Physiotherapy in a Burn Patient Admitted in Intensive Care Unit

BackgroundEarly physiotherapy in critical ill patients is a key component to their functional recovery. Burn patients are presented with severe complications that lead to reduced functional ability.ObjectiveThe aim of this paper is to present the case of a 22 year old male patient with a 45% burn of total body surface area, who was admitted in the Intensive Care Unit.MethodsEarly physiotherapy commenced from the early stages of acute illness and involved respiratory and musculoskeletal interventions in order to prevent and address complications from prolonged immobilization and mechanical ventilation. ResultsPatient through his stay in the ICU presented significant clinical improvements. He was successfully liberated from mechanical ventilation and decannulated from tracheostomy tube. Improvements in muscle strength and functional ability was noted once discharged from the ICU to a High Dependence Unit.ConclusionIn the current case study physiotherapy was a vital and effective component of the therapeutic plan of severe burn patient being admitted in a acute care facility and positioning of the upper and lower limbs is of huge importance, in order to minimize and avoid contractures

Therapeutic Applications of Neuromuscular Electrical Stimulation in Critical Care Patients

Neuromuscular Electrical Stimulation (NMES) is commonly used by physiotherapists for pain relief, stimulation of denervated or disused muscles, and the promotion of wound healing.  The purpose of this review is to discus the applications of NMES in Intensive Care Unit (ICU) patients according to the current research evidence. The first application is the neuromuscular electrical stimulation (NMES) in  ICU acquired weakness with research evidence indicating significant benefits such as preservation of  muscle mass, prevention of  polyneuromyopathy and improvement of muscle performance. Secondly, NMES has been proved to be effective in preventing pressure ulcers and accelerating wound healing through mechanisms which are clearly demonstrated by many experimental and clinical studies. However, very few studies have examined the effect of E.S. in pressure ulcers of long term hospitalized ICU patients. Lastly, NMES in ICU can be applied in the form of functional electrical stimulation (FES), a well known technique used to mobilize patients with permanent neurological deficits such as stroke and spinal cord injury. Current evidence in this area is reviewed and future research is proposed

The Effectiveness of Inspiratory Muscle Training in Weaning Critically Ill Patients from Mechanical Ventilation

BACKGROUND: Inspiratory muscle weakness is a consequence of mechanical ventilation that contributes to weaning failure in critical ill patients. Since 1980, case reports of inspiratory muscle training (IMT) in ventilated, difficult to be weaned patients have proposed that this training strategy is associated with successful weaning. OBJECTIVE: We evaluated the efficacy of the inspiratory muscle training on the weaning process. METHODS: We conducted a literature search in the following databases: PubMed, EMBASE, Scopus and Google scholar. Selected keywords included inspiratory/ respiratory muscle training, weaning/failure, mechanical ventilation, critically ill, threshold load, intubated/ tracheostomy. RESULTS: In our analysis we included three randomized control trials involving 150 patients. The studies used different devices of training and training protocols. Inspiratory muscle training significantly increased inspiratory muscle strength in relation to sham or no training. CONCLUSION: Although IMT leads to significant increase of respiratory muscle strength, it has not yet been clearly demonstrated that this also leads to successful weaning. Further large randomized studies are needed to determine the beneficial effect of IMT in weaning patients from ventilatory support

Effect of neuromuscular stimulation and individualized rehabilitation on muscle function in Intensive Care Unit survivors

Introduction: Intensive Care Unit (ICU) survivors experience muscle weakness leading to restrictions in functional ability. Neuromuscular electrical stimulation has been an alternative to exercise in critically ill patients. The aim of our study was to investigate the effects of Neuromuscular electrical stimulation and individualized rehabilitation on muscle strength of ICU survivors.Design: Randomized controlled trial.Patients: Following ICU discharge, 128 patients (age: 53±16years) were randomly assigned to daily NMES sessions and individualized rehabilitation program (NMES group) or to the control group.Methods: Muscle strength was assessed by the Medical Research Council (MRC) scale and hand grip at hospital discharge. Secondary outcome was functional ability and hospital length of stay. Results: MRC, handgrip strength, functional status and hospital length of stay did not differ at hospital discharge between groups (p>0.05). ΔMRC% one and two weeks after ICU discharge tended to be higher in the NMES group, while it was higher in the NMES group of patients with ICU-aw (p 72 ώρες και μπορούσαν να εκτελέσουν απλές εντολές, τυχαιοποιήθηκαν κατά επίπεδα (ηλικία & MRC) στην ομάδα ΗΝΜΕ ή στην ομάδα ελέγχου. Στην ομάδα ΗΝΜΕ έγινε καθημερινή εφαρμογή ΗΝΜΕ και προγράμματος ασκήσεων ενώ στην ομάδα ελέγχου έγινε εφαρμογή εικονικού ΗΝΜΕ και δέχτηκαν τη συνήθη θεραπευτική παρέμβαση. Η κλίμακα μυϊκής ισχύος Medical Research Council (MRC) και η δυναμομέτρηση χειρός χρησιμοποιήθηκαν για την αξιολόγηση της μυϊκής ισχύος. Η λειτουργικότητα αξιολογήθηκε με την κλίμακα Functional Independence Measure (FIM) και η ποιότητα ζωής με τα ερωτηματολόγια Euro-Qol 5D (Euro- Quality of Life) και Nottingham Health Profile. Αποτελέσματα: Η MRC μυϊκής ισχύος κατά την έξοδο από τη ΜΕΘ και το νοσοκομείο δεν διέφερε μεταξύ των δυο ομάδων. Η ΔMRC% έτεινε να είναι υψηλότερη στην ομάδα ΗΝΜΕ κατά την 1η και 2η εβδομάδα παραμονής στο Νοσοκομείο. Στους ασθενείς με MRC<48/60 κατά την έξοδο από τη ΜΕΘ, η ΔMRC% ήταν σημαντικά υψηλότερη στην ομάδα ΗΝΜΕ σε σχέση με την ομάδα ελέγχου κατά την 1η και 2η εβδομάδα παραμονής στο Νοσοκομείο (33%±31% vs 18%±15%, p=0.07, 59%±54% vs 30%±20%, p=0.05, αντίστοιχα). Η δυναμομέτρηση χειρός και η κλίμακα λειτουργικότητα δεν έδειξαν διαφοροποίηση μεταξύ των δύο ομάδων. Επίσης δεν υπήρξε διαφορά και στην ποιότητα ζωής. Συμπέρασμα: Η εφαρμογή του ΗΝΜΕ συμπληρωματικά με ένα πρόγραμμα αποκατάστασης μπορεί να συμβάλλει στη βελτίωση της μυϊκής ισχύς κυρίως ασθενών με σοβαρή μυϊκή αδυναμία .Ο ΗΝΜΕ φαίνεται να είναι ιδιαίτερα αποτελεσματικός στη βραχεία περίοδο εξόδου από τη ΜΕΘ επιτυγχάνοντας τη φυσική διαδικασία ίασης

Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis

Chronic Obstructive Pulmonary Disease (COPD) is characterized by irreversible airflow limitation. Patient participation in Pulmonary Rehabilitation (PR) programs has a beneficial effect on disease management, improving patients’ functional capacity and quality of life. As an alternative to traditional programs or as a complementary activity, the inclusion of virtual reality (VR) games is proposed. The aim of this research study was to investigate the effectiveness of incorporating VR in the pulmonary rehabilitation program of patients with COPD. A systematic literature search was performed for randomized controlled trials (RCTs) in the electronic databases Google Scholar, PubMed, and Pedro from January 2014 to March 2022. The search involved screening for studies examining the effectiveness of enhancing PR with VR. The PEDro (Physiotherapy Evidence Database) scale was chosen as the tool to assess the quality of studies. A meta-analysis was performed where possible. Six studies were included in this systematic review. The PEDro scale showed five studies of good methodological quality and one of fair quality. The variables examined were aerobic capacity for exercise, lung function, and anxiety and depression, with significant improvement regarding 6MWT and FEV1 (p < 0.05). There was variability noted in the VR applications and the proposed rehabilitation that the experimental groups followed. The application of VR is recommended for COPD patients, in combination with conventional PR. VR was found to be effective in increasing therapeutic effect and should be considered as a mean of increasing accessibility to PR. Therefore, further research, as well as additional RCTs regarding the effectiveness of VR in patients with COPD, seems necessary

Reply to Salimi, M. Comment on “Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. <i>Adv. Respir. Med.</i> 2023, <i>91</i>, 324–336”

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Correction: Patsaki et al. Benefits from Incorporating Virtual Reality in Pulmonary Rehabilitation of COPD Patients: A Systematic Review and Meta-Analysis. <i>Adv. Respir. Med.</i> 2023, <i>91</i>, 324–336

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The combination of inspiratory muscle training and high-flow nasal cannula oxygen therapy for promoting weaning outcomes in difficult-to-wean patients: protocol for a randomised controlled trial

Background: According to the literature, 20-30% of intubated patients are difficult to wean off mechanical ventilation and have a prolonged intensive care unit (ICU) stay with detrimental effects on muscle strength, functional ability and quality of life. Inspiratory muscle training (IMT) via a threshold device has been proposed as an effective exercise for minimising the effects of mechanical ventilation on respiratory muscles of critically ill patients with prolonged weaning. In addition, high-flow nasal cannula (HFNC) oxygen has been proved to provide efficient support for both high- and low-risk patients after extubation, thus preventing re-intubation. Material and methods: A randomised controlled trial was designed to assess the efficacy of combining IMT and HFNC as therapeutic strategies for patients with high risk for weaning failure. Once patients with prognostic factors of difficult weaning are awake, ventilated with support settings and cooperative, they will be randomised to one of the two following study groups: intervention group (IMT and HFNC) and control group (IMT and Venturi mask). IMT will start as soon as possible. Each allocated oxygen delivery device will be applied immediately after extubation. IMT intervention will continue until patients’ discharge from ICU. The primary outcome is the rate of weaning failure. Secondary outcomes are maximal inspiratory and expiratory strength, endurance of respiratory muscles, global muscle strength, functional ability and quality of life along with duration of ventilation (days) and ICU and hospital length of stay. Conclusion: The present study could significantly contribute to knowledge of how best to treat patients with difficult weaning and high risk of re-intubation