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Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients

Abstract

The Task Force reviewed and discussed the available literature on the effectiveness of physiotherapy for acute and chronic critically ill adult patients. Evidence from randomized controlled trials or meta-analyses was limited and most of the recommendations were level C (evidence from uncontrolled or nonrandomized trials, or from observational studies) and D (expert opinion). However, the following evidence-based targets for physiotherapy were identified: deconditioning, impaired airway clearance, atelectasis, intubation avoidance, and weaning failure. Discrepancies and lack of data on the efficacy of physiotherapy in clinical trials support the need to identify guidelines for physiotherapy assessments, in particular to identify patient characteristics that enable treatments to be prescribed and modified on an individual basis. There is a need to standardize pathways for clinical decision-making and education, to define the professional profile of physiotherapists, and increase the awareness of the benefits of prevention and treatment of immobility and deconditioning for critically ill adult patients.

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References

  1. 1.

    Ackerman MH, Mick DJ (1998) Instillation of normal saline before suctioning in patients with pulmonary infections: a prospective randomized controlled trial. Am J Crit Care 7:261–266

  2. 2.

    Aguilo R, Togores B, Salvador P, Rubi M, Barbe F, Agust A (1997) Non-invasive ventilatory support after lung resectional surgery. Chest 112:117–121

  3. 3.

    Aldrich TK, Karpel JP, Uhrlass RM, Sparapani MA, Eramo D, Ferranti R (1989) Weaning from mechanical ventilation: adjunctive use of inspiratory muscle resistive training. Crit Care Med 17:143–147

  4. 4.

    Anonymous (1992) AARC clinical practice guideline. Nasotracheal suctioning. American Association for Respiratory Care (update 2004). Respir Care 37:1176–1179

  5. 5.

    Bach JR, Saporito LR (1996) Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning. Chest 110:1566–1571

  6. 6.

    Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, Veale K, Rodriquez L, Hopkins RO (2007) Early activity is feasible and safe in respiratory failure patients. Crit Care Med 35:139–145

  7. 7.

    Berney S, Denehy L (2002) A comparison of the effects of manual and ventilator hyperinflation on static lung compliance and sputum production in intubated and ventilated intensive care patients. Physiother Res Int 7:100–108

  8. 8.

    Berney S, Denehy L, Pretto J (2004) Head-down tilt and manual hyperinflation enhance sputum clearance in patients who are intubated and ventilated. Aust J Physiother 50:9–14

  9. 9.

    Blackwood B (1999) Normal saline instillation with endotracheal suctioning: primum non nocere (first do no harm). J Adv Nurs 29:928–934

  10. 10.

    Bott J, Carroll MP, Conway JH, Keilty SE, Ward EM, Brown AM, Paul EA, Elliot MW, Godfrey RC, Wedzicha JA, Moxham J (1993) Randomised controlled trial of nasal ventilation in acute ventilatory failure due to chronic obstructive airways disease. Lancet 341:1555–1557

  11. 11.

    Burtin C, Clerckx B, Robbeets C, Gall S, Pillen R, Leclercq H, Caluwé K, Lommers B, Wilmer A, Troosters T, Ferdinande P, Gosselink R (2006) Effectiveness of early exercise in critically ill patients: preliminary results. Intensive Care Med 32:109

  12. 12.

    Capdevila XJ, Perrigault PF, Perey PJ, Roustan JP, d’Athis F (1995) Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial. Chest 108:482–489

  13. 13.

    Carson SS, Bach PB (2002) The epidemiology and costs of chronic critical illness. Crit Care Clin 18:461–476

  14. 14.

    Chang A, Paratz J, Rollston J (2002) Ventilatory effects of neurophysiological facilitation and passive movement in patients with neurological injury. Aust J Physiother 48:305–310

  15. 15.

    Chang AT, Boots R, Hodges PW, Paratz J (2004) Standing with assistance of a tilt table in intensive care: a survey of Australian physiotherapy practice. Aust J Physiother 50:51–54

  16. 16.

