[PC-1-4] Occupational therapy in adult ICU in Taiwan
Early mobilization in critical care is an increasingly prevalent topic worldwide. With the advances in medical science and the growing surviving rate in ICU, it needs early interventions to address the complications of critical illness. The ABCDEFGH bundle is a well-known multidisciplinary approach that copes with the complications in ICU. The purpose of the case report is to present the perspective and understanding of the OT’s role in ICU through describing a critical patient’s experience of ADHF complicated with acute respiratory failure and ventilated support in ICU, receiving the early and personalized OT intervention.
Mr. W, a 65-year-old and retired man, was admitted to the emergency department with symptoms of palpitation and dyspnea, diagnosed as ADHF with pulmonary edema and developed ARF. Therefore, he was intubated with mechanical ventilation support and transferred to MICU for further care.
The consciousness was E3VEM4 with low doses of Fentanyl and Midatin on the day 2. The ventilator was set to PC Mode with FiO2 40%. He could respond to questions by nodding and shaking head, but the accuracy wasn’t ideal. His chief complain was suffering resulted from intubation and restrains, so sedation was applied for pain control and anesthesia. The MRC score was 42/60; ADL function was graded as step1 by 5-Steps (METs=1.0-1.5); the cognition was defined as mod. impairment in SPMSQ. As for delirium monitor, the CAM-ICU was documented as positive and RASS score -1 initially. He was regarded as hypoactive subtype delirium. The early OT intervention started from orientation to time, person, place and therapeutic goals on the day 3. Having him understanding the current situation, enhancing the sense of reality and self-control, and establish daily routines were the emphasis of the program, and afterwards his arousal level increased significantly. At the same time, providing alternative communication strategies reduced the barrier between patient and medical team, thereby the use of sedative and analgesic drugs decreased and the sleep schedule became more regular. The frequency and duration of delirium also became shorter. In addition, through participation in ADL, the sense of self-control significantly improved, and his mood was more stable. The efficiency of medical treatment was at rapid advance. He could learn the pacing skill for BADL practice even though he was still ventilated dependent. During the course in the MICU, OT intervention were offered for 9 times. With multidisciplinary care, he was successfully weaned from the ventilator. Based on stabilized condition, he was transferred to the general ward.
Based the core value of OT professional, as long as the patient has the need and difficulty to participate in occupation, occupational therapist could offer the profession. Further evidence-based practice guideline and advanced training of the OT in critical care are recommended to encourage the development of ICU OT.
Mr. W, a 65-year-old and retired man, was admitted to the emergency department with symptoms of palpitation and dyspnea, diagnosed as ADHF with pulmonary edema and developed ARF. Therefore, he was intubated with mechanical ventilation support and transferred to MICU for further care.
The consciousness was E3VEM4 with low doses of Fentanyl and Midatin on the day 2. The ventilator was set to PC Mode with FiO2 40%. He could respond to questions by nodding and shaking head, but the accuracy wasn’t ideal. His chief complain was suffering resulted from intubation and restrains, so sedation was applied for pain control and anesthesia. The MRC score was 42/60; ADL function was graded as step1 by 5-Steps (METs=1.0-1.5); the cognition was defined as mod. impairment in SPMSQ. As for delirium monitor, the CAM-ICU was documented as positive and RASS score -1 initially. He was regarded as hypoactive subtype delirium. The early OT intervention started from orientation to time, person, place and therapeutic goals on the day 3. Having him understanding the current situation, enhancing the sense of reality and self-control, and establish daily routines were the emphasis of the program, and afterwards his arousal level increased significantly. At the same time, providing alternative communication strategies reduced the barrier between patient and medical team, thereby the use of sedative and analgesic drugs decreased and the sleep schedule became more regular. The frequency and duration of delirium also became shorter. In addition, through participation in ADL, the sense of self-control significantly improved, and his mood was more stable. The efficiency of medical treatment was at rapid advance. He could learn the pacing skill for BADL practice even though he was still ventilated dependent. During the course in the MICU, OT intervention were offered for 9 times. With multidisciplinary care, he was successfully weaned from the ventilator. Based on stabilized condition, he was transferred to the general ward.
Based the core value of OT professional, as long as the patient has the need and difficulty to participate in occupation, occupational therapist could offer the profession. Further evidence-based practice guideline and advanced training of the OT in critical care are recommended to encourage the development of ICU OT.