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PICU

Paediatric intensive care unit (PICU)

What do we do?

We assess and treat patients who are unable to cough and clear their own secretions. We also help patients with mobility and exercise to increase their strength when they are ready. We will always make sure we explain what we are going to do and why, and to gain your consent. Feel free to ask as many questions as you like.

Who do we treat?

  1. Children who are on ventilators - particularly those who have evidence of retained secretions, or have changes on their chest x-rays that indicate physiotherapy input.
  2. Patients who are on non-invasive ventilation, achieved by using a facemask - particularly when they have difficulty clearing those secretions; either due to weakness or sheer volume of secretions.
  3. Patients requiring rehabilitation - this may be simply for patients who have had recent cardiac surgery and need help or guidance to get up as part of their recovery, or patients who have been unwell and on prolonged bed-rest, and so need help getting moving again. Sometimes specialist rehabilitation is required for neurological conditions. In these circumstances, input will be sought from other specialist physiotherapists, and we will jointly ensure appropriate rehabilitation is delivered.  

Do we see everyone?

Not all patients on PICU will need physiotherapy intervention. Not all respiratory conditions respond well to physiotherapy intervention, in these cases the physiotherapists will work closely with the medical and nursing team to assess if physiotherapy intervention is necessary.  

What does physiotherapy treatment involve?

An in depth assessment will be carried out by a specialist paediatric physiotherapist in order to gather all the relevant information about the patients current condition. This will involve a thorough assessment of the patient's medical notes, a discussion with the designated nurse looking after the patient and a full bedside assessment of the patient's current situation. Treatments on PICU may involve;

  1. Manual hyperinflation - this is when we place ventilated patients onto a manual bagging circuit, this allows the physiotherapists to control the rate and depth of breathing. This is important to help us replicate a deep breath and cough for the patient, particularly if they are struggling to do these themselves. This helps move secretions from the smaller airways to the larger airways making them easier to be cleared.
  2. Manual techniques - this often involves manual vibrations which are done in conjunction with manual hyperinflation on the expiratory (out) breath. It involves the physiotherapist providing kinetic energy through the chest wall to help 'shake and loosen' secretions; making it easier to clear them.
  3. Saline - we may put a measured amount of saline solution (salty water) directly down the breathing tube in a controlled manner, to help loosen sticky secretions that otherwise may be difficult to remove.
  4. Positioning - we position patients in bed or chairs in order to optimise their breathing and oxygenation. We also position patients to help drain secretions into the main airways to help us clear them with our treatments.
  5. Other physiotherapy adjuncts - we may also use different equipment to help deliver big breaths and thus remove secretions that may be causing problems. The use of these pieces of equipment will be assessed on an individual basis, and clear explanations given.
  6. Mobility and rehabilitation - for patients who are able to start getting out of bed, or get moving, we will work with them to strengthen different muscles and achieve their rehabilitation goals. We will always make the sessions as much fun as possible.

What wards do we cover?

We mainly cover Paediatric intensive care (PICU). However we also provide cover on a bleep referral basis the Neonatal Intensive care unit (NICU),

How do you refer to us?

The physiotherapists every morning (Monday to Friday) will attend the medical handover where patients with potential needs for physiotherapy input are highlighted. For any patients who may require physiotherapy throughout the day we can be reached via a bleep (between the hours of 08.30 and 17.00).

For those patients who require urgent respiratory physiotherapy treatment out of hours there is a 24 hour on-call service available. This referral needs to be governed by a senior doctor. The physiotherapist will assess the appropriateness of the referral and treat urgently where applicable.