Réhabilitation précoce en réanimation. C’est possible

Early rehabilitation in ICU is possible

Résumé

La réhabilitation en réanimation comprend un ensemble de techniques et de procédés dont le but est de s’opposer aux effets délétères de l’immobilisation prolongée au lit et de l’inactivité. Les méthodes qui sont abordées dans cette revue sont : mobilisation active et passive des membres supérieurs et des membres inférieurs, exercices actifs au lit avec ou sans l’aide d’un soignant comme l’utilisation d’un pédalier, standing et verticalisation, transfert du lit au fauteuil avec maintien au fauteuil au moins 20 minutes deux fois par jour, marche avec ou sans un cadre de marche, en ventilation mécanique. Le caractère précoce est très important car il souligne la volonté de mettre en œuvre ces techniques alors que le patient est encore assisté notamment par la ventilation mécanique. L’objectif de cet article est de montrer que cette stratégie est possible et bénéfique aux malades.

Abstract

Rehabilitation in the intensive care unit includes all the techniques aiming to prevent deleterious the effects of prolonged immobilisation. Different methods are presented in this review: active and passive mobilisation of upper and lower limbs, active bed excercices with or without a caregiver such as cycling, standing-up, bed to chair transfer with periods of 20-minute sitting in the chair per day, walking with or without help while the patient is still mechanically ventilated. Early mobilisation is very important and should be started while the patients is still mechanically ventilated. The aim of this article is to show that such a strategy is feasible and beneficial for the patient.

References

  1. 1.

    Topp R, Ditmyer M, King K, et al (2002) The effect of bed rest and potential of prehabilitation on patients in the intensive care unit. AACN Clin Issues 13:263–76

    Article  PubMed  Google Scholar 

  2. 2.

    De Jonghe B, Lacherade JC, Durand MC, Sharshar T (2007) Critical illness neuromuscular syndromes. Crit Care Clin 23:55–69

    Article  PubMed  Google Scholar 

  3. 3.

    Curtis JR (2002) The long-term outcomes of mechanical ventilation: what are they and how should they be used? Respir Care 47:496–505

    PubMed  Google Scholar 

  4. 4.

    Orme J Jr, Romney JS, Hopkins RO, et al (2003) Pulmonary function and health-related quality of life in survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 167:690–4

    Article  PubMed  Google Scholar 

  5. 5.

    Herridge MS, Cheung AM, Tansey CM, et al (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 348:683–93

    Article  PubMed  Google Scholar 

  6. 6.

    Bloomfield SA (1997) Changes in musculoskeletal structure and function with prolonged bed rest. Med Sci Sports Exerc 29:197–206

    Article  CAS  PubMed  Google Scholar 

  7. 7.

    Griffiths RD, Jones C (1999) Recovery from intensive care. BMJ 319:427–9

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. 8.

    Morris PE (2007) Moving our critically ill patients: mobility barriers and benefits. Crit Care Clin 23:1–20

    Article  PubMed  Google Scholar 

  9. 9.

    Needham DM (2008) Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA 300:1685–90

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Roeseler J, Sottiaux T, Lemiale V, et al (2013) Prise en charge de la mobilisation précoce en réanimation, chez l’adulte et l’enfant (électrostimulation incluse) Réanimation 22:207–18

    Article  Google Scholar 

  11. 11.

    Staudinger T, Kofler J, Mullner M, et al (2001) Comparison of prone positioning and continuous rotation of patients with adult respiratory distress syndrome: results of a pilot study. Crit Care Med 29:51–6

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Richard JC, Maggiore SM, Mancebo J, et al (2006) Effects of vertical positioning on gas exchange and lung volumes in acute respiratory distress syndrome. Intensive Care Med 32:1623–6

    Article  PubMed  Google Scholar 

  13. 13.

    Morris PE, Goad A, Thompson C, et al (2008) Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 36:2238–43

    Article  PubMed  Google Scholar 

  14. 14.

    Thomsen GE, Snow GL, Rodriguez L, Hopkins RO (2008) Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med 36:1119–24

    Article  PubMed  Google Scholar 

  15. 15.

    Kress JP, Pohlman AS, O’Connor MF, Hall JB (2000) Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation. N Engl J Med 342:1471–7

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Schweickert WD, Pohlman MC, Pohlman AS, et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–82

    Article  PubMed  Google Scholar 

  17. 17.

    Bailey P, Thomsen GE, Spuhler VJ, et al (2007) Early activity is feasible and safe in respiratory failure patients. Crit Care Med 35:139–45

    Article  PubMed  Google Scholar 

  18. 18.

    Bourdin G, Barbier J, Burle JF, et al (2010) The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care 55:400–7

    PubMed  Google Scholar 

  19. 19.

    Nydahl P, Ruhl AP, Bartoszek G, et al (2014) Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med 42:1178–86

    Article  PubMed  Google Scholar 

  20. 20.

    Berney SC, Harrold M, Webb SA, et al (2013) Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc 15:260–5

    PubMed  Google Scholar 

  21. 21.

    Needham DM, Korupolu R, Zanni JM, et al (2010) Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil 91:536–42

    Article  PubMed  Google Scholar 

  22. 22.

    Engel HJ, Needham DM, Morris PE, Gropper MA (2013) ICU early mobilization: from recommendation to implementation at three medical centers. Crit Care Med 41:S69–80

    Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to C. Guérin.

Additional information

Cet article correspond à la conférence faite par l’auteur au congrès de la SRLF 2015 dans la session : Dysfonction neuromusculaire acquise en réanimation.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Guérin, C., Burle, J.-. Réhabilitation précoce en réanimation. C’est possible. Réanimation 24, 371–378 (2015). https://doi.org/10.1007/s13546-014-1005-7

Download citation

Mots clés

  • Réhabilitation
  • Kinésithérapie
  • Lever précoce
  • Immobilisation
  • Réanimation
  • Sevrage

Keywords

  • Rehabilitation
  • Physiotherapy
  • Immobilisation
  • ICU
  • Weaning