All That Work and No Gain: What Should We Do to Restore Physical Function in Our Survivors?

摘要

Excellent mechanistic studies have demonstrated how early and intense muscle injury occurs in patients in the intensive care unit (ICU). Muscle mass diminishes within 24 hours, and patients may lose 10% or more within the first week of illness. ICU-acquired weakness can be measured in more than 50% of patients ventilated for longer than 48 hours, and this weakness is associated with increased mortality. In the face of this, there is strong pressure to do something to ameliorate this complication of ICU care, and it feels as if it is something we ought to be able to fix. Interventional and observational trials have proven that "physical therapy" in the ICU is safe and feasible, particularly emphasizing exercise during endotracheal intubation. A recent meta-analysis concluded that early rehabilitation can lead to more patients walking without assistance at hospital discharge. However, not all trials have proven benefit, including prior randomized controlled trials on ICU-based rehabilitation; in-hospital, post-ICU rehabilitation; and outpatient interventions. Substantial uncertainty remains as to exactly when and how to provide this treatment to patients in the ICU.