Relevant aspects of early rehabilitation in the patient admitted to an intensive care unit
DOI:
https://doi.org/10.5281/zenodo.10578132Keywords:
seriously ill patient, AHP Saaty, intensive care unit, early rehabilitation, interdisciplinarityAbstract
Introduction: early rehabilitation of seriously ill patients is a comprehensive and multidisciplinary process. Being a comprehensive and multidisciplinary process, early rehabilitation not only seeks to address physical and mental disabling consequences, but also prevents possible future complications.
Objective: systematize aspects to prioritize in the early rehabilitation of the patient admitted to an intensive care unit.
Method: a narrative review was carried out using the following descriptors: rehabilitation, early rehabilitation, early mobilization, critical patient and their terms in English, in different databases (PubMed, LILACS, Scopus, Redalyc, SciELO). The order of priority was determined through the AHP Saaty methodology.
Results: aspects of physiatric diagnosis, staff training, creation of multidisciplinary teams, criteria for initiation, contraindication and suspension of rehabilitation were described, based on the 22 most relevant documents found. The essential factors for early rehabilitation and their order of priority were determined. Alternatives to take into account in the early rehabilitation process are detailed.
Final considerations: early rehabilitation in intensive care units is feasible and safe, it not only improves the health of the seriously ill patient, but can also have a significant impact on their recovery and overall healthcare costs. The determination of the order of priorities of the factors that are essential for early rehabilitation must be taken into account to apply it in intensive care units, since it provides improvement in the physical and functional health of the patient, reduction of the stay and associated costs. with healthcare.
Downloads
Download data is not yet available.
References
1. González Seguel FA. Movilidad temprana en UCI [Internet]. Santiago de Chile: Sociedad Chilena de Medicina crítica y urgencias; 2016. [citado 28 Jul 2023]; Disponible en: https://www.studocu.com/es/document/universidad-de-la-frontera/kinesiologia/resumenes/movilidad-temprana-en-uci/1134653/view
2. Meza-Ontiveros JR, Pedroza-Morán YG, Villanueva-Acosta CM, Zamudio-Sánchez ML, Arreola-Guerra JM, Domínguez-Reyes C. El fisioterapeuta en la unidad de terapia intensiva: impacto de su intervención en la fuerza muscular del paciente críticamente enfermo. Lux Médica [Internet]. 2014 Ago [citado 28 Jul 2023]; 13(39):11-17. DOI: https://doi.org/10.33064/39lm20181329
3. Sánchez RIA, Ayala NEG. Prescripción del ejercicio en paciente crítico adulto: una propuesta desde la planificación del entrenamiento. Rev UNIANDES Cienc Salud [Internet]. 2018 [citado 28 Jul 2023]; 1(1):2-17. Disponible en: https://revista.uniandes.edu.ec/ojs/index.php/RUCSALUD/article/view/1080
4. Hickmann CE, Castanares ZD, Bialais E, Dugernier J, Tordeur A, ColmantL, et al. Team work enables high levelo fearly mobilization in critically ill patients. Ann Inten Care [Internet]. 2016 Feb [citado 28 Jul 2023]; 6(1):80. DOI: https://doi.org/10.1186/s13613-016-0184-y
5. Rocha M, Martínez BP, Maldaner VZ, Forgiarini LA. La movilización temprana: ¿Por qué, para qué y cómo? Med Inten [Internet]. 2017 Mar [citado 28 Jul 2023]; 41(7):429-436. DOI: http://dx.doi.org/10.1016/j.medin.2016.10.003
6. Goodson CM, Tipping C, Mantheiy EC, Nikayin S, Seltzer J, Outten C, et al. Physical rehabilitation in the ICU: understanding the evidence. Manag Prac [Internet]. 2017 Feb [citado 28 Jul 2019]; 17(3):80. Disponible en: https://healthmanagement.org/c/icu/issuearticle/physical-rehabilitation-in-the-icu-understanding-the-evidence
7. Castro AC, Seron P, Fan E, Gaete M, Mickan S. Effecto fearly rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis. PLoS One [Internet]. 2015 Feb [citado 28 Jul 2023]; 10:e0130722. DOI: https://doi.org/10.1371/journal.pone.0130722
