Role of physiotherapy for adult patients with critical illness

Abstract

Long-term complications of critical illness include intensive care unit (ICU)-acquired weakness and neuropsychiatric disease. Immobilisation secondary to sedation might potentiate these problems. Critical illness can last from hours to months, depending on the underlying pathophysiology and response to treatment. It carries high morbidity and mortality rates, and the associated care is a major determinant of healthcare costs. The evolution of intensive care medicine and integrated team management has greatly improved the survival of critically ill patients. In view of the high costs associated with ICU, every attempt should continue to be made to prevent complications and appropriately treat the primary underlying pathophysiology to minimize length of stay in ICU. There are common complications particularly associated with a prolonged ICU stay, including deconditioning, muscle weakness, dyspnoea, depression and anxiety, and reduced health-related quality of life. Chronic critical illness is associated with prolonged immobility and intensive care unit (ICU) stay and accounts for 5–10% of ICU stays, a proportion that appears to beincreasing . Because of these detrimental sequelae of long-term bed rest, there is a need for rehabilitation throughout the critical illness and thereafter , to address these effects. The amount of rehabilitation rehabilitation performed in ICUs is often inadequate, A strategy for whole-body rehabilitation-consisting of interruption of sedation and physical and occupational therapy in the earliest days of critical illness-was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care.