Other supportive careBMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7203.175 (Published 17 July 1999) Cite this as: BMJ 1999;319:175
- Sheila Adam,
- Sally Forrest
As well as specific organ support techniques such as mechanical ventilation and renal replacement therapy, patients in intensive care require other interventions to maintain organ function and prevent further damage. These include nutritional support, preserving skin integrity, psychological support, and mobilisation. These interventions enable patients to recover their previous level of health, prevent intercurrent problems such as nosocomial infection and lung atelectasis, and support psychological and physical wellbeing.
Patients who are intubated or mechanically ventilated require chest physiotherapy to remove excess bronchial secretions, re-expand atelectatic areas, improve ventilation, decrease ventilation-perfusion mismatch, and mobilise the thoracic cage.
Respiratory complications associated with tracheal intubation and mechanical ventilation
Inability to clear secretions
Trauma related to high inflation pressures, large tidal volumes, and shear stresses
Microatelectasis and consolidation
Alterations in ventilation-perfusion matching
Bronchial secretions increase in intubated patients as the tracheal mucous membrane is irritated. These secretions may become tenacious as the patients' natural humidification has been bypassed. Expectoration may also be reduced by an ineffective cough, decreased ciliary action, and loss of sigh breaths.
Secretion tenacity can be reduced by adequate humidification and systemic hydration. Clearance of secretions is achieved by chest physiotherapy, suctioning, and occasionally bronchial lavage.
Disadvantages of immobility
Increased risk of venous thrombosis and pulmonary embolism
Decrease in functional residual capacity (when supine)
Decreased lung compliance
Increased excretion of nitrogen, calcium, potassium, magnesium, and phosphorus
Decrease in muscle bulk
Loss of bone density
Decreased range of joint movement
The primary aims of chest physiotherapy are to improve gas exchange and prevent atelectasis and consolidation, which occur as a result of mucus plugging or infection. Patients are assessed daily and will receive the following treatments as appropriate.
Positioning—For postural drainage or to improve ventilation-perfusion matching.