Case study: PICU physiotherapy management of 90% TBSA burns patient

Miss Sinead O’Connor1

1Women’s and Children’s Hospital, Adelaide, Australia

Management of major burns in the acute phase is complex and multi-faceted. This case study explores the respiratory and burns early physiotherapy management of a 9-year-old boy with 90% TBSA flame burn and inhalation injury. The patient was intubated and ventilated for 7 weeks during which time he developed varying areas of collapse and secretion retention.  He had significant issues with medical instability, a mobile oral tube, ongoing diarrhoea and vomiting and severe pain, particularly when positioning the limbs in a dependent position. He went to theatre twice weekly for dressing changes, debridement, and application of Integra and grafting and had major post-operative movement restrictions secondary to this. Airway clearance was unable to be managed via conventional chest physiotherapy methods and was instead managed with the Phillips CoughAssist E70 device and high frequency oscillation (Metaneb) therapies via endotracheal tube. The PICU physiotherapist undertook passive & active-assisted range of motion three times daily, and additional range exercises were performed by nursing staff as needed. Early mobilisation out of bed was unable to be achieved due to the significant issues discussed. The first transfer out of bed occurred at 2 months post injury, where he spent time sitting in a Hausted chair and weight bearing on the tilt table as able. The complexity of therapy in major burns patients proves challenging for physiotherapists and this review provides details of novel respiratory therapies applied and of the lessons learned  on a 90% TBSA burns patient over his 3 month PICU stay.

Miss Abbot is a PICU physiotherapist at the Women’s and Children’s Hospital, Adelaide.

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