Physiotherapy treatment approaches for survivors of critical illness: a proposal from a Delphi study (original) (raw)
2019, Physiotherapy Theory and Practice
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Post-Intensive Care Syndrome (PICS): Physical Therapist Role in Recovery
Intensive care and critical care treatments have increased positive patient outcomes considerably over the years, and healthcare has begun to consider the lingering associated aftereffects of ICU care. While many patients may successfully survive invasive ICU treatment such as mechanical ventilation, a significant portion of these patients may develop symptoms which considerably affect their quality of life. PICS, or post-intensive care syndrome, describes the cluster of patient symptoms which may develop or persist following their survival and discharge from ICU. Cognitive impairment, mental health disorders, and physical issues stemming from increased neuromuscular weakness have all been identified as symptoms which can develop following ICU discharge and have been labeled under the umbrella of PICS. PICS-family, or PICS-F, is a coordinating condition affecting the family or caregivers who provide support during ICU admission and is primarily characterized by mental health symptoms such as anxiety and depression. This paper examines the pivotal role that physical therapists may play in the treatment of PICS and alleviation of symptoms which can occur during patient's ICU treatment as well as following discharge. This paper specifically identifies physiotherapy tools for alleviation or prevention of PICS symptoms and increasing positive patient outcomes following ICU admission.
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Patients discharged from Critical Care suffer from excessive longer term morbidity and mortality. Physical and mental health measures of quality of life show a marked and immediate fall after admission to Critical Care with some recovery over time. However, physical function is still significantly reduced at 6 months. The National Institute for Health and Care Excellence clinical guideline on rehabilitation after critical illness, identified the need for high-quality randomised controlled trials to determine the most effective rehabilitation strategy for critically ill patients at risk of critical illness-associated physical morbidity. In response to this, we will conduct a randomised controlled trial, comparing physiotherapy aimed at early and intensive patient mobilisation with routine care. We hypothesise that this intervention will improve physical outcomes and the mental health and functional well-being of survivors of critical illness. 308 adult patients who have received more...
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