    Chiang LL, Wang LY, Wu CP, Wu HD, Wu YT (2006) Effects of physical training on functional status in patients with prolonged mechanical ventilation. Phys Ther 86:1271–1281

  17. 17.

    Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C, Chastre J (2003) Morbidity, mortality, and quality-of-life outcomes of patients requiring > or = 14 days of mechanical ventilation. Crit Care Med 31:1373–1381

  18. 18.

    Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Umberto MG (1999) Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 160:1585–1591

  19. 19.

    Copnell B, Fergusson D (1995) Endotracheal suctioning: time-worn ritual or timely intervention? Am J Crit Care 4:100–105

  20. 20.

    Corrado A, Roussos C, Ambrosino N, Confalonieri M, Cuvelier A, Elliott M, Ferrer M, Gorini M, Gurkan O, Muir JF, Quareni L, Robert D, Rodenstein D, Rossi A, Schoenhofer B, Simonds AK, Strom K, Torres A, Zakynthinos S (2002) Respiratory intermediate care units: a European survey. Eur Respir J 20:1343–1350

  21. 21.

    De Jonghe B, Bastuji-Garin S, Sharshar T, Outin H, Brochard L (2004) Does ICU-acquired paresis lengthen weaning from mechanical ventilation? Intensive Care Med 30:1117–1121

  22. 22.

    Dean E (1997) Oxygen transport deficits in systemic disease and implications for physical therapy. Phys Ther 77:187–202

  23. 23.

    Dean E, Ross J (1992) Discordance between cardiopulmonary physiology and physical therapy. Toward a rational basis for practice. Chest 101:1694–1698

  24. 24.

    Dehaven CB Jr., Hurst JM, Branson RD (1985) Postextubation hypoxemia treated with a continuous positive airway pressure mask. Crit Care Med 13:46–48

  25. 25.

    Dodek P, Keenan S, Cook D, Heyland D, Jacka M, Hand L, Muscedere J, Foster D, Mehta N, Hall R, Brun-Buisson C (2004) Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 141:305–313

  26. 26.

    Eisner MD, Thompson T, Hudson LD, Luce JM, Hayden D, Schoenfeld D, Matthay MA (2001) Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med 164:231–236

  27. 27.

    Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, Johnson MM, Browder RW, Bowton DL, Haponik EF (1996) Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med 335:1864–1869

  28. 28.

    Esteban A, Alia I, Ibanez J, Benito S, Tobin MJ (1994) Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest 106:1188–1193

  29. 29.

    Fletcher SN, Kennedy DD, Ghosh IR, Misra VP, Kiff K, Coakley JH, Hinds CJ (2003) Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med 31:1012–1016

  30. 30.

    Fontaine DK (1994) Nonpharmacologic management of patient distress during mechanical ventilation. Crit Care Clin 10:695–708

  31. 31.

    Gayan-Ramirez G, Decramer M (2002) Effects of mechanical ventilation on diaphragm function and biology. Eur Respir J 20:1579–1586

  32. 32.

    Gayan-Ramirez G, Testelmans D, Maes K, Racz GZ, Cadot P, Zador E, Wuytack F, Decramer M (2005) Intermittent spontaneous breathing protects the rat diaphragm from mechanical ventilation effects. Crit Care Med 33:2804–2809

  33. 33.

    Gibson JNA, Smith K, Rennie MJ (1988) Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesis. Lancet 2(8614):767–769

  34. 34.

    Goldman JM, Rose LS, Williams SJ, Silver JR, Denison DM (1986) Effect of abdominal binders on breathing in tetraplegic patients. Thorax 41:940–945

  35. 35.

    Gomez-Merino E, Sancho J, Marin J, Servera E, Blasco ML, Belda FJ, Castro C, Bach JR (2002) Mechanical insufflation-exsufflation: pressure, volume, and flow relationships and the adequacy of the manufacturer’s guidelines. Am J Phys Med Rehabil 81:579–583

  36. 36.

