Modalities for Physical Rehabilitation

Abstract

The progress of intensive care medicine has dramatically improved survival of critically ill patients, especially in patients with acute respiratory distress syndrome (ARDS) and sepsis [1, 2]. However, this improved survival is often associated with general deconditioning, muscle weakness, prolonged mechanical ventilation, dyspnoea, depression, anxiety, and reduced health-related quality of life after intensive care unit (ICU) discharge [3, 4]. Deconditioning and specifically muscle weakness have a key role in impaired functional status after ICU stay [5, 6]. Bed rest and limited mobility during critical illness result in profound physical deconditioning and dysfunction of the respiratory, cardiovascular, musculoskeletal, neurological, renal, and endocrine systems [7]. These effects can be exacerbated by inflammation and pharmacological agents, such as corticosteroids, neuromuscular blockers, and antibiotics associated with critical illness and its treatment. The prevalence of skeletal muscle weakness in the intensive care unit (ICU-acquired weakness) varies up to 50%. Skeletal muscle wasting appears to be the highest during the first 2–3 weeks of ICU stay [8–11] and is associated with weaning failure, ICU and hospital length of stay, and increased 1-year mortality [5, 12].