Severe Immobility And Malnutrition In Post ICU Patients Requiring Prolonged Mechanical Ventilation: An Unmet Rehabilitation Need

Verceles, Avelino C.; Wells, Chris; Steinbrenner, Gregory; Beans, Jeffrey; Jenkins, Toye; Miller, Susanne; Stevenson, Troy G.; Goldberg, Andrew P.

doi:10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6852

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“…One small pilot study functionally assessed 14 older survivors of critical illness requiring PMV in a university-based LTACH, using a battery of validated measures of strength (handgrip), physical performance battery (SPPB), mobility (gait speed), balance, and coordination (short and endurance [6-minute walk], estimated VO 2 by upper extremity bicycle ergometry). 121 This functional testing demonstrated weakness (handgrip ¼ 20 AE 8 kg, n ¼ 9; reference ¼ 45 AE 8 kg men, 28 AE 6 women 122 ), impaired balance and coordination 123 (SPPB score ¼ 4, n ¼ 9, severe disability <8), poor mobility (gait speed ¼ 0.26 AE 0.30 m/s, reference >1 m/s 124 ), and low endurance (6-minute walk distance ¼ 57 AE 126 ft, n ¼ 5, reference ¼ 2,070 AE 305 ft 125 ; and estimated VO 2 ¼ 6.1 AE 1.2 mL/kg/min, n ¼ 4, reference 27-31 mL/kg/min; METS 1.8 AE 0.3). These results contextualized these patients' severe weakness, functional impairment, and disability but more importantly demonstrated feasibility in rehabilitating these patients.…”

Section: Early Mobility/exercisementioning

confidence: 99%

Adapting the ABCDEF Bundle to Meet the Needs of Patients Requiring Prolonged Mechanical Ventilation in the Long-Term Acute Care Hospital Setting: Historical Perspectives and Practical Implications

Balas

Devlin

Verceles

et al. 2016

Semin Respir Crit Care Med

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When robust clinical trials are lacking, clinicians are often forced to extrapolate safe and effective evidence-based interventions from one patient care setting to another. This article is about such an extrapolation from the intensive care unit (ICU) to the long-term acute care hospital (LTACH) setting. Chronic critical illness is an emerging, disabling, costly, and yet relatively silent epidemic that is central to both of these settings. The number of chronically critically ill patients requiring prolonged mechanical ventilation is expected to reach unprecedented levels over the next decade. Despite the prevalence, numerous distressing symptoms, and exceptionally poor outcomes associated with chronic critical illness, to date there is very limited scientific evidence available to guide the care and management of this exceptionally vulnerable population, particularly in LTACHs. Recent studies conducted in the traditional ICU setting suggest interprofessional, multicomponent strategies aimed at effectively assessing, preventing, and managing pain, agitation, delirium, and weakness, such as the ABCDEF bundle, may play an important role in the recovery of the chronically critically ill. This article reviews what is known about the chronically critically ill, provide readers with some important historical perspectives on the ABCDEF bundle, and address some controversies and practical implications of adopting the ABCDEF bundle into the everyday care of patients requiring prolonged mechanical ventilation in the LTACH setting. We believe developing new and better ways of addressing both the science and organizational aspects of managing the common and distressing symptoms associated with chronic critical illness and prolonged mechanical ventilation will ultimately improve the quality of life for the many patients and families admitted to LTACHs annually.

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Section: Early Mobility/exercisementioning

confidence: 99%