ICU Presentation - Rosalea Bradley

OCCUPATIONAL
THERAPY Rosalea Bradley, OTR/L, OTD
INTENSIVE CARE UNIT

OBJECTIVES
 To understand the importance and role of occupational therapy
in the ICU
To recognize the impact of delirium and strategies to reduce the
incidence rate
To gain further knowledge about the impacts of stress, sleep
deprivation and sensory deprivation on patient outcomes
To have a guide for ICU treatment ideas and goal writing
OCCUPATIONAL THERAPY’S
ROLE IN THE ICU
 Restore a sense of daily routine and personal independence- activity of daily living
programs
 Reverse the immobility cycle
 Speed recovery
 Reduce rehabilitation complications
WHAT IS DELIRIUM ?
https://www.youtube.com/watch?v=FpAKs1ZWH04-
IMPACTS OF DELIRIUM
 Impacts 20% non-mechanically ventilated, 80% in mechanically- ventilated
patients (Ineke, 2017)
 Delirium increases ICU admission, hospital length of stay, costs, morbidity and
mortality rates (Ineke, 2017)
 Mortality rate increases by 11% for every 48hours that delirium persists (Saunders,
2016)
 “Preventing and managing delirium is fundamental to reducing it negative impact,
and it’s been estimated that up to 40 % of cases are preventable in non- ICU
cases”(Saunders, 2016).
DELIRIUM MANAGEMENT
Early mobilization
Sound Reduction, Minimizing alarm volume
Frequent Re-orientation
Bundling Care
Correction of Sensory Deficits (Glasses, hearing Aids)
Positioning
Cognitive Stimulation Notebook
Family Participation
Monitoring
SLEEP DEPRIVATION
Sleep deprivation is common among patients in the ICU and impacts
1) Recovery
2) Ability to resist infection
3) Neurological problems- increases chances of delirium
4) Respiratory problems -weakens upper air way muscles thus prolonging duration
of ventilation
SLEEP DEPRIVATION
MANAGEMENT
Bed time rituals
Comfortable positioning
Sleep wake/cycle
Noise reduction- 50-65 dB (busy road)
Ventilator synchrony
Non sleep inhibiting drugs
Relaxation Techniques
Dimmed lights/calm environment
Earbuds
COGNITIVE IMPAIRMENT
“Affects 60%-80% of patients who are mechanically ventilated and is associated with several
adverse outcomes. Long term cognitive impairment is common following critical illness and
has dramatic effects on patients ability to function autonomously” (Brummel,2012).
 Prolonged mechanical ventilation

 Delayed hospital discharge
 Increased risk of death
 Long term implications of cognitive deficits

COGNITIVE IMPAIRMENT
MANAGEMENT
Cognitive Treatment- Improved executive function and less disability in instrumental ADL’s
compared with controls. (Brummel, 2012)
“Use it or lose it”
 Orientation
 Memory
 Attention (Forward and Reverse Digit Spans)
 Matrix Puzzles
 Letter- number sequences
 Pattern Recognition
Resources- https://www.studenthandouts.com/study-games/printable-games/
SENSORY DEPRIVATION AND
STRESS
“Sensory deprivation: exposure to meaningless or unpaterned stimuli, social isolation
and immobilization. These sources of stress, together with fear, depression and pain of
being ill, often lead patients to a state of generalized disorientation, thought
disorganization and even delirium (Francis,2009)”.
Promote Meaningful Stimulus

