Background:

Physiotherapists in critical care play a vital role beyond physical rehabilitation. They contribute to holistic multidisciplinary decision-making, including complex and emotionally heavy discussions about goals of care. Physiotherapy review and functional assessment perspective can provide clinical insights that shape shared understanding between the healthcare team, patient and family.

Case Description:

82 years old male patient was admitted to ITU post cardiac arrest and Sepsis. Patient required prolonged ventilation due to poor neurology and required tracheostomy insertion. Despite medical stabilisation, progress with rehabilitation and weaning was limited by profound ICU acquired weakness, poor neurology and cardiovascular instability. The physiotherapy assessment identified minimal meaningful functional recovery, prompting multidisciplinary discussions regarding prognosis. Although regular updates were given to the family, the family found it hard to accept the medical advice regarding the ceiling of care and possible palliation. The physiotherapy team along with MDT contributed objective, function-based assessment including formal response monitoring that helped in gaining family’s insight and understanding of the patient’s presentation and need of comfort-oriented care.

Discussion:

This case highlights the essential role of physiotherapists in supporting ethically sensitive conversations within critical care. Critical care physiotherapists can help in building relationships with families and contribute effectively to discussions around recovery potential, quality of life and end of life decision making.

Keywords:

Physiotherapy, critical care , complex needs, decision making, multidisciplinary team

I have been working in NHS for the past 20 years in various respiratory settings but exclusively in critical care for the past 6 years. I have keen interest in treating patients with prolonged ventilation and ICU acquired weakness. At present I am a clinical lead physiotherapist in critical care but also provides support in complex respiratory patients in general.