Pulmonary and Physical Rehabilitation in Critically Ill Patients

다국어 초록 (Multilingual Abstract)

Some patients admitted to the intensive care unit (ICU) because of an acute illness, complicated surgery, or multiple traumas develop muscle weakness affecting the limbs and respiratory muscles during acute care in the ICU. This condition is referred to as ICU-acquired weakness (ICUAW), and can be evoked by critical illness polyneuropathy (CIP), critical illness myopathy (CIM), or critical illness polyneuromyopathy (CIPNM). ICUAW is diagnosed using the Medical Research Council (MRC) sum score based on bedside manual muscle testing in cooperative patients. The MRC sum score is the sum of the strengths of the 12 regions on both sides of the upper and lower limbs. ICUAW is diagnosed when the MRC score is less than 48 points. However, some patients require electrodiagnostic studies, such as a nerve conduction study, electromyography, and direct muscle stimulation, to differentiate between CIP and CIM. Pulmonary rehabilitation in the ICU can be divided into modalities intended to remove retained airway secretions and exercise therapies intended to improve respiratory function. Physical rehabilitation, including early mobilization, positioning, and limb exercises, attenuates the weakness that occurs during critical care. To perform mobilization in mechanically ventilated patients, pretreatment by removing secretions is necessary. It is also important to increase the strength of respiratory muscles and to perform lung recruitment to improve mobilization in patients who are weaned from the ventilator. For these reasons, pulmonary rehabilitation is important in addition to physical therapy. Early recognition of CIP, CIM, and CIPNM and early rehabilitation in the ICU might improve patients’ functional recovery and outcomes.

참고문헌 (Reference)

1 Cumming TB, "Very early mobilization after stroke fast-tracks return to walking : further results from the phase II AVERT randomized controlled trial" 42 : 153-158, 2011

2 Latronico N, "Validation of the peroneal nerve test to diagnose critical illness polyneuropathy and myopathy in the intensive care unit : the multicenter Italian CRIMYNE-2 diagnostic accuracy study" 3 : 127-, 2014

3 AARC clinical practice guideline, "Use of positive airway pressure adjuncts to bronchial hygiene therapy : American Association for Respiratory Care" 38 : 516-521, 1993

4 Parry SM, "Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function" 30 : 1151-, 2015

5 Vanpee G, "The interobserver agreement of handheld dynamometry for muscle strength assessment in critically ill patients" 39 : 1929-1934, 2011

6 Bourdin G, "The feasibility of early physical activity in intensive care unit patients : a prospective observational one-center study" 55 : 400-407, 2010

7 Tipping CJ, "The effects of active mobilisation and rehabilitation in ICU on mortality and function : a systematic review" 43 : 171-183, 2017

8 Meynaerts A, "The effectiveness of incentive spirometry in hospitalised patients with blunt thoracic trauma" 50 : 139-, 1999

9 Chang AT, "Standing with assistance of a tilt table in intensive care : a survey of Australian physiotherapy practice" 50 : 51-54, 2004

10 Looijaard WG, "Skeletal muscle quality as assessed by CT-derived skeletal muscle density is associated with 6-month mortality in mechanically ventilated critically ill patients" 20 : 386-, 2016

11 Gerovasili V, "Short-term systemic effect of electrical muscle stimulation in critically ill patients" 136 : 1249-1256, 2009

12 Moss M, "Screening for critical illness polyneuromyopathy with single nerve conduction studies" 40 : 683-690, 2014

13 Wallace JD, "Sarcopenia as a predictor of mortality in elderly blunt trauma patients : comparing the masseter to the psoas using computed tomography" 82 : 65-72, 2017

14 Nydahl P, "Safety of patient mobilization and rehabilitation in the intensive care unit : systematic review with metaanalysis" 14 : 766-777, 2017

15 Damluji A, "Safety and feasibility of femoral catheters during physical rehabilitation in the intensive care unit" 28 : 535-, 2013

