How Critical Illness Affects Breathing

A critical illness can impact various body parts, including your lungs and breathing muscles, which may weaken due to reduced use. Your primary breathing muscles are the diaphragm (a dome-shaped muscle between your chest and abdomen) and the intercostal muscles (between your ribs). Normally, these muscles facilitate inhalation and exhalation, allowing oxygen to enter your bloodstream and energize your muscles.

Impact on Lungs During Critical Illness

If you were on a ventilator during your illness, it would have assisted with breathing by delivering air and possibly oxygen. This reliance on the machine can lead to weakened breathing muscles. Additionally, being on a ventilator can increase the risk of chest infections, as it bypasses the natural filtering function of the nose and mouth, making it easier for bacteria to enter the lungs.

Role of Physiotherapy in Breathing Recovery

Physiotherapists in the ICU may have assisted with breathing exercises to:

• Enhance oxygen flow to the lungs and muscles
• Strengthen breathing muscles
• Facilitate coughing to clear mucus

They would have monitored your breathing patterns, depth, and listened for mucus to ensure proper lung function. Clearing excess mucus is crucial to prevent infections and improve breathing efficiency.

Managing Breathlessness Post-Illness

Feeling breathless after a critical illness is common. Simple activities might make you short of breath, which can be alarming. To manage breathlessness:

• Continue activities to avoid muscle weakening
• Breathe regularly during tasks (e.g., inhale when stepping up stairs)
• Pace your activities and rest between them
• Use a handheld fan to ease breathlessness
• Stay calm, relax your shoulders, and breathe slowly
• Find supportive positions to ease breathing (e.g., leaning forward)
• Use a walking aid if needed to reduce upper body strain
• Perform breathing control exercises

Exercise and Activity

Fatigue and difficulty with daily activities are typical after a critical illness due to muscle weakness. Gradually increasing your activity levels, starting with daily routines and then incorporating gentle exercise, is vital for muscle recovery. Monitor your ability to converse during activities to gauge if you're overexerting yourself. Keeping a diary can help track progress.

Breathing Exercise: Active Cycle of Breathing Technique (ACBT)

Rebuilding lung function can be supported by ACBT, which involves three stages:

• Breathing Control: Relax and focus on diaphragmatic breathing.
• Deep Breathing: Inhale slowly through your nose and exhale gently.
• Huffing: Exhale forcefully through an open mouth to help move mucus.

Optimal Position for ACBT

Perform ACBT in a comfortable position, such as sitting or lying on your side, to maximize mucus clearance.

Recommended Frequency and Timing for ACBT

Start with one or two cycles per session and gradually increase to 3-4 cycles as you build stamina. Aim to perform ACBT 2-4 times a day, especially if mucus is present, to prevent accumulation and reduce breathlessness.

Conclusion

Breathlessness is a common issue after a critical illness, but it improves as your lungs and muscles recover. Balancing activity and rest, along with regular mucus clearance through techniques like ACBT, will aid in your recovery and help strengthen your breathing muscles.

Additional Resources

Association of Chartered Physiotherapists in Respiratory Care
British Lung Foundation
Derriford Hospital Physiotherapy Department ACBT Video

This sheet was created by Catherine White, Eleanor Douglas, and Ashley Quinn and is provided by ICUsteps, a charity dedicated to supporting ICU patients. For more information, visit ICUsteps.