    Greenbaum DM, Millen JE, Eross B, Snyder JV, Grenvik A, Safar P (1976) Continuous positive airway pressure without tracheal intubation in spontaneously breathing patients. Chest 69:615–620

  37. 37.

    Gregg RW, Friedman BC, Williams JF, McGrath BJ, Zimmerman JE (1990) Continuous positive airway pressure by face mask in Pneumocystis carinii pneumonia. Crit Care Med 18:21–24

  38. 38.

    Griffiths RD, Palmer A, Helliwell T, Maclennan P, Macmillan RR (1995) Effect of passive stretching on the wasting of muscle in the critically ill. Nutrition 11:428–432

  39. 39.

    Grill E, Quittan M, Huber EO, Boldt C, Stucki G (2005) Identification of relevant ICF categories by health professionals in the acute hospital. Disabil Rehabil 27:437–445

  40. 40.

    Hall JB, Wood LD (1987) Liberation of the patient from mechanical ventilation. JAMA 257:1621–1628

  41. 41.

    Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–693

  42. 42.

    Hinderer SR, Dixon K (2001) Physiologic and clinical monitoring of spastic hypertonia. Phys Med Rehabil Clin N Am 12:733–746

  43. 43.

    Hodgson C, Ntoumenopoulos G, Dawson H, Paratz J (2007) The Mapleson C circuit clears more secretions than the Laerdal circuit during manual hyperinflation in mechanically-ventilated patients: a randomised cross-over trial. Aust J Physiother 53:33–38

  44. 44.

    Holliday JE, Hyers TM (1990) The reduction of weaning time from mechanical ventilation using tidal volume and relaxation biofeedback. Am Rev Respir Dis 141:1214–1220

  45. 45.

    Ibanez J, Raurich JM, Abizanda R, Claramonte R, Ibanez P, Bergada J (1981) The effect of lateral positions on gas exchange in patients with unilateral lung disease during mechanical ventilation. Intensive Care Med 7:231–234

  46. 46.

    Jenkins SC, Soutar SA, Moxham J (1988) The effects of posture on lung volumes in normal subjects and in patients pre- and post-coronary artery surgery. Physiotherapy 74:492–496

  47. 47.

    Jones AYM, Hutchinson RC, Oh TE (1992) Chest physiotherapy practice in intensive care units in Australia, the UK and Hong Kong. Physiother Theory Pract 8:39–47

  48. 48.

    Jones C, Macmillan RR, Griffiths RD (1994) Providing psychological support for patients after critical illness. Clin Intensive Care 5:176–179

  49. 49.

    Jones C, Skirrow P, Griffiths RD, Humphris GH, Ingleby S, Eddleston J, Waldmann C, Gager M (2003) Rehabilitation after critical illness: a randomized, controlled trial. Crit Care Med 31:2456–2461

  50. 50.

    King J, Crowe J (1998) Mobilization practices in Canadian critical care units. Physiother Can 50:206–211

  51. 51.

    Kollef MH, Shapiro SD, Silver P, St.John RE, Prentice D, Sauer S, Ahrens TS, Shannon W, Baker-Clinkscale D (1997) A randomized, controled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 25:567–574

  52. 52.

    Kraemer WJ, Adams K, Cafarelli E, Dudley GA, Dooly C, Feigenbaum MS, Fleck SJ, Franklin B, Fry AC, Hoffman JR, Newton RU, Potteiger J, Stone MH, Ratamess NA, Triplett-McBride T (2002) American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 34:364–380

  53. 53.

    Kramer N, Meyer TJ, Meharg J, Cece RD, Hill NS (1995) Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory failure. Am J Respir Crit Care Med 151:1799–1806

  54. 54.

    Krishnan JA, Moore D, Robeson C, Rand CS, Fessler HE (2004) A prospective, controlled trial of a protocol-based strategy to discontinue mechanical ventilation. Am J Respir Crit Care Med 169:673–678

  55. 55.

    Kwan MW, Ha KW (2002) Splinting programme for patients with burnt hand. Hand Surg 7:231–241

  56. 56.