16 Paneroni M, "Safety and efficacy of short-term intrapulmonary percussive ventilation in patients with bronchiectasis" 56 : 984-988, 2011

17 Shepherd S, "Review of critical illness myopathy and neuropathy" 7 : 41-48, 2017

18 Pathmanathan N, "Respiratory physiotherapy in the critical care unit" 15 : 20-25, 2015

19 Bartlett RH, "Respiratory maneuvers to prevent postoperative pulmonary complications : a critical review" 224 : 1017-1021, 1973

20 Ambrosino N, "Rehabilitation, weaning and physical therapy strategies in chronic critically ill patients" 39 : 487-492, 2012

21 Fuest K, "Recent evidence on early mobilization in critical-Ill patients" 31 : 144-150, 2018

22 Levine S, "Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans" 358 : 1327-1335, 2008

23 Sommers J, "Physiotherapy in the intensive care unit : an evidence-based, expert driven, practical statement and rehabilitation recommendations" 29 : 1051-1063, 2015

24 Gosselink R, "Physiotherapy in the Intensive Care Unit" 15 : 66-75, 2011

25 Gosselink R, "Physiotherapy for adult patients with critical illness : recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on physiotherapy for critically ill patients" 34 : 1188-1199, 2008

26 Engels PT, "Physical rehabilitation of the critically ill trauma patient in the ICU" 41 : 1790-1801, 2013

27 De Jonghe B, "Paresis acquired in the intensive care unit : a prospective multicenter study" 288 : 2859-2867, 2002

28 Gruther W, "Muscle wasting in intensive care patients:ultrasound observation of the M. quadriceps femoris muscle layer" 40 : 185-189, 2008

29 Homnick DN, "Mechanical insufflation-exsufflation for airway mucus clearance" 52 : 1296-1305, 2007

30 Looijaard WG, "Measuring and monitoring lean body mass in critical illness" 24 : 241-247, 2018

31 Tzanis G, "Maximum inspiratory pressure, a surrogate parameter for the assessment of ICU-acquired weakness" 11 : 14-, 2011

32 McCarren B, "Manual vibration increases expiratory flow rate via increased intrapleural pressure in healthy adults : an experimental study" 52 : 267-271, 2006

33 Hermans G, "Interventions for preventing critical illness polyneuropathy and critical illness myopathy" (1) : CD006832-, 2009

34 Moodie LH, "Inspiratory muscle training to facilitate weaning from mechanical ventilation : protocol for a systematic review" 4 : 283-, 2011

35 Bernie Bissett, "Inspiratory muscle training for intensive care patients: A multidisciplinary practical guide for clinicians" Elsevier BV 32 (32): 249-255, 2019

36 Vorona S, "Inspiratory muscle rehabilitation in critically ill adults : a systematic review and meta-analysis" 15 : 735-744, 2018

37 Hermans G, "Impact of intensive insulin therapy on neuromuscular complications and ventilator dependency in the medical intensive care unit" 175 : 480-489, 2007

38 Patel BK, "Impact of early mobilization on glycemic control and ICU-acquired weakness in critically ill patients who are mechanically ventilated" 146 : 583-589, 2014

39 Bach JR, "Extubation of patients with neuromuscular weakness : a new management paradigm" 137 : 1033-1039, 2010

40 Kuchnia A, "Evaluation of bioelectrical impedance analysis in critically ill patients : results of a multicenter prospective study" 41 : 1131-1138, 2017

41 Edwards J, "Electrical muscle stimulation in the intensive care unit : an integrative review" 15 : 142-149, 2014

42 Brimioulle S, "Effects of positioning and exercise on intracranial pressure in a neurosurgical intensive care unit" 77 : 1682-1689, 1997

43 Chiang LL, "Effects of physical training on functional status in patients with prolonged mechanical ventilation" 86 : 1271-1281, 2006

