Respiratory Physiotherapy in Intensive Care Patients: Assessment, Airway Clearance, and Rehabilitation Approaches

<jats:p>Respiratory complications are common among critically ill patients due to prolonged mechanical ventilation, immobilization, sedation, and the severity of the underlying disease. These factors contribute to respiratory muscle weakness, secretion retention, atelectasis, impaired gas exchange, ventilator-associated pneumonia, and delayed functional recovery. Respiratory physiotherapy plays a central role in preventing these complications, facilitating liberation from mechanical ventilation, and improving overall patient outcomes. This chapter provides a comprehensive overview of evidence-based respiratory physiotherapy practices in intensive care units. It describes systematic respiratory assessment, including evaluation of clinical status, hemodynamic stability, respiratory mechanics, airway secretions, oxygenation, respiratory muscle function, and functional capacity to guide individualized treatment planning. Airway clearance techniques such as controlled coughing, forced expiratory technique, active cycle of breathing techniques, positive expiratory pressure therapy, chest physiotherapy, and endotracheal suctioning are discussed according to current clinical indications. Lung expansion interventions—including deep breathing exercises, diaphragmatic and segmental breathing, inspiratory hold techniques, incentive spirometry, therapeutic positioning, and prone positioning—are presented as strategies to improve alveolar recruitment and optimize gas exchange. The chapter also highlights the role of inspiratory muscle training in patients with inspiratory muscle weakness, particularly during weaning from mechanical ventilation, emphasizing appropriate patient selection and individualized training protocols. Furthermore, respiratory physiotherapy interventions in mechanically ventilated patients, safety considerations, monitoring requirements, and evidence-based clinical recommendations are summarized to support safe and effective clinical practice. Overall, individualized, evidence-based respiratory physiotherapy integrated within a multidisciplinary intensive care team contributes to improved respiratory function, reduced pulmonary complications, earlier mobilization, successful liberation from mechanical ventilation, and enhanced functional recovery in critically ill patients.</jats:p>