    Laghi F, Cattapan SE, Jubran A, Parthasarathy S, Warshawsky P, Choi YS, Tobin MJ (2003) Is weaning failure caused by low-frequency fatigue of the diaphragm? Am J Respir Crit Care Med 167:120–127

  57. 57.

    Langou RA, Wolfson S, Olson EG, Cohen LS (1977) Effects of orthostatic postural changes on myocardial oxygen demands. Am J Cardiol 39:418–421

  58. 58.

    Lindgren S, Almgren B, Hogman M, Lethvall S, Houltz E, Lundin S, Stenqvist O (2004) Effectiveness and side effects of closed and open suctioning: an experimental evaluation. Intensive Care Med 30:1630–1637

  59. 59.

    Lorente L, Lecuona M, Martin MM, Garcia C, Mora ML, Sierra A (2005) Ventilator-associated pneumonia using a closed versus an open tracheal suction system. Crit Care Med 33:115–119

  60. 60.

    Mackenzie CF, Shin B (1985) Cardiorespiratory function before and after chest physiotherapy in mechanically ventilated patients with post-traumatic respiratory failure. Crit Care Med 13:483–486

  61. 61.

    Mancinelli-Van Atta J, Beck SL (1992) Preventing hypoxemia and hemodynamic compromise related to endotracheal suctioning. Am J Crit Care 1:62–79

  62. 62.

    Marini JJ, Pierson DJ, Hudson LD (1979) Acute lobar atelectasis: a prospective comparison of fiberoptic bronchoscopy and respiratory therapy. Am Rev Respir Dis 119:971–978

  63. 63.

    Marini JJ, Smith TC, Lamb V (1986) Estimation of inspiratory muscle strength in mechanically ventilated patients: the measurement of maximal inspiratory pressure. J Crit Care 1:32–38

  64. 64.

    Martin AD, Davenport PD, Franceschi AC, Harman E (2002) Use of inspiratory muscle strength training to facilitate ventilator weaning: a series of 10 consecutive patients. Chest 122:192–196

  65. 65.

    Martin D, Davenport PW, Gonzalez-Rothi J, Baz M, Banner J, Caruso L, Layon J, Gabrielli A (2006) Inspiratory muscle strength training improves outcome in failure to wean patients. p 369s

  66. 66.

    Martin UJ, Hincapie L, Nimchuk M, Gaughan J, Criner GJ (2005) Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation. Crit Care Med 33:2259–2265

  67. 67.

    Masip J, Roque M, Sanchez B, Fernandez R, Subirana M, Exposito JA (2005) Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and meta-analysis. JAMA 294:3124–3130

  68. 68.

    Maxwell L, Ellis E (1998) Secretion clearance by manual hyperinflation: possible mechanisms. Physiother Theory Pract 14:189–197

  69. 69.

    Milberg JA, Davis DR, Steinberg KP, Hudson LD (1995) Improved survival of patients with acute respiratory distress syndrome (ARDS): 1983–1993. JAMA 273:306–309

  70. 70.

    Montuclard L, Garrouste-Org, Timsit JF, Misset B, De Jonghe B, Carlet J (2000) Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med 28:3389–3395

  71. 71.

    Morris PE (2007) Early mobility of the ICU patient. Crit Care Clin 23:1–116

  72. 72.

    Moser DK, Chung ML, McKinley S, Riegel B, An K, Cherrington CC, Blakely W, Biddle M, Frazier SK, Garvin BJ (2003) Critical care nursing practice regarding patient anxiety assessment and management. Intensive Crit Care Nurs 19:276–288

  73. 73.

    Nava S (1998) Rehabilitation of patients admitted to a respiratory intensive care unit. Arch Phys Med Rehabil 79:849–854

  74. 74.

    Nava S, Ambrosino N, Clini E, Prato M, Orlando G, Vitacca M, Brigada P, Fracchia C, Rubini F (1998) Noninvasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. A randomized, controlled trial. Ann Intern Med 128:721–728

  75. 75.

