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Promoting physical recovery in critical illness 

Promoting physical recovery in critical illness
Chapter:
Promoting physical recovery in critical illness
Author(s):

Gregory A. Schmidt

and Kevin Doerschug

DOI:
10.1093/med/9780199600830.003.0378
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date: 29 November 2020

Survivors of critical illnesses are often faced with persistent neuromuscular weakness that interferes with daily activities. Advancements in survival from critical illness have led to a rise in the number of patients afflicted with post-intensive care unit (ICU) incapacity. It is clear that the pathology leading to ICU-acquired weakness is present within 24 hours of the start of ICU care. Care-givers must consider interventions to limit or reverse these processes from the onset of critical illness. We suggest strategies both for avoiding harms and for actively promoting recovery of skeletal and respiratory muscles. Muscular silence contributes to, while muscular activity alleviates, myopathy. Thus, limiting sedation and neuromuscular blockade will facilitate spontaneous muscle activity, and allow for active participation in physical therapy. Protocols that aggressively assess for the potential for extubation shorten the duration of ventilation and thus decrease exposure to sedation. Mobility teams should safely guide patients in their progress from a passive range of motion through more active therapies despite ongoing critical illness. Early ICU mobility is not only safe, but reduces the incidence of delirium and duration of mechanical ventilation. Importantly, early ICU mobility increases the likelihood of a return to independent function among ICU survivors. A change in culture from one that practices deep sedation and protective support is suggested, to one that demonstrates an urgency to liberate patients from the confines and perils of critical illness.

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