Improving access to rehabilitation services for ICU patients
Historically, success in critical care medicine was gauged using patient survival rates, with significant focus placed on early identification and stabilization of the patient's primary diagnosis. Underlying this approach was a long-standing belief that patients could wait to receive physical and occupational therapy until recovery, usually after being discharged from the intensive care unit (ICU). However, although patient survival rates following ICU admission have improved, it's become apparent that many of these patients have profound weakness along with new challenges to their brains and emotional states.
Physical consequences include ICU-acquired weakness that occurs in 25 to 80 percent of patients on mechanical ventilation for more than four days and in 50 to 75 percent of patients with sepsis. Cognitive impairment occurs in 30 to 80 percent of ICU patients and includes problems with memory, processing, planning, problem-solving and visual-spatial awareness. From 10 to 50 percent of ICU patients have symptoms of post-traumatic stress disorder (PTSD), which can persist for eight years. Experts who gathered at a 2010 meeting of the Society of Critical Care Medicine named the combination of difficulties that survivors experience post-intensive care syndrome (PICS).
"I cannot overstate the value of the PM&R group to our critical care practice!" says anesthesiologist and critical care specialist Jeffrey B. Jensen, M.D., medical director of the Thoracic/Vascular Intensive Care Unit at Mayo Clinic Hospital.
The idea that many ICU patients would benefit from rehabilitation services as early as 24 to 48 hours after admission, even while they are very ill, is gaining acceptance. Multiple studies have confirmed that early therapy interventions are both safe and feasible. Early mobility programs have been shown to reduce ICU and hospital lengths of stay and thus decrease the cost of care. Access to rehabilitation services also can help increase strength, improve functional status, and decrease delirium, depression and anxiety. Read more...