Muñoz-Muñoz F1,2, Merino-Osorio C1
1Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, Santiago, Chile, 2Clinica INDISA, Burn Intensive Care Unit, Santiago, Chile
Background: The World Health Organization reported that around 11 million people with severe burns required medical attention in 2004. Early mobilization in these patients is limited due to the wound's characteristics and management. Commonly, this make it difficult to achieve a full range of movement, perform activities of daily living and return to work, so it is relevant to identify early rehabilitation strategies achievable in burn intensive care unit (BICU).
Purpose: To describe the physiotherapeutic interventions in BICU reported in the literature will contribute with specific knowledge for physiotherapists, promoting to practice based on available scientific evidence, patient characteristics, and professional clinical expertise.
Methods: Scoping review in the electronic databases PubMed, Cochrane library, SUMSEARCH, EBSCO, LASPAIN, Scielo, and LILACS; Grey literature and hand search. We used a search strategy with keywords and free terms associated with "Burn Intensive Care Unit", "Respiratory Therapy" and "Physical Therapy". We included articles reporting physiotherapeutic interventions in adult burn intensive care units, selected after the filter by title, summary and full text according to inclusion-exclusion criteria. The variables of interest were: characteristics of the burns, physiotherapeutic intervention area (motor or respiratory), and intervention technique. The selection of articles and data extraction was subjected to a quality control by a second researcher.
Results: The search identified 8 articles published between 2007 and 2016. Five corresponded to primary studies (3 are case series and 2 cohort studies); the remaining 3 articles corresponded to secondary studies (clinical guidelines). Of the primary studies, 3 studies reported the percentage of affected body surface area, location, and depth of burn, while secondary characteristics did not specify the characteristics of the lesion. Of the total, 6 studies combined passive and active mobility in bed, in addition to active mobility outside the bed; and in 4 of them it also incorporates chest physiotherapy. The use of external equipment (tilt table, splint or respiratory stimulators) was observed in three of these studies. Another respiratory intervention reported was suctioning techniques in two secondary studies.
Conclusion(s): Motor intervention is the main physiotherapeutic strategy performed in adult burn intensive care units. The evidence coming from specialized units in burned patients is scarce and their therapeutic approach is heterogeneous. Future studies should consider mobilization alternatives in patients with extensive burns and skin grafts.
Implications: This study will allow comparing the current clinical practice in these patients with the available scientific evidence, in addition to guiding future clinical studies in the area that specify the feasible physiotherapeutic interventions to perform, considering the particular context of these patients.
Keywords: Burns, Intensive Care Units, Physical Therapy Modalities
Funding acknowledgements: None.
Purpose: To describe the physiotherapeutic interventions in BICU reported in the literature will contribute with specific knowledge for physiotherapists, promoting to practice based on available scientific evidence, patient characteristics, and professional clinical expertise.
Methods: Scoping review in the electronic databases PubMed, Cochrane library, SUMSEARCH, EBSCO, LASPAIN, Scielo, and LILACS; Grey literature and hand search. We used a search strategy with keywords and free terms associated with "Burn Intensive Care Unit", "Respiratory Therapy" and "Physical Therapy". We included articles reporting physiotherapeutic interventions in adult burn intensive care units, selected after the filter by title, summary and full text according to inclusion-exclusion criteria. The variables of interest were: characteristics of the burns, physiotherapeutic intervention area (motor or respiratory), and intervention technique. The selection of articles and data extraction was subjected to a quality control by a second researcher.
Results: The search identified 8 articles published between 2007 and 2016. Five corresponded to primary studies (3 are case series and 2 cohort studies); the remaining 3 articles corresponded to secondary studies (clinical guidelines). Of the primary studies, 3 studies reported the percentage of affected body surface area, location, and depth of burn, while secondary characteristics did not specify the characteristics of the lesion. Of the total, 6 studies combined passive and active mobility in bed, in addition to active mobility outside the bed; and in 4 of them it also incorporates chest physiotherapy. The use of external equipment (tilt table, splint or respiratory stimulators) was observed in three of these studies. Another respiratory intervention reported was suctioning techniques in two secondary studies.
Conclusion(s): Motor intervention is the main physiotherapeutic strategy performed in adult burn intensive care units. The evidence coming from specialized units in burned patients is scarce and their therapeutic approach is heterogeneous. Future studies should consider mobilization alternatives in patients with extensive burns and skin grafts.
Implications: This study will allow comparing the current clinical practice in these patients with the available scientific evidence, in addition to guiding future clinical studies in the area that specify the feasible physiotherapeutic interventions to perform, considering the particular context of these patients.
Keywords: Burns, Intensive Care Units, Physical Therapy Modalities
Funding acknowledgements: None.
Topic: Critical care; Professional practice: other; Disability & rehabilitation
Ethics approval required: No
Institution: Universidad del Desarrollo, Facultad de Medicina, Clínica Alemana
Ethics committee: Ethics Research Committee of the Faculty of Medicine UDD
Reason not required: This study does not require ethical approval because it contemplates the review of published scientific articles.
All authors, affiliations and abstracts have been published as submitted.