8. Saaty TL. Decision making with the Analytic Hierarchy Process. Int J Serv Scienc [Internet]. 2008 [citado 28 Jul 2023]; 1(1):83-98. DOI: https://doi.org/10.1504/IJSSci.2008.01759
9. Tipping C, Bailey M, Bellomo R, Berney S, Buhr H, Denehy L, Hodgson C. The ICU mobility scale has construct and predictive validity and is responsive: A multicenter observational study. Ann Ame Thor Soc [Internet]. 2016 [citado 28 Jul 2023]; 13(6):887–893. DOI: https://doi.org/10.1513/AnnalsATS.201510-717OC
10. Parry SM, Berney S, Granger CL, Dunlop DL, Murphy L, El-Ansary D, et al. A new two-tier strength assessment approach to the diagnosis of weakness in intensive care: an observational study. Crit Care [Internet]. 2015 Feb [citado 28 Jul 2023]; 19(1):52. DOI: https://doi.org/10.1186%2Fs13054-015-0780-5
11. Hermans G, Van den Berghe G. Clinical review: intensive care unitacquired weakness. Crit Care [Internet]. 2015 Feb [citado 20 Jun 2023]; 19(1):274. DOI: https://doi.org/10.1186/s13054-015-0993-7
12. Calixto MAA, Mendoza MNG, Pérez NOR, Martínez CMA, Pérez MB. Movilización temprana como prevención y tratamiento para la debilidad adquirida en la unidad de cuidados intensivos en pacientes en ventilación mecánica. Experiencia en un hospital de segundo nivel. Eur Scien J [Internet]. 2018 Jul [citado 28 Jul 2023]; 14(21):19-30. DOI: http://dx.doi.org/10.19044/esj.2018.v14n21p19
13. Moss M, Nordon CA, Malone D, Van Pelt D, Frankel SK, Warner ML, et al. A randomized trial of an intensive physical therapy program for patients with acute respiratory failure. Am J Respir Crit Care Med [Internet]. 2016 [citado 28 Jul 2023]; 193(10):1101-10. DOI: https://doi.org/10.1164/rccm.201505-1039oc
14. Fan E, Cheek F, Chlan L, Gosselink R, Hart N, Herridge MS. An official
American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med [Internet]. 2014 [citado 28 Jul 2023]; 190:1437-46. DOI: https://doi.org/10.1164/rccm.201411-2011st
15. Connolly B, Salisbury L, O’Neill B, Geneen L, Douiri A, Grocott MP. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Database Syst Rev [Internet]. 2015 [citado 28 Jul 2023]. DOI: https://doi.org/10.1002/14651858.CD008632.pub2
16. Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H. Early mobilization and recovery in mechanically ventilated patients in the ICU: abinational, multicentre, prospective cohort study. Crit Care [Internet]. 2017 Feb [citado 28 Jul 2023]; 19:81. DOI: https://doi.org/10.1186/s13054-015-0765-4
17. Dubb R, Nydah lP, Hermes C, Schwabbauer N, Toonstra A, Parker AM, et al. Barriers and strategies for early mobilization of patients in intensive care units. Ann Am Thorac Soc [Internet]. 2016 [citado 28 Jul 2023]; 13:724-30. DOI: https://doi.org/10.1513/AnnalsATS.201509-586CME
18. Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med [Internet]. 2014 [citado 28 Jul 2023]; 42(5):1178-86. DOI: https://doi.org/10.1097/CCM.0000000000000149
19. Dantas CM, Silva PFDS, Siqueira FH, Pinto RMF, Matias S, Maciel C, et al. Influência da mobilizacão precoce na foca muscular periférica e respiratória em pacientes críticos. Rev Bras Ter Inten [Internet]. 2012 [citado 28 Jul 2023]; 24:173-8. Disponible en: https://www.scielo.br/j/rbti/a/HM49WXx5YmvjZFLhVnhFqtg/
20. Gómez-Cruz JM, Caneiro-González T, Polo-Amarante A, Madrigal-Torres Y. Guía de práctica clínica para la rehabilitación delpaciente en estado crítico. Medisur [Internet]. 2009 [citado 28 Jul 2023]; 7(1):82-91. Disponible en: https://medisur.sld.cu/index.php/medisur/article/view/722/4291
21. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care [Internet]. 2014 [citado 28 Jul 2023]; (18):658. DOI: https://doi.org/10.1186/s13054-014-0658-y
22. Samosawala NR, Vaishali K, Kalyana BC. Measurement of muscle strength with handheld dynamometerin Intensive Care Unit. Indian J Crit Care Med [Internet]. 2016 Feb [citado 28 Jul 2023]; 20:21-6. DOI: https://doi.org/10.4103/0972-5229.173683
