Physical Therapy....in the ICU?

“So, you’re a Physical Therapist that works in the ICU? Okay, but what exactly do you DO? I mean, those people on ventilators can’t move, right?”

If you’re a PT that works in acute care, you’ve likely gotten this question more than once. I certainly hear it all the time, and am sometimes tempted to be annoyed that no one seems to know what I actually do on a daily basis. BUT… how on earth is anyone supposed to understand if I don’t tell them?! So, if you’re in the acute care therapy boat with me, or you’re curious about what I do all day- WELCOME! I’m about to get up on my soapbox and share some things.

I spend every day in the Medical and/or Cardiothoracic Intensive Care Units (majority medical). Occasionally I run away and see 1 or 2 patients on the general medicine floors, but 90% of my time is spent in the ICU. Yes, the patients I see are VERY sick. So what exactly is the role of a PT in that setting? How can I help a person that is critically ill?

Well, first of all, I don’t work with patients that are medically unstable. Acute care PTs are experts in determining medical readiness to participate in therapy. I am in constant conversation about the care of my patients with my physician, nursing, and respiratory therapy colleagues. I am always looking in the chart at medical history, lab values, and medication trends. As soon as my patient is stable, I’ll be there to help them start the process of recovery.

Physical Therapists are movement specialists. We are the experts in identifying and treating functional deficits. As a cardiovascular and pulmonary specialist, I train muscles of breathing and the muscle of the heart in order to help people recover after major and devastating illness.

On a practical level:

I’m the one that analyzes which muscles of breathing are working, and which ones are not, and then trains those weak muscles to get stronger, so that you can wean off the ventilator more quickly while recovering from sepsis and Adult Respiratory Distress Syndrome (ARDS) after getting the flu and pneumonia.

I’m the one responsible for helping to maximize your aerobic capacity while you’re waiting for a lung transplant by providing the right amount of oxygen plus the right dose of exercise to generate strength to tolerate surgery.

I’m the one to help you get out of bed and start the process of walking again after coronary bypass. I’ll teach you how to move safely. I’ll monitor your heart rate, respiratory rate, blood pressure, and oxygen saturation while teaching you how to safely get in and out of a chair when you’re not supposed to use your arms for 6 weeks. I will take you through specific phases of activity based on your vital sign response, so that when you get home you can safely and confidently participate in the tasks you need and want to. I will monitor your heart rhythm for changes when you’re active. I will make sure that your fear doesn’t keep you in bed, where you’re at risk for developing blood clots, pneumonia, and joint contractures. I will help you start the process of living the life at which you’ve been given a second chance.

Acute care PTs are expert puzzle solvers. We can find a way to help you move regardless of the catheters, invasive lines and tubes, and mechanical support devices you may need. Have 3 chest tubes? No problem. Walk while you’re on a ventilator? Yeah, we can help you do that.

So what do I do every day? When you’re my patient, I laugh with you when you achieve a goal, and I cry with you when you’re frustrated. I learn about your family and your life and your goals. I educate and motivate. I strategize and mobilize.

Some days I see a lot of suffering. Some days I see death. Many days I see life, and hope. Every day I see humanity.

It’s good, and it’s difficult. It’s an amazing profession, and I wouldn’t trade it for the world.