Physiotherapy goals and treatment in Pediatric ICU & Neonatal ICU

1. PHYSIOTHERAPY IN
PEDIATRIC ICU
Dr. AMNA IMRAN

2. Table of contents
• What is a Pediatric ICU ?
• Conditions with which patients are presented in a pediatric ICU
• Role of physiotherapy
• Assessment of pediatric population for physiotherapy
• Physiotherapy indications and contraindications in pediatric ICU
• Physiotherapy management in pediatric ICU

3. PEDIATRIC ICU
The PICU is a specialized
unit of the hospital where
the extremely sick pediatric
patients are admitted. Most
PICUs are in tertiary care
children’s hospitals,
although smaller PICUs in
community hospitals also
exist.

4. CONDITIONS PRESENTED IN PEDIATRIC ICU
• Respiratory disorders
• Neurological disorders
• Cardiovascular disorders
• Infection/sepsis
• Gastrointestinal disorders
• Trauma/brain injury
• RTA
• misc

5. Role of Physiotherapy
• Critically ill patients frequently suffer long-term physical and
psychological complications.
• They are on long-term mechanical ventilation and as a result,
display significant muscle weakness.
• Approximately 90% of long-term ICU survivors will have ongoing
muscle weakness.
• Physiotherapy treatment as part of a multi-disciplinary approach
to care is integral in promoting lung function, reducing the
incidence of ventilator-associated pneumonia, facilitating weaning
and promoting safe and early discharge from the intensive care
unit.

6. Short-term Goals:
• Early activity - Both passive and active to maintain integrity of musculoskeletal
system
• Positioning patients: To allow gravity to help sputum drain from the lungs.
• Manual techniques such as shaking and vibrations: These are applied to the ribs
to try to loosen and clear the sputum.
• Suction: By placing a small tube into the lungs to suck out the excess sputum.
• They play a vital role in weaning a patient off ventilation.
Long-term Goals
• plan an extensive rehabilitation program to integrate and re-initiate the
patient into society.
• set goals in conjunction with the medical team to rehabilitate the patient.

7. Assessment of pediatric population
• History (including investigation of symptoms and review of
systems)
• Systemic review
• Lab and radiological findings

8. Indications for physiotherapy in PICU
• Pneumonia
• Atelectasis
• Cystic fibrosis
• Respiratory muscle weakness
• Asthma
• Lung abscess

9. Contraindications
• Active infection/inflammation
• Weak/fractured ribs
• Edema in lungs
• Increased ICP ( >20 mm Hg)
• Unstable head or neck injury
• Active hemorrhage or hemoptysis
• Flail chest
• Pulmonary embolism
• Acute spinal injury
• Anticoagulation
• Empyema
• Tuberculosis

10. PHYSIOTHERAPY MANAGEMENT

11. Respiratory Physiotherapy Techniques for
Pediatric ICU Patients
AIRWAY CLEARANCE
• Positioning & Postural drainage
• Percussions & vibrations
BREATHING EXERCISES & RETRAINING
• ACBT
• Nebulization
• Airway suctioning

12. Positioning & Postural drainage

13. Positioning & Postural drainage
• The patient is tilted or propped at an angle required and chest
percussion is performed to loosen the secretions. Frames, tilt
tables, and pillows may be used to support patients in these
positions.
• In general, the upper lobe segments have the advantage of gravity
drainage so postural drainage can be facilitated in sitting or lying
posture. The middle and lower lobes do not have the advantage of
gravity drainage
• In critical care patients, including those on mechanical
ventilation, Postural Drainage should be performed from every 4
to every 6 hours as indicated.

14. Percussion & Vibrations
• Percussion:
For percussion, the therapist uses a single hand or both cupped
hands or three fingers with the middle finger tented, or a facemask
with the port either covered or occluded by a finger and strikes
repeatedly at a rate of three per second over the part of the
bronchopulmonary segment that needs to be drained.
• Vibration:
• In this technique, a rapid vibratory impulse is transmitted through
the chest wall from the flattened hands of the therapist by
isometric alternate contraction of forearm flexor and extensor
muscles, to loosen and dislodge the airway secretions.

15. ACBT
ACBT consists of three main phases:
• Breathing Control
• Deep Breathing Exercises or Thoracic Expansion Exercises
• Huffing or Forced Expiratory Technique (FET)
The technique can be modified according to the condition of the
patient. Additionally, a manual technique (MT) or positive pressure
can be added if and when indicated, to create a more complex
cycle to help improve removal of secretions on the lungs. this may
include percussion or expiratory vibrations.

16. ACBT

17. Nebulization

19. References
• https://www.physio-
pedia.com/Active_Cycle_of_Breathing_Technique
• https://www.physio-pedia.com/Suctioning
• https://blog.sscor.com/how-to-suction-a-pediatric-patients-trach-
tube
• https://www.physio-
pedia.com/Respiratory_Physiotherapy_Techniques_for_ICU_Patient
s

20. Recommended Textbooks