Page 2 P H Y S I O T H E R A P Y SEPTEMBER, 1970

The Physiotherapist 
in an 

Intensive Care Unit
b y

C. J. M1ENY, Ch.M., F.R.C.S., F.C.S.(S.A.).
Senior Surgeon Johannesburg General Hospital

Intensive Care Units are being established in most big 
hospitals in the world today. The reasons for this develop­
ment are twofold. Concentration o f specialized nurses and 
equipment, and unification o f the efforts of various special­
ist groups, both medical and para-medical, necessary for 
the care o f patients after major trauma, major surgery and 
medical emergencies, such as respiratory failure, renal 
failure and coronary thrombosis.

I
Chest complications and deep vein thrombosis are 

common in patients in an Intensive Care Ward because 
many o f the predisposing factors are accentuated (Table I).

■ T able I.

PREDISPOSING FACTORS
Age
Smoking
Existing chest disease — previous D.V.T.
Lack o f pre-operative preparation
Type of operation — upper abdominal
Delay in mobilisation
Dehydration and distension

To illustrate this an analysis of admissions to the Surgical 
Intensive Care Ward at the Johannesburg General Hospital 
for one year will be presented.

It can be seen in Table II that the majority o f cases were 
older than 50 years.

Although most cases stayed in the unit for a few days 
only, 42 per cent remained for longer than a week. Forty- 
four patients were admitted wjth severe trauma, 67 for 
surgical emergencies and 107 after elective surgery. The 
other 15 patients were kidney transplants and other miscel­
laneous conditions.

T able II.
ADMISSION FOR ONE YEAR 

Sex No.
M A L E .. . .  141 
FEMALE . .  92

TOTAL 233 

AGE—60% over 50

T able III. 

TYPE OF CASES

No. IPPR* Mortality

Upper abdominal surgery 101 7 18
Major arterial surgery 22 3 7
Severe head injuries 20 15 13
Major viscus injuries 18 12 4

*IPPR =  Intermittent positive pressure respiration.

The serious condition o f most of these patients is stressed 
in Table i n .  Of the 161 patients analyzed, 37 needed inter­
mittent positive pressure respiration and there was a mor­
tality of 26 per cent.

Forty-five per cent of all cases developed chest complica­
tions and eight per cent developed, deep vein thrombosis.

DISCUSSIO N

From an analysis o f these facts it becomes obvious that 
all the patients warranting admission to this unit needed 
not only urgent treatment from medical and nursing staff, 
but also from the Department of Physiotherapy.

Patients were admitted to the unit at all hours of the day 
or night which made it imperative that emergency physio­
therapy should be available at all times.

The serious and urgent nature of most of these cases 
made it necessary that medical officers, intensive care nurses 
and physiotherapists should discuss individual cases together 
to plan an intensive course of treatment.

Physiotherapists must be prepared to join these highly 
specialized teams by supplying full-time services with staff 
familiar with the highly sophisticated equipment in such a 
unit, and trained in the care o f these severely ill patients.

ACKNOWLEDGEMENT

I wish to thank Dr. Kenny, Medical Superintendent of 
the Johannesburg General Hospital, for permission to 
publish this short paper.

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