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Rehabilitation in ICU

Sami Ridwan, Horst Urbach, Susanne Greschus, Johanna von Hagen, Jonas Esche, Azize Boström
BACKGROUND: Given the young age of onset and the high probability of long-term disability after SAH, the financial impact is expected to be substantial. Primary objective was to highlight subsequent treatment costs after the acute in-hospital stay including rehabilitation and home care in comparison to ischemic stroke. METHODS: The study included 101 patients with aneurysmal SAH treated July 2007 through April 2009. In-hospital expenses were calculated using the German Diagnose Related Groups DRG...
October 12, 2016: World Neurosurgery
Janet F Jensen, Ingrid Egerod, Morten H Bestle, Doris F Christensen, Ask Elklit, Randi L Hansen, Heidi Knudsen, Louise B Grode, Dorthe Overgaard
PURPOSE: The aim of this randomized controlled trial (RCT) was to test the effectiveness of a post-ICU recovery program compared to standard care during the first year after ICU discharge. METHODS: A pragmatic, non-blinded, multicenter, parallel-group RCT was conducted between December 2012 and December 2015, at ten intensive care units (ICUs) in Denmark. We randomly assigned 386 adult patients (≥18 years) after receiving mechanical ventilation (≥48 h) to standard care (SC) plus a nurse-led intensive care recovery program or standard care alone after ICU discharge (190 intervention, 196 SC)...
September 30, 2016: Intensive Care Medicine
Tiphaine Bourseau, Flavie Fremondière, Valérie Dubus, Bénédicte Gohier, Dewi Le Gal, Fabien Cave, Isabelle Richard, Nicolas Lerolle
OBJECTIVE: After critical illness, some survivors experience long-term physical, functional, neurocognitive and/or mental health impairments, which has been termed "Post-Intensive Care syndrome" (PICS) [1]. A specific follow-up is required and many specialized follow-up clinics have been created both abroad and in France. The aim of this study is to evaluate long-term outcomes after critical illness, through the International Classification of Functioning, Disability and Health, and to analyse rehabilitation needs after intensive care unit (ICU) discharge...
September 2016: Annals of Physical and Rehabilitation Medicine
Soumaya Boudokhane, Amine Kalai, Aymen Haj Salah, Houda Migaou, Sana Salah, Anis Jellad, Mourad Gahbiche, Zohra Ben Salah Frih
OBJECTIVE: The aim of our study was to determine the demographic characteristics and the pathway of severe traumatic brain injury (STBI) victims in the Tunisian population. MATERIAL/PATIENTS AND METHODS: Our study included 26 patients victims of STBI hospitalized in intensive care unit, among 450 traumatic head injuries admitted to the Teaching Hospital of Fattouma Bourguiba in Monastir during the year 2014. The studied parameters were: demographic characteristics of the population, circumstances of the accident, transport modalities to the hospital, assessments of the injury types, duration of coma, length of hospitalization in the Intensive Care Unit (ICU) and finally the discharge mode after the ICU stay (transfer to neurosurgery ward, to rehabilitation unit, or home discharged)...
September 2016: Annals of Physical and Rehabilitation Medicine
Simone Thomas, Wolfgang Sauter, Ulrike Starrost, Marcus Pohl, Jan Mehrholz
BACKGROUND: Treatment of critical illness on intensive-care-units (ICU) results often in persistent invasive endotracheal intubation which might delay rehabilitation and increases the risk of mortality. Recent longitudinal studies have described the recovery of critically ill people, but the detailed time course of decannulation in patients with chronic critical illness with ICU- acquired muscle weakness (ICUAW) is not well known. AIM: The aim of our study was therefore to describe the decannulation times and associated risk factors in patients who are chronic critically ill with ICU acquired weakness...
September 27, 2016: European Journal of Physical and Rehabilitation Medicine
Simone Thomas, Jane H Burridge, Marcus Pohl, Frank Oehmichen, Jan Mehrholz
OBJECTIVES: To describe the time course of recovery of sit-to-stand function in patients with intensive-care-unit-acquired muscle weakness and the impact of recovery. METHODS: A cohort study in post-acute intensive care unit and rehabilitation units. Patients with chronic critical illness and intensive-care-unit-acquired muscle weakness were included. Sit-to-stand function was measured daily, using a standardized chair height, defined as 120% of the individual's knee height...
October 12, 2016: Journal of Rehabilitation Medicine
Janneke G J Hoeijmakers, Catharina G Faber, Carien J Miedema, Ingemar S J Merkies, Johan S H Vles
Small fiber neuropathy (SFN) is a debilitating condition that often leads to pain and autonomic dysfunction. In the last few decades, SFN has been gaining more attention, particularly in adults. However, literature about SFN in children remains limited. The present article reports the cases of 2 adolescent girls diagnosed with SFN. The first patient (14 years of age) complained about painful itch and tingling in her legs, as well as dysautonomia symptoms for years. She also reported a red/purple-type discoloration of her legs aggravated by warmth and standing, compatible with erythromelalgia...
September 22, 2016: Pediatrics
P Nydahl, R Dubb, S Filipovic, C Hermes, F Jüttner, A Kaltwasser, S Klarmann, H Mende, S Nessizius, C Rottensteiner
Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters...
September 6, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Domenico Intiso, Andrea Fontana, Giuseppe Maruzzi, Maurizio Tolfa, Massimiliano Copetti, Filomena Di Rienzo
BACKGROUND: Medical and surgical complications are common after brain lesions and may require acute care unit readmission (ACUR) during the rehabilitation stay. This clinical phenomenon has not been explored in subjects with severe brain injury (sBI). AIM: Because sBI patients come from the intensive care unit (ICU), patients may be transferred to rehabilitation before complete clinical stabilization. We investigated ACUR and causes as well as whether those who required ACUR had different functional outcomes...
