monitored and beginning therapeutic exercises and functional activities in the intensive care unit is beneficial in minimizing the systemic purports of immobility. However, the necessary commonness duration, and intensity of early physical therapy have not been studied. The optimum and most numerous cost effective interventions for specific patient populations have not been determined.

The intention of the paper is to describe the lines, tubes, and hemodynamic devices that physical therapists may engagement when consulted to treat critically ill patients. The authors have relied upon their clinical experience and a brief review of the literature. Equipment may vary from institution to institution, besides the underlying principles remain the same. Tracheal and chest tubes, vibration oximeters, hemodynamic monitoring, and devices to monitor intracranial compressing are described in detail and summarized in Table 1 The reader is also expos to the waveforms that are noted onward bedside monitoring devices. Many ICU patients are in renal failure, therefore peritoneal and hemodialysis are included. Lastly, the reader will learn about the intra-aortic balloon cross-examine which is indicated for the chiefly critically ill patient who is unable to maintain an adequate relations pressure. Implications for physical therapy examination and interventions are also included. It is the intent of this paper to give the novice ICU therapist general guidelines for working with the paraphernalia commonly seen when administering physical therapy to critically ill patients.

The therapist entering the ICU must first carefully examine the patient, noting which paraphernalia is not past nor future and how it will impact physical therapy examination and interventions. The in the greatest degree frequently encountered lines and tubes, hemodynamic and neurologic monitoring, dialysis equipment, and intra-aortic balloon counterpulsation are discussed.

TUBES

Tracheal Tubes

Tracheal tubes allow access to the upper airway for patients with upper airway obstruction, permit easier, safer suctioning of patients with excessive pulmonary secretions, and enable mechanical ventilation in the port of respiratory failure. Endotracheal tubes are inserted either by the agency of the nose (nasotracheal) or cavity between the jaws (orotracheal) and are used for short-term airway management. Tracheostomy tubes are inserted by the and of an incision in the trachea below the vocal cords, usually between the third or fourth tracheal rings.8 Fenestrated tracheostomy tubes have an opening in the posterior wall of the tube above the stroke Fenestrated tubes are used to assess a patient's readiness for extubation and permit articulate utterance as gases pass through the fenestration and vocal cords to the oropharynx. An inner cannula without an opening in the posterior wall should be in inserted and the blow inflated prior to suctioning a patient with a fenestrated tracheotomy tube.