Rehabilitation Therapy and Outcome in Acute Respiratory Failure

Introduction:

Acute respiratory failure is a critical emergency in which the lungs fail to perform their normal function of exchanging gases, which is the exchange of oxygen into the blood and carbon dioxide from the blood. Increased levels of carbon dioxide can damage the tissue or organ. This causes difficulty in breathing. Acute respiratory failure occurs suddenly without giving any warning signs. Quick diagnosis and hospitalization are necessary for the treatment of the disease.

What Are the Causes of Acute Respiratory Failure?

Various factors are responsible for acute respiratory failure. These factors include:

• Airway Obstruction: Weakness after the stroke, collapsed air passage, food particles getting stuck, and blocking the windpipe.

• Chronic Lung Disease: Asthma and chronic obstructive pulmonary disease (COPD) can cause narrowing of the air passage, making it difficult to breathe.

• Lung Collapse: Lung collapse can occur due to several situations, such as injury to the ribs and chest or blockage of one of the large air passages due to mucus.

• Fluid in the Lungs: Pneumonia, acute respiratory distress syndrome, drowning, or other lung diseases can cause fluid buildup in the lungs. This makes breathing difficult.

• A Problem with the Breathing Muscles: These problems can occur after a spinal cord injury or a nerve and muscle condition such as muscular dystrophy.

What Are the Risk Factors for Acute Respiratory Failure?

Various factors increase the risk of pulmonary failure. These include:

Age:

• Premature babies with neonatal respiratory distress( Difficulty breathing in newborns) or congenital lung defects have a higher risk of respiratory failure.

• Older adults are at higher risk of respiratory failure, as the muscles responsible for breathing become weak. This results in difficulty in breathing.

Environment or Occupation:

• People who have continuous exposure to air pollution, chemical fumes, dyes and paints, dust, and passive smoke (smoke inhalation due to other people smoking) are at higher risk of respiratory failure.

Lifestyle Habits:

• Smoking can cause lung diseases that increase the risk of respiratory failure.

• Using drugs or an overdose of alcohol affects the part of the brain that controls breathing, which decreases the breathing rate and can cause acute respiratory failure.

What Is Rehabilitation Therapy?

Rehabilitation therapy is care given to patients admitted to the hospital for a long time to improve their daily activities, including their physical, mental, and cognitive abilities. Acute respiratory failure requires immediate hospitalization as it is a life-threatening condition. The patients with this condition are kept in the ICU (intensive care unit) and may be given noninvasive respiratory support, or they may be kept on mechanical ventilation, depending upon the condition of the patient. This leads to weakness of the muscles, which may occur due to various factors:

• Pre-existing weakness before hospitalization.

• ICU-acquired neuromuscular abnormalities.

• Lack of mobility due to best rest in ICU.

To overcome this, rehabilitation therapy is given along with medical treatment to prevent muscle atrophy, deconditioning muscle shortening, and muscle weakness.

How Is Rehabilitation Therapy Done?

Rehabilitation therapy is done by a team of healthcare professionals, including doctors, nurses, respiratory therapists, physiotherapists, exercise therapists, and dieticians.

The primary indications for physical therapy for patients in the intensive care unit are excessive pulmonary secretion or atelectasis (partial lung collapse). Physical therapy interventions include:

1. Secretion Clearance Technique:

• Percussion: In this technique, the physiotherapist will clap the chest with the cupped hand to vibrate the chest. This will move the mucus from smaller airways to larger airways, which can be coughed off.

• Vibration: This technique is used manually by the respiratory physiotherapist to vibrate the lung. This helps to clear the mucus out of the lungs. In this technique, the physiotherapist uses both hands to hold the lower wall of the chest and vibrate it. This will lose the mucus and can be thrown out with coughing.

• Manual Hyperinflation and Suctioning: Manual hyperinflation is used to increase lung volumes and help to clear mucus secretion when used in combination with suctioning. Manual hyperinflation involves using a manual resuscitator bag (MRB) connected to oxygen to provide a slow, deep inspiratory breath followed by an inspiratory pause of 1 to 2 seconds and a rapid release of the resuscitation bag. Suctioning is the mechanical aspiration of pulmonary secretions from a patient who cannot do it effectively by themselves through an artificial air pathway in place.

• Coughing and Huffing: Coughing helps the mucus move out of the large passage of the lungs, but mucus from the small passage requires an additional clearance technique. Huffing is the technique using which mucus is removed from the small air passage of the lungs. In this technique, a person needs to breathe in the air, hold it for some time, and exhale it forcefully but slowly. Breathing in and holding the air allows it to get behind the mucus and helps separate it from the lung wall, which can then be coughed out.

• Postural Drainage: It is the process of draining the mucus out of the lung by using gravitational force. The preferred time to perform the postural drainage is before the meal or half an hour after the meal when the stomach is empty. It can be performed by using any one of the following positions:

  • Sitting.

  • Lying on the back, stomach, or sideways.

  • Sitting or lying with head flat, up, or down.

Hold the position for 5 minutes or as recommended. Breathe in from the nose

and breathe out from the mouth. Breathing out should take twice the time as breathing in.

2. Breathing Exercises: Certain breathing exercises help the lungs to perform their normal function. These include:

• Pursed Lip Breathing: To perform this, inhale through the nose and exhale twice as long through the mouth. This will decrease the number of breaths while keeping the air pathway open for a longer time.

• Belly Breathing: Similar to pursed breathing, breathe in through the nose and breathe out from the mouth and concentrate on the movement of the diaphragm.

3. Therapeutic Exercises and Functional Mobility Training: Therapeutic exercises and functional mobility training are done to improve functions and flexibility, improve strength, and decrease pain. These exercises include:

• Range of motion exercises (passive, active assisted, and active).

• Progressive resistive exercise.

• Balance training.

• Strength training.

• Aerobic conditioning.

What Are the Outcomes of Rehabilitation in Acute Respiratory Failure?

Mechanically ventilated patients are often seriously ill and are connected to tubes and monitored to sustain life. Early rehabilitation therapy can prevent patients from developing ICU-acquired neuromuscular abnormalities, muscle weakness, and muscle atrophy due to lack of mobility in the ICU.

Conclusion:

Rehabilitation in the ICU setting is particularly relevant for patients who require mechanical ventilation because they frequently experience little to no activity or mobility while in the ICU. In preliminary studies, an intensive, early mobility approach to mobilizing mechanically ventilated ICU patients appears to be safe, feasible, and beneficial. However, this approach is not commonly practiced in most ICUs, and patients generally remain immobile throughout their ICU stay. Thus early rehabilitation therapy should be implemented to prevent the patients from suffering future consequences.