September 1, 2016: European Journal of Physical and Rehabilitation Medicine
Maryse C Cnossen, Suzanne Polinder, Hester F Lingsma, Andrew I R Maas, David Menon, Ewout W Steyerberg
INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study...
2016: PloS One
M McCullough, M Burg, E Lin, D Peng, W Garner
INTRODUCTION: The diffuse epidermal exfoliation seen in Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) is similar to skin loss in second degree burns, and many of these patients are referred for treatment at burn centers. Treatment can differ markedly from center to center, and mortality can range from 25% to 70%, including a considerable morbidity. However, our experience over a 15-year period from 2000 to 2015 with 40 patients found a mortality rate of only 10% (4/40)...
August 20, 2016: Burns: Journal of the International Society for Burn Injuries
Joanne McPeake, Tara Quasim
No abstract text is available yet for this article.
December 2016: Intensive & Critical Care Nursing: the Official Journal of the British Association of Critical Care Nurses
Irene Dot, Purificación Pérez-Teran, Manuel-Andrés Samper, Joan-Ramon Masclans
Muscle involvement is found in most critical patients admitted to the intensive care unit (ICU). Diaphragmatic muscle alteration, initially included in this category, has been differentiated in recent years, and a specific type of muscular dysfunction has been shown to occur in patients undergoing mechanical ventilation. We found this muscle dysfunction to appear in this subgroup of patients shortly after the start of mechanical ventilation, observing it to be mainly associated with certain control modes, and also with sepsis and/or multi-organ failure...
August 20, 2016: Archivos de Bronconeumología
Konstantinos Karatolios, Georgios Chatzis, Birgit Markus, Ulrich Luesebrink, Anette Richter, Bernhard Schieffer
BACKGROUND: Cardiogenic shock remains a clinical challenge with high mortality rate. Mechanical circulatory support (MCS) devices have become an integral component of the therapeutic armamentarium expanding the treatment options for refractory cardiogenic shock (RCS). METHODS: We included all consecutive patients with biventricular unloading with Impella-2.5 and VA-ECMO admitted for RCS between October 2013 and March 2015. Outcome data included survival to discharge, bridging to VAD and 28-day mortality...
November 1, 2016: International Journal of Cardiology
Kathleen Ann Puntillo, Ramana Naidu
PURPOSE OF REVIEW: Is to describe the potential for patients to undergo an acute-to-chronic pain transition after ICU discharge as a result of pain they experienced in ICU and to explore the phenomenon of ICU-acquired opioid dependence. Both topics are timely, in that they can negatively influence patient recovery after critical illness and contribute to post-ICU syndrome. RECENT FINDINGS: Recognizing and treating pain in patients while they are in the ICU has always been important...
October 2016: Current Opinion in Critical Care
Guosheng Gu, Jianan Ren
Over the past decades, the evolution of the techniques used in the intensive care has led on one side to better survival rates in ICU patients. On the other side, it has resulted in a growing number of patients who survive an acute event to chronic condition, and who then become dependent on one or more life support treatments. Such patients are called chronic critical illness(CCI) patients. Even these patients can dismiss from intensive care unit (ICU) or transfer to specialized rehabilitation care settings, the mortality of these patients is still very high...
July 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Ufuk Kuyrukluyildiz, Orhan Binici, İlke Kupeli, Nurel Erturk, Barış Gulhan, Fethi Akyol, Adalet Ozcicek, Didem Onk, Guldane Karabakan
Objective. Effects of high frequency chest wall oscillation technique were investigated on intubated ICU patients. Background. Thirty intubated patients were included in the study. The control group (n = 15) received routine pulmonary rehabilitation technique. In addition to the pulmonary rehabilitation technique, the study group (n = 15) was given high frequency chest wall oscillation (HFCWO). APACHE II, dry sputum weight, lung collapse index, and blood gas values were measured at 24th, 48th, and 72nd hours and endotracheal aspirate culture was studied at initial and 72nd hour...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
Gloria-Beatrice Wintermann, Kerstin Weidner, Bernhard Strauß, Jenny Rosendahl, Katja Petrowski
BACKGROUND: Prolonged mechanical ventilation for acute medical conditions increases the risk of chronic critical illness (CCI). Close family members are confronted with the life-threatening condition of the CCI patients and are prone to develop posttraumatic stress disorder affecting their health-related quality of life (HRQL). Main aim of the present study was to investigate patient- and family-related risk factors for posttraumatic stress and decreased HRQL in family members of CCI patients...
December 2016: Annals of Intensive Care
C S Bruells, J Bickenbach, G Marx
Weaning from mechanical ventilation is generally not the most urgent topic on many ICUs, because acutely endangered patients are usually the staff's main focus. Nevertheless, even these patients whose underlying problem has been mostly solved-whether it was neurologic, internal or surgical-are in need of a structured weaning strategy. The aim of this weaning "road map" is ventilator independence, decannulation and regaining of muscular strength. Achieving of these aims needs a well-educated team of physicians, nurses, respiratory/physical therapists, logopedists and pychologists...
July 13, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Anup Bhat, Kalyana Chakravarthy, Bhamini K Rao
CONTEXT: The rehabilitation needs of the patients in neurological Intensive Care Units (ICUs) vary from that of a medical ICU patient. Early mobilization is known to improve the various neurological outcomes in patients admitted to neurological ICUs, although little is known about the practice pattern among physiotherapists. The mobilization practice pattern may vary significantly than that of developed countries due to the reasons of differences in training of professionals, availability of equipment, and financial assistance by health insurance...
June 2016: Indian Journal of Critical Care Medicine
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