Wegner (2017) Hydrotherapy for a long term ventilated patient – A case study and implications for practice

Introduction to Hydrotherapy in Critical Care

Hydrotherapy has emerged as a feasible and safe rehabilitation strategy for patients undergoing long-term mechanical ventilation. Despite its unconventional nature, hydrotherapy offers a unique rehabilitation environment that can significantly aid in the recovery of critically ill patients. This case study illustrates the hydrotherapy sessions of a 36-year-old female who, after complications from pneumococcal meningitis, required long-term mechanical ventilation and became an incomplete quadriplegic.

Implementing Hydrotherapy: Considerations and Preparation

Implementing hydrotherapy for mechanically ventilated patients involves meticulous planning and consideration of various factors such as staff resources, training, airway and ventilation management, and patient safety protocols. The case of Ms. C, a long-term ventilated patient, highlights the importance of preparing for hydrotherapy sessions by addressing airway clearance, waterproofing enteral feeding sites, and ensuring patient comfort and safety through the use of appropriate flotation devices and monitoring routines.

Hydrotherapy Session Activities and Rehabilitation Focus

Ms. C’s hydrotherapy sessions were tailored to her specific rehabilitation needs, focusing on three main positions: floating, supported sitting, and supported standing. These positions facilitated active range of motion exercises and trunk and limb muscle activation in a supportive and less fatiguing environment. The buoyancy of water enabled Ms. C to achieve greater movement and postural control, thereby enhancing her motivation for therapy and rehabilitation.

Staffing Requirements and Safety Measures

Hydrotherapy for ventilated patients is resource-intensive and requires a skilled multidisciplinary team. Key staff members include physiotherapists with expertise in cardiorespiratory management, therapy assistants, and possibly additional medical staff. Safety considerations are paramount, with detailed emergency response plans and equipment readiness being crucial for the safe conduct of hydrotherapy sessions. The case study underscores the necessity of having dedicated staff for airway management and ventilation support throughout the session.

Discussion and Implications for Clinical Practice

This case study demonstrates that hydrotherapy can be a valuable addition to the rehabilitation program for long-term ventilated patients. It provides insights into the practical aspects of conducting hydrotherapy sessions, including patient preparation, staffing requirements, and safety protocols. The positive outcomes observed in Ms. C’s case advocate for the broader implementation of hydrotherapy in critical care settings, highlighting its potential benefits in enhancing patient recovery and well-being.

Keywords: Hydrotherapy, Mechanical ventilation, Critical care, Rehabilitation