44 Mezidi M, "Effects of patient positioning on respiratory mechanics in mechanically ventilated ICU patients" 6 : 384-, 2018

45 Gonçalves MR, "Effects of mechanical insufflation-exsufflation in preventing respiratory failure after extubation : a randomized controlled trial" 16 : R48-, 2012

46 Griffiths RD, "Effect of passive stretching on the wasting of muscle in the critically ill" 11 : 428-432, 1995

47 Fossat G, "Effect of in-bed leg cycling and electrical stimulation of the quadriceps on global muscle strength in critically ill adults : a randomized clinical trial" 320 : 368-378, 2018

48 Schaller SJ, "Early, goal-directed mobilisation in the surgical intensive care unit : a randomised controlled trial" 388 : 1377-1388, 2016

49 Mendez-Tellez PA, "Early physical rehabilitation in the ICU and ventilator liberation" 57 : 1663-1669, 2012

50 Mendez-Tellez PA, "Early physical rehabilitation in the ICU : a review for the neurohospitalist" 2 : 96-105, 2012

51 Lai CC, "Early mobilization reduces duration of mechanical ventilation and intensive care unit stay in patients with acute respiratory failure" 98 : 931-939, 2017

52 Abrams D, "Early mobilization of patients receiving extracorporeal membrane oxygenation : a retrospective cohort study" 18 : R38-, 2014

53 Hashem MD, "Early mobilization and rehabilitation of patients who are critically ill" 150 : 722-731, 2016

54 Morris PE, "Early intensive care unit mobility therapy in the treatment of acute respiratory failure" 36 : 2238-2243, 2008

55 Burtin C, "Early exercise in critically ill patients enhances short-term functional recovery" 37 : 2499-2505, 2009

56 Butts CA, "Do simple beside lung function tests predict morbidity after rib fractures?" 213 : 473-477, 2017

57 Witteveen E, "Diagnostic accuracy of quantitative neuromuscular ultrasound for the diagnosis of intensive care unitacquired weakness : a cross-sectional observational study" 7 : 40-, 2017

58 Shibahashi K, "Decreasing skeletal muscle as a risk factor for mortality in elderly patients with sepsis : a retrospective cohort study" 5 : 8-, 2017

59 Hristara-Papadopoulou A, "Current devices of respiratory physiotherapy" 12 : 211-220, 2008

60 Linos K, "Critical illness weakness : common questions" 18 : 252-260, 2007

61 Latronico N, "Critical illness polyneuropathy and myopathy : a major cause of muscle weakness and paralysis" 10 : 931-941, 2011

62 Latronico N, "Critical illness polyneuropathy and myopathy 20years later. No man’s land? No, it is our land!" 42 : 1790-1793, 2016

63 Schieren M, "Continuous lateral rotational therapy in trauma : a systematic review and meta-analysis" 83 : 926-933, 2017

64 Hermans G, "Clinical review : intensive care unit acquired weakness" 19 : 274-, 2015

65 Devlin JW, "Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU" 46 : e825-e873, 2018

66 Wang TH, "Chest physiotherapy with early mobilization may improve extubation outcome in critically ill patients in the intensive care units" 12 : 2613-2621, 2018

67 Gillespie DJ, "Body position and ventilation-perfusion relationships in unilateral pulmonary disease" 91 : 75-79, 1987

68 Paris M, "Assessment of skeletal muscle mass in critically ill patients : considerations for the utility of computed tomography imaging and ultrasonography" 19 : 125-130, 2016

69 Vanpee G, "Assessment of limb muscle strength in critically ill patients : a systematic review" 42 : 701-711, 2014

70 Grammatopoulou E, "Active cycle of breathing techniques contributes to pain reduction in patients with rib fractures" 82 : 52-58, 2010

71 Nyland BA, "A preventative respiratory protocol to identify trauma subjects at risk for respiratory compromise on a general in-patient ward" 61 : 1580-1587, 2016