My name is Paul and I am one of the Intensive Care (ICU) Physiotherapists at St Peters hospital. I work as part of a team of Physios and we cover ICU, SDU (surgical dependency unit), SAU (surgical assessment unit), Heron (vascular ward) and both surgical wards.

On a typical day we head to the intensive care unit in the morning and we speak to the nurse in charge to update us on how the patients have been overnight, plus any new patients admitted to the unit. Some of us head straight to the other wards to do the same and communicate via pager throughout the day.

To think simply, Physiotherapy can be very broadly divided into respiratory and mobility.

On ICU, many patients are connected to a breathing machine (ventilator) to help them breath, often immediately after surgery to help wake them up gradually but also if they become very sick and weak that they need help to maintain their breathing. These patients cannot cough or clear their lungs as they are sedated with drugs to help them tolerate the ventilator tubing and treatment they are receiving, so they are often at risk their lungs accumulating phlegm (or mucous). To put into perspective, a healthy person’s lungs clears about 3-500ml of mucous per day (just over the size of a can of coke) and we swallow it mostly so don’t notice – the mucous is normal and helps to keep bacteria out of our lungs. This mucous gets worse with chest infections and other illness’s that patients may be admitted to hospital for. For the respiratory side, we will listen to the patient’s lungs and can help to clear any extra mucous they may have accumulated using different techniques and specialised machines to help do this.

As a whole department, the Physios provide a 24/7 Respiratory On Call service, 365 days a year for patients who urgently need treatment, not just on ICU, but for the entire hospital.

Also as part of the respiratory side, we lead on weaning the patients off their ventilators as they get stronger and recover from their illness. You will often see detailed plans on white boards above the patients’ bed which we prescribe telling the nurses how to wean their patient for that day. We will consider all what is going on with the patient, often liaising with doctors, dieticians and pharmacists to try and get this process right, but it is often challenging!

The other side of Physio is making sure that patients keep their limbs moving so they don’t get stiff and involve them with this rehabilitation as soon as they can participate. Early on this will involve hoisting the patients out of bed into supportive chairs, sitting them on the edge of the bed, exercising their legs with a specialised set of pedals that can be used in bed, or simply moving their arms and legs for them. Later we have machines to help patients stand and walk again, even whilst still connected to the ventilator. It is a tricky balance to ensure we work patients hard enough to improve but not too much that they are too tired the next time.

Once the patients start recovering from their condition and get to a particular level of strength and mobility, they will be moved off the ICU to the wards or high dependency areas, where another team of Physios are waiting to continue their rehab. We will speak to individual teams in person for each patient who leaves, giving them a detailed handover of their progress and plans to move forward.

We meet with the whole team on ICU once a week to discuss the patients in depth, bringing forward any issues and keeping track of their overall progress. We will very often speak with relatives and friends who visit often to get involved where they can and help their loved ones get better. For patients that stay on the unit for longer periods of time we keep diaries of their day to day activities, as research has suggested that this daily information can later help patients piece together their recovery by understanding in more detail what has happened to them whilst they have been so unwell.

During working hours ICU can contact the Physio team to review patients as required, or simply ask for advice.