Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients 2023 (J-ReCIP 2023)

Abstract

Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the “Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit” to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This endeavor resulted in the formulation of Clinical Practice Guidelines (CPGs), designed to elucidate best practices in early ICU rehabilitation. The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making, ultimately contributing to the enhancement of patient outcomes in critical care settings. No previous CPGs in the world has focused specifically on rehabilitation of critically ill patients, using the GRADE approach. Multidisciplinary collaboration is extremely important in rehabilitation. Thus, the CPGs were developed by 73 members of a Guideline Development Group consisting of a working group, a systematic review group, and an academic guideline promotion group, with the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the JSICM at its core. Many members contributed to the development of the guideline, including physicians and healthcare professionals with multiple and diverse specialties, as well as a person who had been patients in ICU. Based on discussions among the group members, eight important clinical areas of focus for this CPG were identified. Fourteen important clinical questions (CQs) were then developed for each area. The public was invited to comment twice, and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four background questions. In addition, information for each CQ has been created as a visual clinical flow to ensure that the positioning of each CQ can be easily understood. We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions. Graphical Abstract

Impact of maximum phonation time on postoperative dysphagia and prognosis after cardiac surgery

“…In addition, the effectiveness of management based on videoendoscopy or videofluoroscopy in intensive care units remains unclear. 33 Further investigation is required to develop a precise and clinically viable method for swallowing assessment that is also sustainable. Lastly, our study did not include an investigation of the temporal extent of PED, which prevented us from gaining understanding into the protracted trajectory of PED recovery.…”

Klinikai táplálás Dysphagia esetén

“…A szövődmények/mellékhatások megelőzése szempontjából három kritikus időszakot azonosítottak be: a táplálásfelépítés, az intézményből történő hazabocsátás és a leszoktatás. 5,6,12…”

“…A kutatások arra hívják fel a figyelmet, hogy az intenzív osztályon lévő kritikus állapotú betegeknél a gépi lélegeztetést követő korai dysphagia az esetek körülbelül 50%-ában fordul elő. 12 A táplálásterápiás terv kidolgozásánál különös gonddal kell eljárni, mert az alul-, illetve a túltáplálás, valamin az alacsony fehérjebevitel is mortalitást növelő tényező, továbbá a kedvezőbb kimenetel érdekében fokozatos táplálásfelépítés szükséges. 6,9,18 A kritikus állapotban lévő betegeknél egészen más összetételű szondatáplálásra kifejlesztett terméket részesítünk előnyben, mint az aktív vagy a krónikus osztályon fekvőknél.…”