Ellis Bee Interview: the role of physiotherapists on the NHS frontline
Ross Kemp becomes emotional discussing NHS frontline staff
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Prior to being potentially ventilated, a patient will be trialled on something called non-invasive ventilation, this is a mask connected to a small machine that helps with the patient’s breathing but doesn’t do it all for them.
The patient’s physical positioning is key, and this is just one area physiotherapists step in. Bee said: “We can help the patients if that kind of positioning to optimise their breathing. We can advise them to lie on their tummy because that helps with ventilation/perfusion [and] teach them breathing exercises, including how to ‘huff’ out any retained phlegm”.
But what about if the patient is in a coma? What happens then?
This where respiratory physiotherapy can become crucial for the survival of the patient.
As mentioned, one of the biggest factors is the position of the patient.
This becomes more complex when the patient is fully sedated because they can’t turn themselves over.
Physiotherapist Bee described what happens in greater detail:
“[This] is called proning and we do it to match the area of healthy lung to the area of the lung that’s getting the most blood flow. This aids the exchange of oxygen into the bloodstream and carbon dioxide out of the bloodstream, which is a delicate balance. Physiotherapists redeployed from other departments, including musculoskeletal outpatients, formed dedicated ‘proning teams’ to ensure patients could be proned or de-proned at any time, day or night.”
Another challenge faced if the patient is fully sedated is the presence of phlegm.
This builds up in the lungs and can cause problems if it isn’t removed quickly.
Physiotherapists use a technique called suctioning to remove the phlegm.
It’s an essential procedure, Bee explained: “This is where a tube is placed into the airway of the patient. Suction is applied and we can literally suck the phlegm from their airway. The bacteria sitting in the phlegm [causes] chest infections that can develop into a pneumonia so us suctioning out the phlegm helps to avoid that happening”
It’s not just managing the ventilation and proning the patients where physiotherapists are critical.
Physiotherapists like Bee use precise manual techniques known as “lung vibs” and percussions.
Bee described them in more detail: “You apply a vibration to the patient’s chest manually using your hands and your upper body to vibrate and shake the patient, transferring mechanical energy through the chest wall, to shift some of that phlegm that might be stuck inside the lungs.
“Similarly, percussions are another example of, “transferring mechanical energy through the chest wall using the palm of your hand to reduce [the] viscosity [of the phlegm] and shift it towards the larger airways so that you can suction it up.”
Respiratory physiotherapists are able to interpret and adjust the ventilator settings helping the patient breath more efficiently.
Whilst it may sound simple, it’s a delicate balancing act when the patient’s condition is changing minute by minute.
Further down the line, physiotherapists work on physical recovery with the patient to help them learn how to sit, stand, and walk again whilst on the ICU. This process often starts long before the patient’s breathing tube is removed and may at first require the assistance of three therapists.
They also work with speech therapists to help patients with a Tracheostomy speak again using a Passy Muir valve; a tube that Bee describes as, “a one-way valve that redirects air up through the larynx (voice box) and up through the mouth and nose so the patient can produce a voice”.
What this means for the patient is measured not just in terms of the speed of their recovery post-Covid, but their likelihood of surviving Covid altogether.
Bee said that the use of these techniques “has been shown to really improve outcomes. The earlier we can get patients moving the better the outcome…in terms of time spent on intensive care, their level of function when they’re released from hospital and their overall risk of mortality”.
This is the essential point that “patients who are moving earlier have a lower risk of dying”.
So as another wave of Covid patients hits the NHS, think of the physiotherapists and all the other NHS personnel on the frontline, who will once again play an essential role in keeping people alive through the long days and even longer nights this winter.
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