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Critical Care
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Jaimie Maines, Lauren A. Plante
What is missing from this discussion are the voices of women themselves who have survived a stay in the intensive care unit. Post-intensive care syndrome encompasses ICU-acquired weakness, neuromuscular dysfunction, cognitive impairment, and psychological distress; most survivors will have one or more of these complications, and in some cases, it can persist for years [156]. The long-term outcome of women who have survived maternal critical care remains underreported in the medical literature, though physical and psychiatric sequelae are common among ICU survivors in general. A few qualitative surveys of women's experiences in maternal critical care elucidate several themes; the distance between their expectations about childbirth and the reality they experienced, the pain of being separated from their newborn regardless of how sick they were, and the difficulty of being transferred out of ICU to a maternity ward [157, 158]. Many women were shocked or frightened to wake up in the ICU, slow in understanding why, disturbed or powerless being in the ICU, and unsupported in their specific needs once out of ICU. The aftercare needed for these ICU survivors is another area in desperate need of research.
Inpatient rehabilitation can improve functional outcomes of post-intensive care unit COVID-19 patients—a prospective study
Published in Disability and Rehabilitation, 2023
Margarida Rodrigues, Ana João Costa, Rui Santos, Pedro Diogo, Eugénio Gonçalves, Denise Barroso, Miguel P. Almeida, Inês Machado Vaz, Ana Lima
SARS-CoV-2 can cause asymptomatic, minimally symptomatic, or severe disease [1]. Whereas patients with mild symptoms may have no limitations in daily activities, survivors of critical illness suffer from a severe functional disability as a consequence of the viral illness, prolonged stay in the intensive care unit (ICU), or both [2,3]. It has been proposed that patients still experiencing respiratory or motor problems should continue their rehabilitation programs in specialized rehabilitation units to improve the chances of recovery, while those with minor sequelae may undergo home or outpatient rehabilitation therapy, mainly aimed to restore motor skills and to promote psychological recovery [4]. The longer a patient remains in the ICU, the higher the risk for long-term physical, cognitive and emotional complications and for development of post-intensive care syndrome (PICS) [5]. In fact, a distinctive feature of SARS-CoV-2 infection is that, when necessary, invasive ventilation is required for a considerably longer period than for other ICU patients and ICU length of stay is also longer [5].
Cardiorespiratory and skeletal muscle damage due to COVID-19: making the urgent case for rehabilitation
Published in Expert Review of Respiratory Medicine, 2021
Rebeca Nunes Silva, Cássia Da Luz Goulart, Murilo Rezende Oliveira, Guilherme Yassuyuki Tacao, Guilherme Dionir Back, Richard Severin, Mark A. Faghy, Ross Arena, Audrey Borghi-Silva
As patients with COVID-19 admitted in ICU are often submitted to invasive MV, sedation and neuromuscular blockers, the onset of muscle weakness and dysfunction are of great concern. The longer the patient remains in the ICU (approximately 21 days or more for COVID-19 patients), the greater the risk of developing long-term reductions in physical function, as well as cognitive and emotional complications [101,102]. Prolonged bed rest is the primary driver for a condition known as ICU-acquired muscle weakness (ICU-AW), which is characterized by decreased muscle protein synthesis, loss of muscle mass, decreased force generation, and increased muscle catabolism [103]. Frequently, discharged ICU patients report dyspnea, pain, impaired lung function, and exercise intolerance, in addition to decreased mobility, more frequent falls and quadriparesis [103]. In addition, when patients recover from the infection and are discharged from the ICU, post-intensive care syndrome (PICS) may occur as a result of secondary injuries from the intensive care treatment and the consequences of severe respiratory issues [104,105]. During the previous SARS-CoV outbreak, a review of available literature found lung function 6–8 weeks after discharge demonstrated a mild-moderate restrictive pattern indicative of respiratory muscle weakness in 6–20% of the patients assessed [106]. Additionally, in a prospective cohort study with 97 survivors of SARS, persist reductions in exercise capacity as measured by in 6-minute walk test at 12 months was apparent [107].
Physiotherapy treatment approaches for survivors of critical illness: a proposal from a Delphi study
Published in Physiotherapy Theory and Practice, 2020
Robin C. H. Kwakman, Mel E. Major, Daniela S. Dettling-Ihnenfeldt, Frans Nollet, Raoul H. H. Engelbert, Marike van der Schaaf
Over the last decade, the number of critically ill patients surviving admission to an intensive care unit (ICU) has significantly increased through improvements in medical care (Hermans, De Jonghe, Bruyninckx, and Van Den Berghe, 2014; Stevens et al, 2007). The flipside is that many patients suffer from long-term limitations in physical and mental well-being as part of the post-intensive care syndrome (PICS) after hospital discharge (Needham et al, 2012). These limitations often result in restrictions in participation and return to daily activities such as work, leisure, and sports (Griffiths and Hall, 2009; Herridge et al, 2016, 2011; Jackson and Ely, 2013; Jones, 2012; Wilcox et al, 2013). Physiotherapy during ICU treatment has been recommended to improve physical recovery and an increasing number of practice guidelines to support physiotherapy as early as possible on the ICU have been published (Connolly et al, 2014; Devlin et al, 2018; Gosselink et al, 2008a; Sommers et al, 2015).