Physical rehabilitation and critical illness

Abstract

Survivors of critical illness suffer a range of physical, psychological and social problems known together as the post-ICU syndrome. Physical weakness is common, long lasting, and interferes with quality of life for many ICU survivors. Physical weakness observed close to the time of ICU discharge is likely be caused by the disordered physiology and immobility associated with critical illness. These factors may be less important in the long term, where pre-existing frailty may be more important. A large number of trials have tested physical interventions (exercise, passive and active mobilization, and neuromuscular electrical stimulation) delivered during and after critical illness. At this time, the evidence suggests that early mobilization can improve important short-term outcomes (such as length of stay, duration of mechanical ventilation, functional independence, and mobility), and may increase days out of hospital alive at 180 days. Effects on other long-term outcomes (such as quality of life) have not been shown. No physical interventions delivered after ICU discharge have demonstrated effectiveness. This article describes the physical problems experienced by ICU survivors, and provides an up to date review of critical care physical intervention trials.

Muscle Mass Loss in the Older Critically Ill Population: Potential Therapeutic Strategies

“…However, it should be noted that physical rehabilitation and mobilization, during the acute period (<3 months) post‐ICU, does not always appear to improve physical recovery or quality of life, 63,64 although greater patient satisfaction has been reported in response to many aspects of the recovery process 63 . Furthermore, Griffith and Walsh recently summarized key trials investigating physical rehabilitation in an ICU setting and demonstrated that, in some but not all cases, physical rehabilitation elicited a small positive influence on important patient‐related outcomes (e.g., physical independence, length of stay, functional mobility on discharge and at 6‐month follow‐up) 65 . What is particularly important to note is that early physical mobilization in an ICU setting rarely, if ever, led to any negative patient‐related outcomes.…”

“…63 Furthermore, Griffith and Walsh recently summarized key trials investigating physical rehabilitation in an ICU setting and demonstrated that, in some but not all cases, physical rehabilitation elicited a small positive influence on important patient-related outcomes (e.g., physical independence, length of stay, functional mobility on discharge and at 6-month follow-up). 65 What is particularly important to note is that early physical mobilization in an ICU setting rarely, if ever, led to any negative patient-related outcomes.…”

Early Detection of Muscle Weakness and Functional Limitations in the Critically Ill: A Retrospective Evaluation of Bioimpedance Spectroscopy

“…Nutritional 44 and early mobility approaches 45 in research studies have not consistently made an impact on patient outcomes, and in the original site-C study, there was no difference in FFM between the intervention and control groups. 29 Also, we were not able to investigate associations between change in body composition over time with strength/function.…”

A Modified Physical Disability Screening Model after Treatment in the Intensive Care Unit: A Nationwide Derivation-Validation Study

“…Increased intensive care unit (ICU) use and improvements in critical care medicine have resulted in an ever-expanding population of survivors with critical illness [ 1 ]. After hospital discharge, a significant proportion of ICU survivors report long-term cognitive, psychiatric, and/or physical disability problems, which are known together as post-ICU syndrome (PICS) [ 2 , 3 ].…”

“…The extra effort, time, and care involved in developing a multidisciplinary management program can improve the long-term performance, capacity, and quality of life of ICU survivors as well as their families [ 8 , 9 ]. Moreover, it is known that the appropriate patient selection and the efficacy of interventions after ICU discharge could improve outcomes [ 2 , 10 ]. Patients who are at high risk for physical disability after treatment in the ICU, rather than all patients, will increase the chance of showing treatment effects in interventional studies [ 11 ].…”