Rehabilitation in intensive care

Abstract

Critical illness is associated with short-and long-term morbidity (weakness, weaning failure, impaired functional status and quality of life). Rehabilitation has become a key component in the management of patients with critical illness. Assessment is focused on cardiorespiratory stability, level of consciousness and cooperation, physical deconditioning (muscle weakness, joint stiffness, impaired functional exercise capacity, physical inactivity) and respiratory impairments (retained airway secretions, atelectasis and respiratory muscle weakness) to identify targets for rehabilitation. Evidence-based targets for rehabilitation are therefore muscular re-conditioning, airway clearance, with the aim to prevent atelectasis and to avoid (re-)intubation and/or weaning failure. In particular, early physical activity and mobilization are essential in the prevention, attenuation or reversion of physical deconditioning related to critical illness. A variety of modalities for assessment and treatment are evidence based and must be implemented depending on the stage of critical illness, comorbid conditions and cooperation of the patient. The physiotherapist should be responsible for implementing mobilization plans and exercise prescription and should make recommendations for progression of the rehabilitation strategies jointly with medical and nursing staff.