Characterization of occupational therapeutic practice regarding daily living activities of patients with respiratory failure in adult intensive care units

Avelar, Thais Gomes Cabral de; Oliveira, Huryel Tarcio de; Nascimento, Janaína Santos; Bombarda, Tatiana Barbieri

doi:10.1590/2526-8910.ctoAO406439691

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Original Article • Cad. Bras. Ter. Ocup. 33 • 2025 • https://doi.org/10.1590/2526-8910.ctoAO406439692 linkcopy

Characterization of occupational therapeutic practice regarding daily living activities of patients with respiratory failure in adult intensive care units

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction Patients in Intensive Care Units (ICUs) may present various clinical conditions, including respiratory failure (RF), defined as a clinical condition in which the respiratory system is unable to maintain oxygen and/or carbon dioxide arterial pressure values within normal limits. The occupational therapist working in the ICU is part of the rehabilitation team, with activities of daily living (ADL) as one of the intervention focuses.

Objective To characterize occupational therapy practice regarding ADL in patients with RF in the ICU context.

Methodology This is a cross-sectional, descriptive, and quantitative study. Participating occupational therapists work in Brazil and provide care in ICUs to people aged 18 or older with RF. Data were collected through a virtual questionnaire and analyzed using descriptive statistics.

Results According to the participants, the most impacted ADL in the ICU context are bathing, functional mobility, and toilet hygiene, while the ADL most targeted by interventions are feeding, functional mobility, and personal hygiene. The main factors identified as restricting ADL performance in this context are cardiovascular and sensory function alterations, presence of delirium, and service dynamics.

Conclusion The characteristics of occupational therapy practice focused on ADL of patients with RF in the ICU highlight the high complexity of this professional role, which demands specific competencies from the occupational therapist to provide qualified, safe, and effective care.

Keywords:
Activities of Daily Living; Respiratory Insufficiency; Intensive Care Units; Occupational Therapy

Sociodemographic profile	Variable	N (24)	%
Sex	Female	21	87.5
Sex	Male	3	12.5
Age range	20 to 29 years	8	33.3
	30 to 39 years	11	45.8
	40 to 49 years	4	6.7
	50 years or more	1	4.2
Training profile	Variable	N (24)	%
Time of graduate training	Up to 1 year	4	16.7
	1 to 5 years	5	20.8
	6 to 10 years	6	25
	11 years or more	9	37.5
Postgraduate	Yes	23	95.8 4.2
Postgraduate	No	1	95.8 4.2
Type of postgraduate degree	Advanced training in the hospital field	4	16.7
	Advanced training in other fields	1	4.2
	Specialization in the hospital field	4	16.7
	Specialization in other fields	16	66.7
	Residency in the hospital field	9	37.5
	Residency in other fields	3	12.5
	Master's degree with research in the hospital field	2	8.3
	Master's degree with research in another field	3	12.5
	Doctorate with research in the hospital field	0	0
	Doctorate with research in another field	1	4.2
Professional profile	Variable	N(24)	%
Time working in hospital settings	Up to 1 year	4	16.7
	1 to 5 years	13	54.2
	6 to 10 years	6	25
	11 to 15 years	1	4.2
Time working in ICU	Up to 1 year	7	29.1
	1 to 5 years	12	50
	6 to 10 years	4	16.7
	11 to 15 years	1	4.2
Other ICUs operating in addition to the adult ICU	neonatal ICU	5	20.8
	pediatric ICU	6	25
	specialized ICU	6	25
	Mixed pediatric ICU	0	0

Characteristics of the work routine in the adult ICU	Variables	N (24)	%
Workload	Up to 5 hours per week	7	29.2
	6 to 10 hours per week	2	8.3
	11 to 20 hours per week	3	12.5
	21 to 30 hours per week	10	41.7
	More than 30 hours per week	2	8.3
Acting shift	Morning	6	25
	Afternoon	6	25
	Morning and Afternoon	11	45.8
	Evening	1	4.2
Number of beds available in the adult ICU	Up to 10 beds	6	25
	11 to 20 beds	14	58.3
	20 to 40 beds	4	16.7
Number of patients for which the occupational therapist is responsible in a work shift of up to 6 hours in the adult ICU	Up to 6 patients	5	20.8
	7 to 10 patients	12	50
	More than 10 patients	2	8.3
	Variable demand, no stipulated number	5	20.8
Carrying out the workday exclusively in the adult ICU	Yes	6	25
Carrying out the workday exclusively in the adult ICU	No	18	75
Team composition	Doctor	24	100
	Nurse	24	100
	Nursing Technician	24	100
	Physical Therapist	24	100
	Nutritionist	24	100
	Psychologist	18	75
	Speech Therapist	16	66.7
	Social Worker	16	66.7
	Occupational Therapist	1	4.2

Profile of patients with RF treated in the adult ICU	Variable	N (24)	%
Level of consciousness	Changes in level of consciousness (vegetative coma, minimally conscious state, sedation, among others)	16	66.7
	Patients with daily awakening	14	58.3
	Patients who are awake but have a clinical contraindication for ADL training	14	58.3
	Patients who are awake and have an indication for ADL training	15	62.5
Mobility	Restricted to bed	17	70.8
	Allowed to sit at the bedside	17	70.8
	Allowed to assume an upright position	12	50
	Allowed to engage in some activity outside of bed	11	45.8
Performance level	Dependent for ADL, but with a favorable prognosis and potential for rehabilitation	17	70.8
	Dependent for ADL, with an unfavorable clinical and functional prognosis	16	66.7
	No limitations in activities of daily living except bathing and bladder and bowel elimination	10	41.7
	Difficulty managing communication	16	66.7
Devices in use	Tracheostomy in mechanical ventilation	18	75
	Oxygen therapy in nasal catheter	17	70.8
	Orotracheal intubation in mechanical ventilation	16	66.7
	Nasogastric or nasogastric tube	16	66.7
	Central venous access	16	66.7
	Indwelling urinary catheter	15	62.5
	Peripheral venous access	15	62.5
	Non-invasive ventilation	14	58.3
	Oxygen therapy in non-rebreathing mask	13	54.2
	Infusion pump	13	54.2
	Hemodialysis catheter	13	54.2
	Drain	11	45.8
	Invasive blood pressure	9	37.5
	ECMO	1	4.2
	External ventricular shunt	1	4.2

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Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
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