Rehabilitation in the intensive care unit: Where are we and what are we aiming for?

David McWilliams, Owen Gustafson, Elizabeth King

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    Abstract

    Much interest has been paid to the implementation of early rehabilitation within the intensive care unit (ICU). With muscle mass losses of 2% for each day of inactivity (Fazzini et al., 2023), delays to the initiation of rehabilitation increases the likelihood of patients experiencing significant physical and non-physical morbidity. There remains a lack of clarity on what ‘early’ really means, with previous studies of early rehabilitation demonstrating the time to first mobilise ranging from 1 to 13 days (Schweickert et al., 2009, Schaller et al., 2016, McWilliams et al., 2021). Due to the heterogeneity of patients admitted to ICU, from a variety of clinical specialities, with a range of comorbidities and pre-existing health states, the answer becomes more complex than a simple time-point. As recently demonstrated by the TEAM trial (Hodgson et al., 2022), too strong a focus on ‘starting early’ with the singular aim of achieving the highest mobility level for the longest duration possible, potentially without the correct clinical context, may tip the scales towards risk over clinical benefit. Instead, it is essential the initiation of rehabilitation is based on consideration of physiological stability, which for some patients may well not occur within the first week or even two of their ICU admission (McWilliams et al, 2021).
    Original languageEnglish
    Article number103404
    Number of pages3
    JournalIntensive & critical care nursing
    Volume77
    Early online date4 Feb 2023
    DOIs
    Publication statusPublished - Aug 2023

    Bibliographical note

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    This document is the author’s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it.

    Funder

    Owen Gustafson, Clinical Doctoral Research Fellow, NIHR301569 is funded by Health Education England (HEE)/National Institute for Health Research (NIHR).

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