超急性期呼吸リハビリテーションの実際

Pulmonary Rehabilitation in Intensive Care

はじめに

　私たちは2007年4月より集中治療室（ICU/HCU）に専任の理学療法士を常駐させ，ICU/HCU入室者に対して早期からの積極的な急性期呼吸リハビリテーション（以下，リハ）を実施してきている．今回はその活動を紹介しつつ，集中治療室での急性期ケアにおける超急性期呼吸リハとはどのようなものなのかを解説する．

Abstract : Pulmonary rehabilitation in intensive care is an integrated care modality for patients with critical illness provided by a multidisciplinary team. It includes common strategies of critical care, such as early mobilization, and also includes some specific respiratory care measures. Positioning is one of the most important techniques in respiratory care, which improves oxygenation, reduces the work of breathing, and enhances mucociliary clearance. Chest physical therapy is a traditional but currently useful technique for airway management. We use postural drainage, manual hyperinflation and airway aspiration to remove sputum from the airway, prevent lung atelectasis, and to re-expand collapsed alveoli. Daily checking of the ability of spontaneous breathing, upper airway patency, and cough effectiveness is very important to assess the optimum timing of weaning from mechanical ventilation. Using these techniques, along with appropriate ventilator settings and sedation control, we try to optimize oxygenation, to prevent extubation failure and ventilator associated pneumonia, and to promote early successful extubation. This style of integrated care combined with early mobilization has recently become known as the ABCDE bundle (A : awaken the patient daily, B : daily interruption of mechanical ventilation, C : coordination, daily awakening and daily breathing, D : delirium monitoring, E : exercise/early mobilization), which aims to reduce the iatrogenic risks of intensive care.