Reduce/ Eliminate Noxious Stimulus
Stress Reduction Strategies
Facilitate Meaningful Tasks
Restore a Sense of Daily Routine and personal independence
ICU STRESS PATTERN
https://ajot.aota.org/article.aspx?articleid=1883547
STRESS MANAGEMENT
“One component of occupational therapist role with ventilated patients is to help
them become independent in managing their stress response during weaning through
purposeful activity (Affleck,1986)”.
Breathing Strategies
Visualization/Guided Imagery
Progressive Relaxation
Relaxation Music- no lyrics/emotional response
Meditation
EARLY MOBILIZATION-
TREATMENT IDEAS
INTERVENTIONS IDEAS
BASED ON RASS SCORE
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513484/
INTERVENTIONS IDEAS
BASED ON RASS SCORE
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513484/
BED LEVEL ACTIVITIES
Delirium Management
Sensory Integration
BUE AROM/ AAROM, HEP
Intrinsic/fine motor coordination
Family education/ RN education
Cognitive Exercises
Stress Management- patient on ventilation
Positioning
Edema Management
Subluxation Management
Chair Mode
Feeding/Grooming/Hygiene in supine
OUT OF BED ACTIVITIES/
SEATED
Bed mobility (lateral rolling, supine> sit)
Dangling EOB
Postural Control Exercises
Challenges to elicit “righting” reflexes
Training in ADL’s (eating or simulated eating, grooming, hygiene, bathing, dressing, toileting)
Functional Transfers
Standing balance tolerance for ADL completion- bring tray table close if limited by lines
Arm bike seated EOB
Folding laundry
GOAL EXAMPLES
In 1 week, patient will be able to communicate simple needs for ADL completion
via: written communication, gestures, communication board, assistive technology
ect.
 In 1 week, patient will be able to use upper extremities for functional tasks in
seated position with Min A for hygiene/grooming.
In 1 week, patient will be able to tolerate 15 minutes sitting balance EOB with min
A for postural control for increased independence with ADL’s.
In 1 week, patient will be assessed for positioning/splinting program to reduce
edema, promote skin and joint integrity, gain function in hands for future ADL
completion.
GOAL EXAMPLES CONTINUED
In 1 week, patient will be able to make use of stress management techniques to
reduce sensory deprivation, depression and prepare for ventilation weaning.
In 2 weeks, patient will be able to perform light hygiene tasks such as oral
suctioning and face and upper extremity bathing with materials setup in supine
position.
In 2 weeks, patient will be able to independently use breathing and visualization
activities to manage stress.
 In 1 week, patient will be able to sit in a position of hip flexion at 80 degrees for
45 minutes per day and sit forward without back support with min A for increased
postural control for future ADL independence.
Thank you
CITATIONS
1. “Effect of nocturnal sound reduction on the incidence of delirium in intensive care unit patients: An interrupted time series
analysis”, Clinical Key for nursing, Ineke van de Pol, Aug. 2017,
https://www.clinicalkey.com/nursing/#!/content/playContent/1-s2.0-S0964339717300319?returnurl=null&referrer=null
www.sciencedirect.com/science/article/abs/pii/S0964339709000718.
2. “Factors That Impact on Sleep in Intensive Care Patients.” Intensive and Critical Care Nursing, Churchill Livingstone, 31
Oct. 2009, www.sciencedirect.com/science/article/abs/pii/S0964339709000718.
3. “Occupational Therapy for Delirium Management in Elderly Patients without Mechanical Ventilation in an Intensive Care
Unit: A Pilot Randomized Clinical Trial.” Journal of Critical Care, W.B. Saunders, 10 Sept. 2016,
www.sciencedirect.com/science/article/pii/S0883944116304877.
4. Nathan E. Brummel, James C. Jackson, Timothy D. Girard, Pratik P. Pandharipande, Elena Schiro, Brittany Work, Brenda T.
Pun, Leanne Boehm, Thomas M. Gill, E. Wesley Ely, A Combined Early Cognitive and Physical Rehabilitation Program for
People Who Are Critically Ill: The Activity and Cognitive Therapy in the Intensive Care Unit (ACT-ICU) Trial, Physical
Therapy, Volume 92, Issue 12, 1 December 2012, Pages 1580–1592, https://doi.org/10.2522/ptj.20110414
5. Anne T. Affleck, Sheri Lieberman, Jan Polon, Kerry Rohrkemper; Providing Occupational Therapy in an Intensive Care Unit.
Am J Occup Ther 1986;40(5):323-332. doi: 10.5014/ajot.40.5.323.
6. “Neuro-Occupation: Linking Sensory Deprivation and Self-Care in the ICU Patient.” Taylor & Francis,
www.tandfonline.com/doi/abs/10.1080/J003v11n04_07.

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OCCUPATIONAL

THERAPY Rosalea Bradley, OTR/L, OTD

INTENSIVE CARE UNIT

 Prolonged mechanical ventilation

Promote Meaningful Stimulus

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