    Nava S, Gregoretti C, Fanfulla F, Squadrone E, Grassi M, Carlucci A, Beltrame F, Navalesi P (2005) Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med 33:2465–2470

  76. 76.

    Nelson BJ, Weinert CR, Bury CL, Marinelli WA, Gross CR (2000) Intensive care unit drug use and subsequent quality of life in acute lung injury patients. Crit Care Med 28:3626–3630

  77. 77.

    Norrenberg M, Vincent JL (2000) A profile of European intensive care unit physiotherapists. European Society of Intensive Care Medicine. Intensive Care Med 26:988–994

  78. 78.

    Paratz J, Burns Y (1993) The effect of respiratory physiotherapy on intracranial pressure, mean arterial pressure, cerebral perfusion pressure and end tidal carbon dioxide in ventilated neurosurgical patients. Physiother Theory Pract 9:3–11

  79. 79.

    Partsch H (2002) Bed rest versus ambulation in the initial treatment of patients with proximal deep vein thrombosis. Curr Opin Pulm Med 8:389–393

  80. 80.

    Plant PK, Owen JL, Parrott S, Elliott MW (2003) Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial. BMJ 326:956

  81. 81.

    Polkey MI, Moxham J (2001) Clinical aspects of respiratory muscle dysfunction in the critically ill. Chest 119:926–939

  82. 82.

    Porta R, Vitacca M, Gile LS, Clini E, Bianchi L, Zanotti E, Ambrosino N (2005) Supported arm training in patients recently weaned from mechanical ventilation. Chest 128:2511–2520

  83. 83.

    Ram FS, Lightowler JV, Wedzicha JA (2003) Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev CD004104

  84. 84.

    Redfern J, Ellis E, Holmes W (2001) The use of a pressure manometer enhances student physiotherapists’ performance during manual hyperinflation. Aust J Physiother 47:121–131

  85. 85.

    Richard R, Ward RS (2005) Splinting strategies and controversies. J Burn Care Rehabil 26:392–396

  86. 86.

    Richards K, Nagel C, Markie M, Elwell J, Barone C (2003) Use of complementary and alternative therapies to promote sleep in critically ill patients. Crit Care Nurs Clin North Am 15:329–340

  87. 87.

    Richards KC (1994) Sleep promotion in the critical care unit. AACN Clin Issues Crit Care Nurs 5:152–158

  88. 88.

    Richards KC, Gibson R, Overton-McCoy AL (2000) Effects of massage in acute and critical care. AACN Clin Issues 11:77–96

  89. 89.

    Rocker GM, Mackenzie MG, Williams B, Logan PM (1999) Noninvasive positive pressure ventilation: successful outcome in patients with acute lung injury/ARDS. Chest 115:173–177

  90. 90.

    Roussos C (1985) Function and fatigue of respiratory muscles. Chest 88:124S–132S

  91. 91.

    Salter RB (1989) The biologic concept of continuous passive motion of synovial joints. The first 18 years of basic research and its clinical application. Clin Orthop Relat Res 242:12–25

  92. 92.

    Schwartz Cowley R, Swanson B, Chapman P, Mackay LE (1994) The role of rehabilitation in the intensive care unit. J Head Trauma Rehabil 9:32–42

  93. 93.

    Sharp JT, Druz WS, Moisan T, Foster J, Machnach W (1980) Postural relief of dyspnea in severe chronic obstructive pulmonary disease. Am Rev Respir Dis 122:201–211

  94. 94.

    Sim J (1998) Interpersonal aspects of care: communication, counselling and health education. In: Pryor JA, Webber BA (eds) Physiotherapy for respiratory and cardiac problems. Churchill Livingstone, Edinburgh, pp 211–226

  95. 95.

    Singer M, Vermaat J, Hall G, Latter G, Patel M (1994) Hemodynamic effects of manual hyperinflation in critically ill mechanically ventilated patients. Chest 106:1182–1187

  96. 96.