23. Villamil-Parra WA. Fisioterapia en cuidados intensivos, más allá del manejo respiratorio. Rev Colom Reh [Internet]. 2018 Jun [citado 28 Jul 2023]; 17(1):96-102. DOI: https://doi.org/10.30788/RevColReh.v17.n1.2018.313
24. Latronico N, Gosselink R. Aguided approach to diagnose severe muscle weakness in the intensive care unit. Rev Bras Ter Inten [Internet]. 2015 [citado 28 Jul 2023]; 27(3):199-201. DOI: https://doi.org/10.5935/0103-507X.20150036
25. Villamil-Parra WA. Revisión sistemática de la eficacia del ejercicio físico en paciente adulto hospitalizado en UCI [Tesis de Maestría]. Colombia: Universidad Nacional deColombia; 2016 Jun [citado 28 Jul 2023]. Disponible en: http://bdigital.unal.edu.co/54295/1/wilderandresvillamilparra.2016.pdf
26.Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet [Internet]. 2009 [citado 28 Jul 2023]; 373(9678):1874-82. DOI: https://doi.org/10.1016/S0140-6736(09)60658-9
2. Meza-Ontiveros JR, Pedroza-Morán YG, Villanueva-Acosta CM, Zamudio-Sánchez ML, Arreola-Guerra JM, Domínguez-Reyes C. El fisioterapeuta en la unidad de terapia intensiva: impacto de su intervención en la fuerza muscular del paciente críticamente enfermo. Lux Médica [Internet]. 2014 Ago [citado 28 Jul 2023]; 13(39):11-17. DOI: https://doi.org/10.33064/39lm20181329
3. Sánchez RIA, Ayala NEG. Prescripción del ejercicio en paciente crítico adulto: una propuesta desde la planificación del entrenamiento. Rev UNIANDES Cienc Salud [Internet]. 2018 [citado 28 Jul 2023]; 1(1):2-17. Disponible en: https://revista.uniandes.edu.ec/ojs/index.php/RUCSALUD/article/view/1080
4. Hickmann CE, Castanares ZD, Bialais E, Dugernier J, Tordeur A, ColmantL, et al. Team work enables high levelo fearly mobilization in critically ill patients. Ann Inten Care [Internet]. 2016 Feb [citado 28 Jul 2023]; 6(1):80. DOI: https://doi.org/10.1186/s13613-016-0184-y
5. Rocha M, Martínez BP, Maldaner VZ, Forgiarini LA. La movilización temprana: ¿Por qué, para qué y cómo? Med Inten [Internet]. 2017 Mar [citado 28 Jul 2023]; 41(7):429-436. DOI: http://dx.doi.org/10.1016/j.medin.2016.10.003
6. Goodson CM, Tipping C, Mantheiy EC, Nikayin S, Seltzer J, Outten C, et al. Physical rehabilitation in the ICU: understanding the evidence. Manag Prac [Internet]. 2017 Feb [citado 28 Jul 2019]; 17(3):80. Disponible en: https://healthmanagement.org/c/icu/issuearticle/physical-rehabilitation-in-the-icu-understanding-the-evidence
7. Castro AC, Seron P, Fan E, Gaete M, Mickan S. Effecto fearly rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis. PLoS One [Internet]. 2015 Feb [citado 28 Jul 2023]; 10:e0130722. DOI: https://doi.org/10.1371/journal.pone.0130722
8. Saaty TL. Decision making with the Analytic Hierarchy Process. Int J Serv Scienc [Internet]. 2008 [citado 28 Jul 2023]; 1(1):83-98. DOI: https://doi.org/10.1504/IJSSci.2008.01759
9. Tipping C, Bailey M, Bellomo R, Berney S, Buhr H, Denehy L, Hodgson C. The ICU mobility scale has construct and predictive validity and is responsive: A multicenter observational study. Ann Ame Thor Soc [Internet]. 2016 [citado 28 Jul 2023]; 13(6):887–893. DOI: https://doi.org/10.1513/AnnalsATS.201510-717OC
10. Parry SM, Berney S, Granger CL, Dunlop DL, Murphy L, El-Ansary D, et al. A new two-tier strength assessment approach to the diagnosis of weakness in intensive care: an observational study. Crit Care [Internet]. 2015 Feb [citado 28 Jul 2023]; 19(1):52. DOI: https://doi.org/10.1186%2Fs13054-015-0780-5
11. Hermans G, Van den Berghe G. Clinical review: intensive care unitacquired weakness. Crit Care [Internet]. 2015 Feb [citado 20 Jun 2023]; 19(1):274. DOI: https://doi.org/10.1186/s13054-015-0993-7
12. Calixto MAA, Mendoza MNG, Pérez NOR, Martínez CMA, Pérez MB. Movilización temprana como prevención y tratamiento para la debilidad adquirida en la unidad de cuidados intensivos en pacientes en ventilación mecánica. Experiencia en un hospital de segundo nivel. Eur Scien J [Internet]. 2018 Jul [citado 28 Jul 2023]; 14(21):19-30. DOI: http://dx.doi.org/10.19044/esj.2018.v14n21p19
