Book chapter
Promoting physical recovery in critical illness
Oxford Textbook of Critical Care
Oxford Textbook, Oxford University Press
04/01/2016
DOI: 10.1093/med/9780199600830.003.0378
Abstract
Survivors of critical illnesses are often faced with persistent neuromuscular weakness that interferes with daily activities. Advancements in survival from critical illness have led to a rise in the number of patients afflicted with postintensive care unit (ICU) incapacity. It is clear that the pathology leading to ICUacquired weakness is present within 24 hours of the start of ICU care. Caregivers must consider interventions to limit or reverse these processes from the onset of critical illness. We suggest strategies both for avoiding harms and for actively promoting recovery of skeletal and respiratory muscles. Muscular silence contributes to, while muscular activity alleviates, myopathy. Thus, limiting sedation and neuromuscular blockade will facilitate spontaneous muscle activity, and allow for active participation in physical therapy. Protocols that aggressively assess for the potential for extubation shorten the duration of ventilation and thus decrease exposure to sedation. Mobility teams should safely guide patients in their progress from a passive range of motion through more active therapies despite ongoing critical illness. Early ICU mobility is not only safe, but reduces the incidence of delirium and duration of mechanical ventilation. Importantly, early ICU mobility increases the likelihood of a return to independent function among ICU survivors. A change in culture from one that practices deep sedation and protective support is suggested, to one that demonstrates an urgency to liberate patients from the confines and perils of critical illness.
Details
- Title: Subtitle
- Promoting physical recovery in critical illness
- Creators
- Gregory A. SchmidtKevin Doerschug
- Resource Type
- Book chapter
- Publication Details
- Oxford Textbook of Critical Care
- Publisher
- Oxford University Press
- Series
- Oxford Textbook
- DOI
- 10.1093/med/9780199600830.003.0378
- Alternative title
- Part 21.1 In-hospital recovery from critical illness
- Language
- English
- Date published
- 04/01/2016
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984363311402771
Metrics
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