    Sivasothy P, Brown L, Smith IE, Shneerson JM (2001) Effect of manually assisted cough and mechanical insufflation on cough flow of normal subjects, patients with chronic obstructive pulmonary disease (COPD), and patients with respiratory muscle weakness. Thorax 56:438–444

  97. 97.

    Squadrone V, Coha M, Cerutti E, Schellino MM, Biolino P, Occella P, Belloni G, Vilianis G, Fiore G, Cavallo F, Ranieri VM (2005) Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. JAMA 293:589–595

  98. 98.

    Stiller K (2000) Physiotherapy in intensive care. Towards an evidence based practice. Chest 118:1801–1813

  99. 99.

    Stiller K, Jenkins S, Grant R, Geake T, Taylor J, Hall B (1996) Acute lobar atelectasis: a comparisosn of five physiotherapy regimens. Physiother Theory Pract 12:197–209

  100. 100.

    Stiller K, Philips A (2003) Safety aspects of mobilising acutely ill patients. Physiother Theory Pract 19:239–257

  101. 101.

    Stoll C, Schelling G, Goetz AE, Kilger E, Bayer A, Kapfhammer HP, Rothenhausler HB, Kreuzer E, Reichart B, Peter K (2000) Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment. J Thorac Cardiovasc Surg 120:505–512

  102. 102.

    Stoller JK, Mascha EJ, Kester L, Haney D (1998) Randomized controlled trial of physician-directed versus respiratory therapy consult service-directed respiratory care to adult non-ICU inpatients. Am J Respir Crit Care Med 158:1068–1075

  103. 103.

    Thomas DC, Kreizman IJ, Melchiorre P, Ragnarsson KT (2002) Rehabilitation of the patient with chronic critical illness. Crit Care Clin 18:695–715

  104. 104.

    Topp R, Ditmyer M, King K, Doherty K, Hornyak J III (2002) The effect of bed rest and potential of prehabilitation on patients in the intensive care unit. AACN Clin Issues 13:263–276

  105. 105.

    Unoki T, Kawasaki Y, Mizutani T, Fujino Y, Yanagisawa Y, Ishimatsu S, Tamura F, Toyooka H (2005) Effects of expiratory rib-cage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation. Respir Care 50:1430–1437

  106. 106.

    Van ’t Hul A, Gosselink R, Hollander P, Postmus P, Kwakkel G (2006) Training with inspiratory pressure support in patients with severe COPD. Eur Respir J 27:65–72

  107. 107.

    Walsh D (1991) Nocioceptive pathways – relevance to the physiotherapist. Physiotherapy 77:317–321

  108. 108.

    Wenger NK (1982) Early ambulation: the physiologic basis revisited. Adv Cardio 31:138–141

  109. 109.

    Winkelman C, Higgins PA, Chen YJ, Levine AD (2007) Cytokines in chronically critically ill patients after activity and rest. Biol Res Nurs 8:261–271

  110. 110.

    Wood CJ (1998) Endotracheal suctioning: a literature review. Intensive Crit Care Nurs 14:124–136

  111. 111.

    Yang KL, Tobin MJ (1991) A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med 234:1445–1450

  112. 112.

    Yohannes AM, Connolly MJ (2003) Early mobilization with walking aids following hospital admission with acute exacerbation of chronic obstructive pulmonary disease. Clin Rehabil 17:465–471

  113. 113.

    Zafiropoulos B, Alison JA, McCarren B (2004) Physiological responses to the early mobilisation of the intubated, ventilated abdominal surgery patient. Aust J Physiother 50:95–100

  114. 114.

    Zanotti E, Felicetti G, Maini M, Fracchia C (2003) Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation. Effect of electrical stimulation. Chest 124:292–296

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Gosselink, R., Bott, J., Johnson, M. et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med 34, 1188–1199 (2008). https://doi.org/10.1007/s00134-008-1026-7

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Keywords

  • Intensive Care Unit
  • Intensive Care Unit Patient
  • Continuous Passive Motion
  • Inhalation Injury
  • Inspiratory Muscle Training