Physical therapy for a patient in acute respiratory failure.
OBJECTIVE
The main indications for physical therapy for patients in intensive care units (ICUs) are excessive pulmonary secretions or atelectasis. Timely physical therapy interventions may improve gas exchange and reverse pathological progression, thereby curtailing or avoiding artificial ventilation. The purpose of this case report is to illustrate 24-hour availability of physical therapy for a patient with acute respiratory failure.


METHODS
The patient was a 66-year-old man who was admitted to an ICU for acute respiratory failure. Intensive physical therapy, based on Dean's physiologic treatment hierarchy for treatment of patients with impaired oxygen transport, consisted of upright body positioning, mobilization and exercise, and active cycles of breathing techniques every 2 hours for the first 12 hours he was in the ICU.


RESULTS
In total, the patient received 11 physical therapy sessions over his 48-hour stay in the ICU (6 sessions on day 1 and 5 sessions on day 2). Arterial oxygenation improved markedly with radiographic resolution of infiltrates, and planned endotracheal intubation and mechanical ventilation were avoided.


CONCLUSIONS
This patient with acute respiratory failure received physical therapy in a timely manner afforded by 24-hour access to physical therapy. The intensive physical therapy might be more cost-effective than if the patient had been managed with intubation and mechanical ventilation. Patients in ICUs who have excessive pulmonary secretions or atelectasis may benefit from access to physical therapy 24 hours a day.
Wong
W P
WP
Physiotherapy Department, Singapore General Hospital, Singapore. gpywwp@sgh.gov.sg
D000208:Acute Disease; D000368:Aged; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D026741:Physical Therapy Modalities / Q000379:methods*; D001261:Pulmonary Atelectasis / Q000150:complications; D011659:Pulmonary Gas Exchange; D011859:Radiography; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome