Physical Therapy Management and Considerations of a Patient with Interstitial Lung Disease in the ICU: A Case Report

Background: Interstitial lung diseases (ILD) refer to a group of diffuse parenchymal lung diseases classified together based on common radiographic, physiologic, or pathologic manifestations. Although there are many different classifications, the hallmark of ILD is fibrosis of alveolar walls, airways, and vasculature resulting in a restrictive lung disease. Some research supports the benefits of pulmonary rehabilitation for sub-acute treatment of ILD, but there is even less information regarding physical therapy interventions for acute exacerbations. Purpose: The purpose of this case report is to present interventions and outcomes for a patient with ILD in an intensive care (ICU) setting, as well as other considerations and interventions to consider with this patient population. Case Description: A 64 year-old female was admitted to the ICU with hypoxic respiratory failure. The patient's past medical history was significant for ILD, systolic heart failure, severe pulmonary hypertension, coronary artery disease, oxygen dependence, obstructive sleep apnea, and hypothyroidism. Physical therapy interventions focused on increasing walking distance, with close monitoring of the patients vitals and respiratory status to ensure safety. Outcome measures: The primary outcome measure used during the patient’s hospital stay was walking distance, showing an improvement from 15 feet to 200 feet over 20 days. Discussion: This case presents an acute plan of care for a patient with ILD in the ICU setting, addressing efficacy of exercise training in this patient population, and demonstrating success in improving walking distance in this patient case in preparation for discharge to sub-acute pulmonary rehabilitation.