Critical Care Assessment

Original Editor - Justin Bryan Top Contributors - Justin Bryan, Rachael Lowe, Karen Wilson and Adam Vallely Farrell

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (7/01/2023

Introduction

Providing physical therapy in the critical care setting retains many of the same goals as that of the general acute care setting, however, given the unique needs and circumstance of this patient population, there are certain aspects that differ in significant ways.

In order to successfully provide PT care to critically ill patients, it is important to understand the unique goals of care, and how these differ from other areas of acute care.  To begin with, discharge planning remain one of the key aspects that a PT will work toward addressing with any patient they are treating in the acute care setting, including those who are critically ill.  This being said, it is important to understand that while discharge planning is a major goal for some who are deemed critically ill (i.e. following a complex but generally routine surgery such as a transplant), it is often not the major focus of therapy for this patient population.

What makes a patient critically ill?

Critical care is an area of medicine that focuses on the management and treatment of patients who are deemed to have a condition that is immediately life-threatening or possesses the risk of becoming life-threatening. These patients are generally cared for in a dedicated intensive care unit (ICU) or ward where specific monitoring of physiology and organ function is possible at a level above that of other units or ward in a hospital. Staffing in ICUs is generally provided at a lower patient to provider ratio (i.e. 1:1). There is a greater emphasis on multidisciplinary care, encompassing individuals from many different backgrounds, and coordinated under a physician with a specialty in critical care medicine. Goals of care often focus on prevention of acute complications, early detection of distress or condition advancement, and immediate response to evolving situations.

History, Systems Review, and Review of Systems

A good physical therapy evaluation should always begin with a through review of patient history, and an examination an examination of the patient's overall body and system functions. More information on these aspects of PT Evaluation in the ICU can be found on the following page: Physiotherapy Assessment of Patients in the ICU

Is a patient appropriate for mobilization?

The first step in assessing a patient in the ICU is determining if they are even appropriate for mobilization, even if that mobilization will be limited to in-bed activity.

Determining appropriateness for therapy should begin with deciding whether a patient is 1) possesses a level of alertness that will allow participation in treatment, and 2) possesses the ability to follow basic instructions. Both can be achieved by using the Richmond Agitation-Sedation Scale (RASS). Generally, patient with a RASS >-1 can be considered for participation in therapy, however it is imperative to consider all factors of the patient's presentation, guidelines set forth by the staff at your facility, and whether those rendering care feel confident that they can maintain the safety of the patient throughout the treatment.