Early physical therapy in intensive care unit improves outcome in an acute respiratory failure due to chronic obstructive pulmonary disease complicated with pneumonia

Abstract

Introduction: Physical rehabilitation plays an important role in the management of critically ill patients. An early physical therapy intervention will improve mortality such improving survival, the quality of life – prolonged bed rest will lead to muscle atrophy and functional impairment. In order to monitor the benefits induced by physical rehabilitation we monitor the arterial blood gases and at the admission in the ICU the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SAPS (Simplified Acute Physiology Score) scores to determine the mortality risks and the SOFA (Sepsis related Organ Failure Assessment score) score was used for the management of the outcome, being a prediction score. Clinical case: A 73 years old female patient known with atrial fibrillation, cardiac failure, hypertensive and chronic obstructive pulmonary disease (COPD) was admitted in the Intensive care Unit (ICU) with an acute respiratory failure due to a pneumonia. At the admission the patient was on ventilatory support with a Glasgow Coma Scale of 13. The APACHE score was 17 with a predictive mortality of 22% and the SAPS score was 45 predicting a mortality of 34.8%. An individualised physical training was established. The ends points of physical rehabilitation were: the maintaining of the ph to normal values, the lowering of the pCO2 from hypercapnic to normal values, the amelioration of theIntroduction: Physical rehabilitation plays an important role in the management of critically ill patients. An early physical therapy intervention will improve mortality such improving survival, the quality of life – prolonged bed rest will lead to muscle atrophy and functional impairment. In order to monitor the benefits induced by physical rehabilitation we monitor the arterial blood gases and at the admission in the ICU the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SAPS (Simplified Acute Physiology Score) scores to determine the mortality risks and the SOFA (Sepsis related Organ Failure Assessment score) score was used for the management of the outcome, being a prediction score. Clinical case: A 73 years old female patient known with atrial fibrillation, cardiac failure, hypertensive and chronic obstructive pulmonary disease (COPD) was admitted in the Intensive care Unit (ICU) with an acute respiratory failure due to a pneumonia. At the admission the patient was on ventilatory support with a Glasgow Coma Scale of 13. The APACHE score was 17 with a predictive mortality of 22% and the SAPS score was 45 predicting a mortality of 34.8%. An individualised physical training was established. The ends points of physical rehabilitation were: the maintaining of the ph to normal values, the lowering of the pCO2 from hypercapnic to normal values, the amelioration of theIntroduction: Physical rehabilitation plays an important role in the management of critically ill patients. An early physical therapy intervention will improve mortality such improving survival, the quality of life – prolonged bed rest will lead to muscle atrophy and functional impairment. In order to monitor the benefits induced by physical rehabilitation we monitor the arterial blood gases and at the admission in the ICU the APACHE II (Acute Physiology and Chronic Health Evaluation II) and SAPS (Simplified Acute Physiology Score) scores to determine the mortality risks and the SOFA (Sepsis related Organ Failure Assessment score) score was used for the management of the outcome, being a prediction score. Clinical case: A 73 years old female patient known with atrial fibrillation, cardiac failure, hypertensive and chronic obstructive pulmonary disease (COPD) was admitted in the Intensive care Unit (ICU) with an acute respiratory failure due to a pneumonia. At the admission the patient was on ventilatory support with a Glasgow Coma Scale of 13. The APACHE score was 17 with a predictive mortality of 22% and the SAPS score was 45 predicting a mortality of 34.8%. An individualised physical training was established. The ends points of physical rehabilitation were: the maintaining of the ph to normal values, the lowering of the pCO2 from hypercapnic to normal values, the amelioration of theoxygenation values, the increasing of the pO2, the increasing of the saturation level of oxygen (SaO2) such the improvement of outcome. The SOFA score was 6 when starting the physical rehabilitation and was improved when scoring at day 7, 14, 22 and 28 decreasing by 4 points at day 7 and maintained. The evaluation of arterial blood gases showed at day 1 acidosis – ph: 7.31 and a normalized ph at day 28 of 7.43. The pCO2 was improved as well from a value of 66.3mmHg to 47 at day 28 (a major improvement being seen at day 14 after physical rehabilitation pCO2: 52.7 mmHg). The pO2 was 71 mmHg normalized at day 28 – a pO2 of 99.2. Conclusion: The physical therapy played an important role in the management of the case, improving the outcome of the patient. At this moment there isn’t a standardised international protocol concerning physical rehabilitation (percussion/vibration, limb exercise, posture) for the critically ill patients, even though different benefits were noticed. This case is part of a pilot study that aims to validate a physical rehabilitation protocol in ICU.