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Mobility and Function

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Passport to Successful ICU Discharge

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Abstract

Patients experiencing critical illness often have extreme derangement of physiological function requiring admission to an intensive care unit (ICU). Within the ICU, there is an initial focus on aggressive life support, coupled with continuous monitoring and treatment for organ failure. While providing this care, management of the critically ill patient has traditionally involved supine or semi-recumbent positioning and bed rest, mechanical ventilation, analgesia, and sedation but with historically little attention placed on long-term outcomes and in particular neuromuscular function. Consequently, survivors of critical illness often experience significant physical, psychological and cognitive morbidity, the effects of which can last for months to years after hospital (Herridge et al., N Engl J Med 364(14):1293–304, 2011).

Preventing or minimising the physical consequences of critical illness and supporting recovery from intensive care are, therefore, essential to improve patient outcomes. This has placed an increased focus on the importance of early rehabilitation during intensive care, followed by structured and comprehensive programmes of rehabilitation throughout the recovery period.

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References

  1. Puthacheary Z, Rawal J, Mcphail M, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310:1591–600.

    Article  CAS  Google Scholar 

  2. Dirks ML, Wall BT, van de Valk B, Holloway TM, Holloway GP, Chabowski A, et al. One week of bed rest leads to substantial muscle atrophy and induces whole-body insulin resistance in the absence of skeletal muscle lipid accumulation. Diabetes. 2016;65(10):2862–75.

    Article  CAS  PubMed  Google Scholar 

  3. Batt J, Dos Santos CC, Cameron JI, Herridge MS. Intensive care unit-acquired weakness: clinical phenotypes and molecular mechanisms. Am J Respir Crit Care Med. 2013;187:238–46.

    Article  PubMed  Google Scholar 

  4. Stevens RD, Marshall SA, Cornblath DR, et al. A framework for diagnosing and classifying intensive care unit-acquired weakness. Crit Care Med. 2009;37:S299–308.

    Article  PubMed  Google Scholar 

  5. Chohan S, Ash S, Senior L. A team approach to the introduction of safe early mobilisation in an adult critical care unit. BMJ. 2018;7(4):e000339.

    Google Scholar 

  6. Hespel P, Op’t Eijnde B, Van Leemputte M, et al. Oral creatine supplementation facilitates the rehabilitation of disuse atrophy and alters the expression of muscle myogenic factors in humans. J Physiol. 2001;536:625–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Veldhuizen JW, Verstappen FT, Vroeme JP, et al. Functional and morphological adaptations following four weeks of knee immobilization. Int J Sports Med. 1993;14:283–7.

    Article  CAS  PubMed  Google Scholar 

  8. De Jonghe B, Bastuji-Garin S, Durand MC, et al. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med. 2007;35:2007–15.

    Article  PubMed  Google Scholar 

  9. Garnacho-Montero J, Amaya-Villar R, Garcia-Garmendia JL, et al. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med. 2005;33:349–54.

    Article  PubMed  Google Scholar 

  10. Griffiths RD, Hall JB. Intensive care unit-acquired weakness. Crit Care Med. 2010;38:779–87.

    Article  PubMed  Google Scholar 

  11. Griffiths J, Hatch RA, Bishop J, et al. An exploration of social and economic outcome and associated health related quality of life after critical illness in general intensive care unit survivors: a 12-month follow-up study. Crit Care. 2013;17(3):R100.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Herridge MS, Tansey CM, Matte A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–304.

    Article  CAS  PubMed  Google Scholar 

  13. Levine S, Nguyen T, Taylor N, et al. Rapid disuse atrophy of diaphragm fibres in mechanically ventilated humans. N Engl J Med. 2008;358:1327–35.

    Article  CAS  PubMed  Google Scholar 

  14. Vorona S, Sabatini U, Al-Maqbali S, Bertoni M, Dres M, Bissett B, et al. Inspiratory muscle rehabilitation in critically ill adults: a systematic review and meta-analysis. Ann Am Thorac Soc. 2018;15(6):735–44.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jung B, Moury PH, Mahul M, et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intensive Care Med. 2016;42:853–61.

