Rehab in ICU

• How many people spend time in critical care each year?

  110,000 people
• What is often the start of an uncertain journey to recovery for patients discharged from critical care?

  Discharge from critical care
• What are some common problems faced by patients after critical care discharge?

  Weakness, loss of energy, physical difficulties, anxiety, depression, post-traumatic stress phenomena, and loss of cognitive function
• What role do family members often take on after a patient is discharged from critical care?

  Informal caregivers
• What can be a secondary toll on family members acting as informal caregivers?

  Ill-health
• What is the title of the NICE clinical guideline related to rehabilitation after critical illness?

  NICE clinical guideline 83
• What is key to improving outcomes for patients after critical illness?

  Early assessment and rehabilitation
• What type of assessment is recommended upon admission to critical care?

  Short clinical assessment to identify risk
• What is the rationale for early structured rehabilitation according to NICE?

  It reduces critical care and hospital length of stay (LOS)
• Who conducted a study that found early mobility reduces critical care and hospital LOS?

  Morris et al (2008)
• What did Schweickert et al (2009) find regarding early physical therapy and occupational therapy?

  It increased return to independent functional status at hospital discharge
• What can structured rehabilitation increase according to McWilliams & Westlake (2011)?

  Functional status of patients at critical care discharge
• What is the impact of a prolonged supine position on cardiac function?

  It leads to a decrease in $V02 \text{ max}$, plasma volume, and stroke volume, and an increase in resting and maximal heart rate
• What are the respiratory impacts of a critical care stay?

  Decreased lung volume and compliance, gas exchange, mucociliary clearance, and respiratory muscle weakness, along with increased work of breathing
• What neuromusculoskeletal issues can arise from a critical care stay?

  Bone demineralization, muscle atrophy, decreased muscle strength, nerve degeneration, and decreased insulin receptor sensitivity
• What is the incidence of critical illness polyneuropathy (ICU-AW)?

  50 - 80%
• What are some clinical features of critical illness polyneuropathy?

  Weakness, increased length of stay, difficulty weaning, and prolonged rehabilitation
• What psychological effects can result from a critical care stay?

  Confusion, memory loss, cognitive problems, psychosis/delirium, anxiety, and depression
• What is delirium in the context of critical care?

  A serious sudden disturbance of mental faculties characterized by confused thinking and reduced awareness
• What are the two types of delirium mentioned?

  Hyperactive and hypoactive
• Why is delirium often under-recognized in critical care settings?

  It is mainly treated with drugs, leading to an imbalance in medication used for subtypes
• What is the implication of early rehabilitation after critical illness?

  It can reduce patient length of stay and improve patient outcomes
• What is the World Health Organisation’s model used in rehabilitation after critical illness?

  The International Classification of Function (ICF) model
• How does the ICF model assist in rehabilitation?

  It helps articulate physiotherapeutic patient-centred problems and goals
• What skills do physiotherapists bring to the rehabilitation process after critical illness?

  • Knowledge
  • Skills
  • Assessment
  • Clinical reasoning
  • Decision making
  • Management
• What can rehabilitation after critical illness potentially achieve?

  • Optimizing recovery of all relevant body systems
  • Regaining normal physiology, range of motion (ROM), strength, and balance
  • Returning to function
  • Adapting to a new normal
• What is the aim of CVR assessment and management for sedated and ventilated patients?

  Recovery
• What is the aim of neuromusculoskeletal assessment and management for awake and ventilated patients?

  Recover as much function as possible through active rehabilitation
• What are the key considerations for early rehabilitation after critical illness?

  • Address preventable consequences and complications
  • Individualized and realistic plans
  • Adequate staff skill mix and equipment
  • Whole unit multidisciplinary team (MDT) approach