Early Physical Rehabilitation in the ICU: A Review for the Neurohospitalist

Abstract

Advances in critical care have resulted in improved intensive care unit (ICU) mortality. However, improved ICU survival has resulted in a growing number of ICU survivors living with long-term sequelae of critical illness, such as impaired physical function and quality of life (QOL). In addition to critical illness, prolonged bed rest and immobility may lead to severe physical deconditioning and loss of muscle mass and muscle weakness. ICU-acquired weakness is associated with increased duration of mechanical ventilation and weaning, longer ICU and hospital stay, and increased mortality. These physical impairments may last for years after ICU discharge. Early Physical Medicine and Rehabilitation (PM&R) interventions in the ICU may attenuate or prevent the weakness and physical impairments occurring during critical illness. This article reviews the evidence regarding safety, feasibility, barriers, and benefits of early PM&R interventions in ICU patients and discusses the limited existing data on early PM&R in the neurological ICU and future directions for early PM&R in the ICU.

Keywords: bed rest; deconditioning; early ICU rehabilitation; early Neuro-ICU rehabilitation; feasibility; immobility; muscle weakness; outcomes; safety.

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

The feasibility of early ambulation is illustrated in this 56-year-old man admitted to The Johns Hopkins Medical Intensive Care Unit with respiratory and renal failure. The patient is being ambulated while on mechanical ventilation, with the assistance of a physical therapist, respiratory therapist, nurse, and a physical therapy technician. Additional equipment included a portable ventilator, a portable cardiac monitor, a wheeled pole with intravenous infusion pumps, and a wheeled walker. A wheelchair is being pushed behind the patient by a physical therapy technician (not seen). Reprinted with permission from Needham et al.

Figure 2.

Screening algorithm to evaluate for appropriateness for PM&R activity. Fio 2 indicates fractional of inspired oxygen; HR, heart rate; MAP, mean arterial pressure; PEEP, positive end-expiratory pressure; RASS, Richmond Agitation Sedation Scale; ROM, range of motion; SBP, systolic blood pressure; SpO2, saturation of peripheral oxygen. Modified from Korupolu et al.