    Article  PubMed  Google Scholar 

  16. Truong AD, Fan E, Brower RG, Needham DM. Bench to bedside review: mobilizing patients in the intensive care unit–from pathophysiology to clinical trials. Crit Care. 2009;13:1–8.

    Article  Google Scholar 

  17. Convertino VA, Bloomfield SA, Greenleaf JE. An overview of the issues: physiological effects of bed rest and restricted physical activity. Med Sci Sports Exerc. 1997;29:187–90.

    Article  CAS  PubMed  Google Scholar 

  18. Kashihara H, Haruna Y, Suzuki Y, et al. Effects of mild supine exercise during 20 days bed rest on maximal oxygen uptake rate in young humans. Acta Physiol Scand. 1994;616:19–26.

    CAS  Google Scholar 

  19. Owen HC, Vanhees I, Solie L, Roberts SJ, Wauters A, Luyten FP, Van Cromphaut S, Van den Berghe G. Critical illness-related bone loss is associated with osteoclastic and angiogenic abnormalities. J Bone Miner Res. 2012;27(7):1541–52.

    Article  CAS  PubMed  Google Scholar 

  20. Zerwekh JE. The effects of twelve weeks of bed rest on bone histology, biochemical markers of bone turnover, and calcium homeostasis in eleven normal subjects. J Bone Miner Res. 1998;13(10):1594–601.

    Article  CAS  PubMed  Google Scholar 

  21. Rawal J, et al. A pilot study of change in fracture risk in patients with acute respiratory distress syndrome. Crit Care. 2015;19(1):165.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Parker A, Sricharoenchai T, Needham DM. Early rehabilitation in the intensive care unit: preventing physical and mental health impairments. Curr Phys Med Rehabil Rep. 2013;1(4):307–14.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Morris PE, Berry MJ, Files DC, Thompson JC, Hauser J, Flores L, et al. Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure. JAMA. 2016;315(24):2694–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Schweickert W, 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. 2009;373:1874–82.13.

    Article  PubMed  Google Scholar 

  25. McWilliams D, Weblin J, Atkins G, et al. Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: a quality improvement project. J Crit Care. 2015;30(1):13–8.

    Article  PubMed  Google Scholar 

  26. Nydahl P, Sricharoenchai T, Chandra S, Sari Kundt F. HuangM, FischillM, et al. Safety of patient mobilization and rehabilitation in the intensive care unit. Systematic review with meta-analysis. Ann ATS. 2017;14(5):766–77. https://doi.org/10.1513/AnnalsATS.201611-843SR.

    Article  Google Scholar 

  27. National Institute for Health and Care Excellence (NICE). Rehabilitation after critical illness. London: NICE (Nice guideline no. 83); 2009.

    Google Scholar 

  28. Devlin JW, Yoanna S, Gelinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46(9):1532–48.

    Article  PubMed  Google Scholar 

  29. Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther. 2012;23(21):5–13.

    Article  Google Scholar 

  30. Arias-Fernandez P, Romero-Martin M, Gomez-Salgado J, Fernandez-Garcia D. Rehabilitation and early mobilisation in the critical care patient: systematic review. J Phys Ther Sci. 2018;30:1193–201.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hodgson CL, Stiller K, Needham DM, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014;18(6):658.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Parry S, Puthucheary Z. The impact of extended bed rest on the musculoskeletal system in the critical care environment. Extreme Physiol Med. 2015;4:16.

    Article  Google Scholar 

  33. Winkleman C. Bed rest in health and critical illness—a body systems approach. AACN Adv Crit Care. 2009;20(3):254–66.

    Google Scholar 

  34. Bakhru R, McWilliams DJ, Wiebe DJ, Spuhler VJ, Schweickert WD. Intensive care unit structure variation and implications for early mobilization practices: an international survey. Ann Am Thorac Soc. 2016;13(9):1527–37.

    Article  PubMed  PubMed Central  Google Scholar 

  35. McWilliams D, Atkins G, Hodson J, Snelson C. The Sara Combilizer as an early mobilisation aid for critically ill patients: a prospective before and after study. Aust Crit Care. 2017;30(4):189–95.

