Are Short-Term Changes in Physiological Variables in ICU Patients as a Result of Physiotherapy of Any Clinical Relevance?

Critically ill patients with intracranial pathology such as traumatic brain injury, subarachnoid hemorrhage, and acute stroke can be some of the most challenging to clinicians regarding delivery of acute respiratory and rehabilitation physiotherapy interventions. There may be delayed delivery of physiotherapy until the acute intracranial pathology has stabilized or the patient is extubated due to concerns of worsening the intracranial pathology and patient outcomes, especially for early rehabilitation in patients following stroke.^1,-,3 As the injured brain (with hemorrhage and edema) is confined within the rigid skull, a compartment syndrome can readily develop and impede the delivery of oxygen and nutrients or, in the most severe cases, lead to brain herniation.⁴ In this cohort of patients, the measurement and control of intracranial pressure (ICP) are important,⁴ and these patients often require deep sedation and or paralysis/barbiturate coma to keep ICP < 22 mm Hg and cerebral perfusion pressure (CPP) > 60 mm Hg.⁵ Physiotherapy interventions may be delivered to patients with intracranial pathology to prevent pulmonary complications, including pneumonia, lobar collapse, muscle deconditioning, and functional decline. The main focus of medical treatment is to achieve a normal ICP and CPP to prevent secondary brain injury,⁵ and a summary of the prophylactic and additional medical and surgical measures to control ICP and optimize CPP are detailed in Figure 1.

Correspondence: George Ntoumenopoulos PhD, Department of Physiotherapy, St. Vincent’s Hospital, 2010, Sydney, Australia. E-mail: georgentou{at}yahoo.com