PT: Bacterial PNA (PT Treatment (Patient Education (Lifestyle Changes…
PT: Bacterial PNA
Manual Airway Clearance Techniques (Strickland et al., 2013; Clini & Ambrosino, 2005)
31% Decrease in occurance of PNA with chest PT
Increased Airway clearance in patients on ventilation with PNA
Mobilization in the ICU can improve neuromuscular weakness and physcial function in individuals who are on mechanical ventilation with sepsis, respiratory failure and multi-organ failure (Needham, 2008).
Possible Progressive Mobilization Program for ICU (Trees et al., 2013)
Unable to follow commands
PROM, position changing
Able to follow simple commands, pt. is weak and requires max A
AA/AROM of UE/LE, Bed mobility skills, Sitting balance, PWB exercises
Pt. is weak, requires min to mod A, can support majority of body weight
Progress sit to stand, transfer bed to chair, Begin gait training (consider use of AD).
Pt. able to transfer and ambulate > 10 ft with minimal assist
Progress gait training, balance activities, HEP
Contraindications for walking program (Perme & Chandrashekar, 2008).
Comatose, unresponsive patients
Changes in EKG
Unstable angina/heart failure
Suspected cerebral edema/aneurysm, PE
Stable patient - hemodynamic, no open wounds, no MI, neurologically intact, following commands.
Safety Equipment - stable airway, well secured vent circuit, cardiac monitor, oximetry, suction, resuscitation bag and mask, crash cart.
Daily prone positioning shows short-term increases in oxygenation(Chatte, 1997; Murre, 1997; Johnson et al., 2017)
Pacing activites with new functional capabilities, safety awarness to prevent falls while weak, compensations for energy conservation until fully recovered (Nordon-Craft et al., 2012).
Healthy lifestyle and lifestyle changes
Deep breathing exercises post vent removal
Pursed lip breathing, Diaphragmatic breathing exercises to assist with respiratory weakness post vent removal in PNA patients (Nordon-Craft et al., 2012).
ROM: PROM, AAROM, AROM (Stiller, 2001)
Active> Passive if patient is able
Increased oxygenation with limb movement (Stiller, 2001)
Bedside Cycle Ergometer: 5 days/week (Burtin et al., 2009)
20 Minute Passive Sessions at 20 cycles/minute
Active 10 minute sessions
Costophrenic assisted coughing to assist with respiratory weakness post vent removal is beneficial in patients ventilated with PNA (Nordon-Craft et al., 2012).
Discharge Plan from ICU
Acute Care or Rehab (only if needed for short period to prepare for safe discharge home)
Patient is not recommended for skilled nursing, as he was living at home prior with his wife and working, and should be able to return to that setting
With the appropriate early mobility program in ICU, the patient is recommended for discharge home once stable and safe.
Continuous rotational therapy (Raoof et al., 1999; Schieren et al., 2017
Decreased pooling of secretions; secretions are mobilized with position changes.
Decreased infection, decreased spread of infection with decrease in stagnant secretions
Respiratory muscle training while on ventilation is beneficial for preparing patients for unassisted breathing post-ventilation, with the earlier the start of the program providing the most significant results (Brace et al., 2015)
Peripheral muscle training while on ventilation prevents the change of muscle fiber types to less aerobically efficient fibers, preserving the utility of the muscles for mobility (Clini & Ambrosino, 2005)
Level of consciousness, ability to follow commands, presence of sedation
Patients physical appearence
Skin check for possible pressure ulcers
Upper and lower extremity MMT and ROM screen
Previous level of function
ABG's, lab values, x-rays, previous medical procedures
Uncompensated respiratory alkalosis
weakness from bed rest
unable to work
unable to interact with family
unable to go out in community
20 pounds overweight
75 pack year smoking history
lives with wife