13. Moss M, Nordon CA, Malone D, Van Pelt D, Frankel SK, Warner ML, et al. A randomized trial of an intensive physical therapy program for patients with acute respiratory failure. Am J Respir Crit Care Med [Internet]. 2016 [citado 28 Jul 2023]; 193(10):1101-10. DOI: https://doi.org/10.1164/rccm.201505-1039oc
14. Fan E, Cheek F, Chlan L, Gosselink R, Hart N, Herridge MS. An official
American Thoracic Society Clinical Practice guideline: the diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med [Internet]. 2014 [citado 28 Jul 2023]; 190:1437-46. DOI: https://doi.org/10.1164/rccm.201411-2011st
15. Connolly B, Salisbury L, O’Neill B, Geneen L, Douiri A, Grocott MP. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Database Syst Rev [Internet]. 2015 [citado 28 Jul 2023]. DOI: https://doi.org/10.1002/14651858.CD008632.pub2
16. Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H. Early mobilization and recovery in mechanically ventilated patients in the ICU: abinational, multicentre, prospective cohort study. Crit Care [Internet]. 2017 Feb [citado 28 Jul 2023]; 19:81. DOI: https://doi.org/10.1186/s13054-015-0765-4
17. Dubb R, Nydah lP, Hermes C, Schwabbauer N, Toonstra A, Parker AM, et al. Barriers and strategies for early mobilization of patients in intensive care units. Ann Am Thorac Soc [Internet]. 2016 [citado 28 Jul 2023]; 13:724-30. DOI: https://doi.org/10.1513/AnnalsATS.201509-586CME
18. Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med [Internet]. 2014 [citado 28 Jul 2023]; 42(5):1178-86. DOI: https://doi.org/10.1097/CCM.0000000000000149
19. Dantas CM, Silva PFDS, Siqueira FH, Pinto RMF, Matias S, Maciel C, et al. Influência da mobilizacão precoce na foca muscular periférica e respiratória em pacientes críticos. Rev Bras Ter Inten [Internet]. 2012 [citado 28 Jul 2023]; 24:173-8. Disponible en: https://www.scielo.br/j/rbti/a/HM49WXx5YmvjZFLhVnhFqtg/
20. Gómez-Cruz JM, Caneiro-González T, Polo-Amarante A, Madrigal-Torres Y. Guía de práctica clínica para la rehabilitación delpaciente en estado crítico. Medisur [Internet]. 2009 [citado 28 Jul 2023]; 7(1):82-91. Disponible en: https://medisur.sld.cu/index.php/medisur/article/view/722/4291
21. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care [Internet]. 2014 [citado 28 Jul 2023]; (18):658. DOI: https://doi.org/10.1186/s13054-014-0658-y
22. Samosawala NR, Vaishali K, Kalyana BC. Measurement of muscle strength with handheld dynamometerin Intensive Care Unit. Indian J Crit Care Med [Internet]. 2016 Feb [citado 28 Jul 2023]; 20:21-6. DOI: https://doi.org/10.4103/0972-5229.173683
23. Villamil-Parra WA. Fisioterapia en cuidados intensivos, más allá del manejo respiratorio. Rev Colom Reh [Internet]. 2018 Jun [citado 28 Jul 2023]; 17(1):96-102. DOI: https://doi.org/10.30788/RevColReh.v17.n1.2018.313
24. Latronico N, Gosselink R. Aguided approach to diagnose severe muscle weakness in the intensive care unit. Rev Bras Ter Inten [Internet]. 2015 [citado 28 Jul 2023]; 27(3):199-201. DOI: https://doi.org/10.5935/0103-507X.20150036
25. Villamil-Parra WA. Revisión sistemática de la eficacia del ejercicio físico en paciente adulto hospitalizado en UCI [Tesis de Maestría]. Colombia: Universidad Nacional deColombia; 2016 Jun [citado 28 Jul 2023]. Disponible en: http://bdigital.unal.edu.co/54295/1/wilderandresvillamilparra.2016.pdf
26.Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet [Internet]. 2009 [citado 28 Jul 2023]; 373(9678):1874-82. DOI: https://doi.org/10.1016/S0140-6736(09)60658-9
Downloads
Published
2024-05-06
How to Cite
1.
Donoso Noroña RF, Gómez Martínez N, Rodríguez Plasencia A. Relevant aspects of early rehabilitation in the patient admitted to an intensive care unit. Rev Inf Cient [Internet]. 2024 May 6 [cited 2025 Apr. 28];103(1 Sup):e4433. Available from: https://revinfcientifica.sld.cu/index.php/ric/article/view/4433