    Article  PubMed  Google Scholar 

  36. Collings N, Cusack R. A repeated measures, randomized cross-over trial, comparing the acute exercise response between passive and active sitting in critically ill patients. BMC Anesthesiol. 2015;15:1.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Parry SM, Huang M, Needham DM. Evaluating physical functioning in critical care: considerations for clinical practice and research. Crit Care. 2017;21(1):249.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Jolley SE, Bunnell AE, Hough CL. ICU-acquired weakness. Chest. 2016;150(5):1129–40.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Stucki G. International Classification of Functioning, Disability, and Health (ICF): a promising framework and classification for rehabilitation medicine. Am J Phys Med Rehabil. 2005;84(10):733–40.

    Article  PubMed  Google Scholar 

  40. Needham DM, Wozniak AW, Hough CL, Morris PE, Dinglas VD, Jackson JC, et al. Risk factors for physical impairment after acute lung injury in a national, multicenter study. Am J Respir Crit Care Med. 2014;189(10):1214–24.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Parry SM, Nydahl P, Needham DM. Implementing early physical rehabilitation and mobilisation in the ICU: institutional, clinician, and patient considerations. Intensive Care Med. 2018;44(4):470–3.

    Article  PubMed  Google Scholar 

  42. Ruhl AP, Huang M, Colantuoni E, Karmarkar T, Dinglas VD, Hopkins RO, Needham DM. Healthcare utilization and costs in ARDS survivors: a 1-year longitudinal national US multicentre study. Intensive Care Med. 2017;43(7):980–91.

    Article  PubMed  Google Scholar 

  43. Kamdar BB, Sepulveda KA, Chong A, Lord RK, Dinglas VD, Mendez-Tellez PA, et al. Return to work and lost earnings after acute respiratory distress syndrome: a 5-year prospective, longitudinal study of long-term survivors. Thorax. 2018;73(2):125–33.

    Article  PubMed  Google Scholar 

  44. Connolly B, Salisbury L, O’Neill B, Geneen L, Douiri A, Grocott MP, et al. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Database Syst Rev. 2015;(6):CD008632.

    Google Scholar 

  45. Major ME, Kwakman R, Kho ME, Connolly B, McWilliams D, Denehy L, et al. Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge. Crit Care. 2016;20(1):354.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. McWilliams DJ, Benington S, Atkinson D. Outpatient-based physical rehabilitation for survivors of prolonged critical illness: a randomized controlled trial. Physiother Theory Pract. 2016;32(3):179–90.

    Article  PubMed  Google Scholar 

  47. Jones C, Eddleston J, McCairn A, Dowling S, McWilliams D, Coughlan E, Griffiths RD. Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: a randomized controlled trial. J Crit Care. 2015;30(5):901–7.

    Article  CAS  PubMed  Google Scholar 

  48. McDowell K, O'neill B, Blackwood B, Clarke C, Gardner E, Johnston P, et al. Effectiveness of an exercise programme on physical function in patients discharged from hospital following critical illness: a randomised controlled trial (the REVIVE trial). Thorax. 2017;72(7):594–5.

    Article  PubMed  Google Scholar 

  49. Battle C, James K, Temblett P, Hutchings H. Supervised exercise rehabilitation in survivors of critical illness: a randomised controlled trial. J Intens Care Soc. 2019;20(1):18–26.

    Article  Google Scholar 

  50. Ferguson K, Bradley JM, McAuley DF, Blackwood B, O’Neill B. Patients’ perceptions of an exercise program delivered following discharge from hospital after critical illness (the revive trial). J Intensive Care Med. 2017:0885066617724738.

    Google Scholar 

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Authors and Affiliations

  1. Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK

    David McWilliams

  2. Therapies Department, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK

    Owen Gustafson

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  1. David McWilliams
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Correspondence to David McWilliams .

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Editors and Affiliations

  1. Intensive Care Unit, Royal Devon & Exeter NHS Foundation, Exeter, Devon, UK

    Carole Boulanger

  2. Therapy Services, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK

    David McWilliams

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McWilliams, D., Gustafson, O. (2020). Mobility and Function. In: Boulanger, C., McWilliams, D. (eds) Passport to Successful ICU Discharge. Springer, Cham. https://doi.org/10.1007/978-3-030-38916-1_6

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  • DOI: https://doi.org/10.1007/978-3-030-38916-1_6

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-38916-1

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