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Rehabilitation from critical illness after hospital discharge 

Rehabilitation from critical illness after hospital discharge
Chapter:
Rehabilitation from critical illness after hospital discharge
Author(s):

Laura Vincent

and Carl Waldmann

DOI:
10.1093/med/9780199600830.003.0386
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date: 23 February 2020

The majority of patients admitted to intensive care units survive to hospital discharge, but then face a long and challenging functional recovery, due to the physical and psychological sequelae of their critical illness. There is associated physical, emotional, and financial strain on families and care-givers, in addition to the ongoing impact on patients themselves. The optimization of post-ICU morbidity and ‘health-related quality of life’ have thus become key components of the critical care treatment pathway. Structured exercise rehabilitation programmes, tailored to the specific needs of individual patients can enhance the long-term recovery from critical illness, but the practical implementation of such programmes remains inconsistent and non-standardized. Validated screening and assessment tools are being developed to identify those patients who would benefit from post-ICU rehabilitation programmes, target the specific needs of individuals and monitor the response to treatment. Ongoing research aims to determine the features of a successful post-ICU rehabilitation programme, with respect to the location and supervision of the regime, and the actual content of the intervention. Rehabilitation commenced as soon as possible after hospital discharge is likely to be most effective, but further evidence is required to identify the timing of treatment that would achieve the optimal therapeutic impact. The National Institute of Clinical Excellence have issued a post-ICU rehabilitation guideline. As well as providing a framework for implementation of such a programme, this further endorses the understanding that exercise rehabilitation can no longer be considered an afterthought and should be fully incorporated into the critical care treatment pathway.

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