S. Ufuk Yurdalan

5611

Yoğun bakım ünitelerinde güncel fizyoterapi yaklaşımları

Farklı yoğun bakım ünitelerindeki (YBÜ) multidisipliner tedavinin bir bölümü de fizyoterapidir. YBÜ’nde interne edilen kritik hastalarda ve postoperatif olgularda; solunumsal, kardiyovasküler ve nöromuskuloskeletal odaklı fizyoterapi programlarıyla olası respiratuar ve nöromuskuler komplikasyonların önlenmesi, inspiratuar kas fonksiyonuyla ilişkili egzersiz kapasitesinin geliştirilmesi klinik hedeflerdendir. Erken başlatılan fizyoterapinin uygulanabilir, güvenli, maliyet etkin ve YBÜ ile hastanede kalış sürelerini kısalttığı bilinmektedir. Yanısıra fizyoterapi YBÜ’de uygulanan diğer tedavilerin (tıbbi, ağrı sağaltımı vb) etkilerini geliştirebilmektedir. YBÜ’de kullanılacak fizyoterapi yaklaşımlarının seçiminde YBÜ ve hasta tipi, varolan teknolojisi, hastalığın akut veya kronik seyri, bilinç açıklığı ile fizyoterapiden beklenen yarar belirleyicidir. Standart fizyoterapi protokolü solunum fizyoterapisi, mobilizasyon, ambulasyon ve donanımsal fizyoterapiden oluşurken; güncel yaklaşımlar olgunun gereksinimleriyle ilişkili çeşitlenmektedir. Program genişletilirken manuel hiperinflasyon, profilaktik sürekli lateral rotasyon, ekspiratuar akım arttırıcı teknik (EFIT), destekli kol egzersizi, kinetik terapi, tilt table tedavisi, iskelet ve solunum kas egzersizi, yatakbaşı bisergo ve nöromuskuler elektrik stimulasyonu tercih edilebilir. Bazı durumlarda yaklaşımların kombine edilmesi veya hastalığın sınırları içinde modifiye edilmesi gerekebilir. Fizyoterapi yoğun bakım hastasının bilincinin açık veya kapalı, oryante veya disoryante, sedatize veya ajite olmasıyla da değişir. Tedavinin, semptomatik ve fonksiyonel iyileşme dikkatle izlenerek her bir seansta yeniden düzenlenmesi, koruyucu uygulamalarda yaklaşımların aralıksız sürdürülmesi önemlidir. Fizyoterapinin hastaya açıklanarak egzersize aktif katılımının sağlanmasıyla da etkileri ve etkinliği maksimize edilir.
Anahtar Kelimeler:

Yoğun bakım, fizyoterapi, kalış süresi

Current physiotherapy approaches in intensive care units

Physiotherapy is a part of the multidisciplinary treatment in different intensive care units. Respiratory, cardiovascular and neuromusculoskeletal- focused physiotherapy programmes and prevention of the respiratory, neuromuscular complications which may be possible, developing the exercise capacity related to inspiratory muscle function in critically patients internalized and postoperative cases in intensive care unit are clinical targets. It is known that physiotherapy initiated early is reliable, practicable, cost effective to shorten the length of stay in intensive care and hospital. Besides, physiotherapy improves the effects of the medical treatments. Intensive care unit and patient type, available technology, acute or chronic prognosis of the disease, consciousness and expected benefit from physiotherapy are determinants of selecting physiotherapy approaches used in intensive care unit. Standard physiotherapy protocol consists of pulmonary physiotherapy, mobilization, ambulation and instrumental physiotherapy and current approaches vary associated with needs of case. Manual hyperinflation, prophylactic continuous lateral rotation, expiratuar flow increase technic (EFIT), supported arm exercise training, kinetic therapy, tilt table treatment, skeletal and pulmonary muscle training, bedside bisergo, and neromuscular electrical stimulation may be preferred by developing the programme. In some cases, approaches are need to be combined or modified within the limitations of the disease. Physiotherapy changes depending on the patient being conscious or unconscious, oriented or disoriented, sedatized or agitated status in intensive care unit. Rearranging the treatment by following symptomatic and functional recovery carefully and maintaining the approaches in preventive applications continuously are significant. Effectiveness and effects of physiotherapy are maximized by explaining the physiotherapy to the patient.
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Clinical and Experimental Health Sciences-Cover
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2011
  • Yayıncı: Marmara Üniversitesi
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Yoğun bakım ünitelerinde güncel fizyoterapi yaklaşımları

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