Mobilization in the Critical Care Unit (How It Works). Craig Moreland, PT, MS Director of Physical Therapy, UPMC Presbyterian, Montefiore, and Western Psychiatric Institute & Clinic Annual PM&R Assembly. The Physical Therapist’s Role in the ICU. 3 main goals:
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Craig Moreland, PT, MS
Director of Physical Therapy, UPMC Presbyterian, Montefiore, and Western Psychiatric Institute & Clinic
Annual PM&R Assembly
Basic cardiopulmonary pathophysiology
Complications of bedrest and physiologic change associated with deconditioning
Common ICU medications
Role of the other ICU team members
All monitoring equipment
Ventilator and respiratory equipment
Previous Level of Function
Time of DIS (Daily Interruption of
Assessment of Lines, Tubes,
Transfer, ADL, and Balance Training
Positioning and Postural Drainage:
~teach a “pump cough”
~a forceful prolonged exhalation can lead to distress
~difficulty with expiration
~do not teach “take a deep breath”
~controlled small breaths
~maximize airway clearance
~make sure the patient can swallow safely
~position for success, couple extension & inhalation, couple flexion & exhalation
Prior to initiating our mobility project, we needed to train all staff in…
Transfer and Balance Training:
Setting Up the Room
Scanning the Lines, Tubes,
Scanning the Ventilator
Inspecting the Patient
Who Holds What Line?
What is each healthcare worker’s role?
Ambulation is Our Ultimate Goal!!
Education is Invaluable!!
What Equipment will the mobility team need?
FiO2 greater than 60%
PEEP greater than 10 cm H20 pressure
Consistent O2 Saturations less than 92%
Hx of desaturations with positional changes
Unstable Blood Pressure
Severe Acidosis with pH less than 7.30
~~~While many of these may not be absolute contraindications to mobilization, they should be cause to stop and discuss with the medical and nursing team prior to continuing~~~
~~~The most important skill for a therapist to develop in the Critical Care Unit is to recognize when to initiate, delay, progress, and terminate treatment~~~