Critical Care Assessment

Original Editor - Justin Bryan Top Contributors - Justin Bryan, Rachael Lowe, Karen Wilson and Adam Vallely Farrell

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (6/01/2023

Introduction

Providing physical therapy in the critical care setting retains many of the same goals as that of the general acute care setting, however, given the unique needs and circumstance of this patient population, there are certain aspects that differ in significant ways.

In order to successfully provide PT care to critically ill patients, it is important to understand the unique goals of care, and how these differ from other areas of acute care.  To begin with, discharge planning remain one of the key aspects that a PT will work toward addressing with any patient they are treating in the acute care setting, including those who are critically ill.  This being said, it is important to understand that while discharge planning is a major goal for some who are deemed critically ill (i.e. following a complex but generally routine surgery such as a transplant), it is often not the major focus of therapy for this patient population.

What makes a patient critically ill?

Critical care is an area of medicine that focuses on the management and treatment of patients who are deemed to have a condition that is immediately life-threatening or possesses the risk of becoming life-threatening. These patients are generally cared for in a dedicated intensive care unit (ICU) or ward where specific monitoring of physiology and organ function is possible at a level above that of other units or ward in a hospital. Staffing in ICUs is generally provided at a lower patient to provider ratio (i.e. 1:1). There is a greater emphasis on multidisciplinary care, encompassing individuals from many different backgrounds, and coordinated under a physician with a specialty in critical care medicine. Goals of care often focus on prevention of acute complications, early detection of distress or condition advancement, and immediate response to evolving situations.

Role of Physical Therapy in the ICU

For critically ill patients, care is often be centered around immediate outcomes, necessitated by the severe and uncertain nature of of their condition. That being said, much focus is now being placed on the long term effects that even short stays in the ICU can have on patient once they are eventually discharged. The high incidence of aspects such as prolonged immobilization, complex drug interventions (i.e. sedation), and invasive supportive care (i.e. mechanical ventilation) have been associated with a meriad of negative outcomes including weakness, reduced joint mobility, cognitive dysfunction, and psychological impairment.

One of the biggest factor that has been identified as being associated with negative outcomes is the high degree of prolonged immobilization seen in ICU patients. The unique circumstances surrounding ICU care though often potentiates this situation with one survey finding that patients in the ICU may spent as much as 89% of their day solely on bed rest.