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Michigan State University

Osteopathic Recognition Resource Library: ICU

Purpose: to provide links to journal articles that can be used for journal clubs in any specialty to support the milestones for OR.


Case Study

A 52 yo M is in the ICU s/p CABG x3 with a covered open chest secondary to sepsis on IV antibiotics.  He has been sedated on a ventilator for more than a week and has not stooled for at least seven days.  He has been on multiple different bowel regimens, all of which have failed to produce any stool.  Portable abdominal x-rays show significant amounts of impacted stool throughout his large and small bowel, and it is likely that he has an ileus.  He is treated at 3 pm with myofascial release of the thoracic inlet, rib raising, paraspinal inhibition to the lumbar region and release of the celiac, superior and inferior mesenteric ganglia.  By 7 pm he begins stooling copiously, and by monday his xray indicates a bowel devoid of impacted stool. 




  • Foundations Chapter 34 “Pulmonology”
  • Greenman Chapter 15
  • Cramer D, et al. Effect of pedal pump and thoracic pump techniques on intracranial pressure in patients with traumatic brain injuries.  J Am Osteopath Assoc. 2010 Apr;110(4):232-8. 
    • Techniques: Pedal pump and Thoracic pump

  • Noll DR, Shores JH, Gamber RG, Herron KM, Swift J Jr. Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia. J Am Osteopath Assoc. 2000 Dec;100(12):776-82. 
  • Noll DR, Johnson JC, Baer RW, Snider EJ. The immediate effect of individual manipulation techniques on pulmonary function measures in persons with chronic obstructive pulmonary disease. Osteopath Med Prim Care. 2009 Oct 8;3:9.
    • Techniques: Condylar Decompression, Thoracic Inlet release, Diaphragm Doming, Cervical Myofascial Release
  • Stretanski MF, Kaiser G. Osteopathic philosophy and emergent treatment in acute respiratory failure. J Am Osteopath Assoc. 2001 Aug;101(8):447-9.
    • Techniques: HVLA of Cervical Vertebra, HVLA of thoracics (Texas Twist, Kirksville Crunch).
  • Hirayama F, Kageyama Y, Urabe N, Senjyu H. The effect of postoperative ataralgesia by manual therapy after pulmonary resection. Man Ther. 2003 Feb;8(1):42-5.
    • Techniques: Pressure-friction and Myofascial release of serratus anterior, latissimus dorsi, external oblique, and pectoralis major/minor

Study Questions from Readings

1. Which of the following statements is most correct regarding the use of OMT in comatose closed head injury patients:
  1. Pedal Pump, but not Thoracic Pump, is contraindicated, as it can cause an increase in ICP.
  2. Thoracic Pump, but not Pedal Pump, is contraindicated, as it can cause an increase in ICP.
  3. Both Thoracic Pump and Pedal Pump are contraindicated, as they can cause increased ICP.
  4. Coughing is contraindicated, as it can cause increased ICP.
  5. Neither Pedal Pump nor Thoracic Pump are contraindicated, and they may contribute to a decrease in ICP.
2. Which of the following statements is false regarding treating pain in post-thoracotomy patients:
  1. Efforts should be made to treat only unincised tissue after surgery, as this will help to decrease pain.
  2. Pain results from stress from shortening upon muscle that has been incised or is attached to ribs affected by the thoracotomy.
  3. Opioid-like analgesic effect comes from intermittent stimulation by manual therapy of skin and deep tissue.
  4. Pain may increase for 2-3 days following treatment, but the net effect is a decrease in post-operative pain.
  5. While transcutaneous electrical stimulation may improve pain in postoperative thoracoscopy pain, TENS has not been shown to be effective in reducing post-thoracotomy pain.
2 part question:

A pediatric patient is intubated as a result of respiratory distress while being treated for pneumonia.  He has also been tachycardic and has a nasogastric tube.  

3A.  In which sympathetic regions is he most likely to demonstrate somatic dysfunction?

  1. T1-5 on the left
  2. C3-5 and T2-7 on the left
  3. C3-5 on the right
  4. C3-5 and T2-6 on the right 
  5. T2-6 on the right
3B.  Which of the following order of procedures is most preferable for treating this patient?
  1. Thoracic Pump, Thoracic Inlet Release, Rib Raising, Diaphragm Redoming, Lumbar paraspinal stretch, Pedal pump
  2. Rib Raising, Diaphragm Redoming, Lumbar paraspinal stretch, Pedal pump, Thoracic Inlet Release, Thoracic Pump
  3. Rib Raising, Lumbar Paraspinal stretch, Thoracic Inlet Release, Pedal Pump, Thoracic Pump, Diaphragm Redoming
  4. Superior Mesenteric Ganglia release, Cervical Muscle Energy, Thoracic Inlet release,   Splenic Pump, Release of L LE Interosseous Membrane
  5. Thoracic Inlet Release, Rib Raising, Lumbar paraspinal stretch, Diaphragm Redoming, Thoracic Pump
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