Guideline on multimodal rehabilitation for patients with post-intensive care syndrome

Background Intensive Care Unit (ICU) survivors often experience several impairments in their physical, cognitive, and psychological health status, which are labeled as post-intensive care syndrome (PICS). The aim of this work is to develop a multidisciplinary and -professional guideline for the reha...

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Veröffentlicht in:Critical care (London, England) Jg. 27; H. 1; S. 301 - 14
Hauptverfasser: Renner, Caroline, Jeitziner, Marie-Madlen, Albert, Monika, Brinkmann, Sabine, Diserens, Karin, Dzialowski, Imanuel, Heidler, Maria-Dorothea, Lück, Martina, Nusser-Müller-Busch, Ricki, Sandor, Peter S., Schäfer, Andreas, Scheffler, Bettina, Wallesch, Claus, Zimmermann, Gudrun, Nydahl, Peter
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 31.07.2023
BioMed Central Ltd
Springer Nature B.V
BMC
Schlagworte:
Anxiety
Critical care
Critical Care - psychology
Critical Care Medicine
Critical Illness - psychology
Delirium
Emergency Medicine
Evidence-based medicine
Guideline
Guidelines
Health aspects
Health Status
Humans
Illnesses
Intensive
Intensive care
Intensive Care Units
Medical personnel
Medicine
Medicine & Public Health
Mental depression
Patient outcomes
Patients
Physical therapy
Physiological aspects
PICS
Post traumatic stress disorder
Post-intensive care syndrome
Professionals
Psychological aspects
Psychotherapy
Quality of life
Rehabilitation
Respiratory distress syndrome
Society
Task forces
Therapeutics, Physiological
Working groups
Germany
Intensive care
Psychological therapy
Critical care
Post-intensive care syndrome
Rehabilitation
PICS
Physical therapy
Guidelines
ISSN:1364-8535, 1466-609X, 1364-8535, 1466-609X, 1366-609X
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Zusammenfassung:Background Intensive Care Unit (ICU) survivors often experience several impairments in their physical, cognitive, and psychological health status, which are labeled as post-intensive care syndrome (PICS). The aim of this work is to develop a multidisciplinary and -professional guideline for the rehabilitative therapy of PICS. Methods A multidisciplinary/-professional task force of 15 healthcare professionals applied a structured, evidence-based approach to address 10 scientific questions. For each PICO-question (Population, Intervention, Comparison, and Outcome), best available evidence was identified. Recommendations were rated as “strong recommendation”, “recommendation” or “therapy option”, based on Grading of Recommendations, Assessment, Development and Evaluation principles. In addition, evidence gaps were identified. Results The evidence resulted in 12 recommendations, 4 therapy options, and one statement for the prevention or treatment of PICS. Recommendations: early mobilization, motor training, and nutrition/dysphagia management should be performed. Delirium prophylaxis focuses on behavioral interventions. ICU diaries can prevent/treat psychological health issues like anxiety and post-traumatic stress disorders. Early rehabilitation approaches as well as long-term access to specialized rehabilitation centers are recommended. Therapy options include additional physical rehabilitation interventions. Statement: A prerequisite for the treatment of PICS are the regular and repeated assessments of the physical, cognitive and psychological health in patients at risk for or having PICS. Conclusions PICS is a variable and complex syndrome that requires an individual multidisciplinary, and multiprofessional approach. Rehabilitation of PICS should include an assessment and therapy of motor-, cognitive-, and psychological health impairments. Key points It is important to assess physical, cognitive, and psychological health functions of critically ill patients at risk for developing post-intensive care syndrome (PICS) during their stay in the ICU, their acute and rehabilitative inpatient and outpatient care. Physical health and motor function can improve through early mobilization, physical therapy, additional ergometer training (cycling) and neuromuscular stimulation. Before initiating oral nutrition, a standardized swallowing test should rule out risks of dysphagia and aspiration. Psychological health can improve through integrating relatives into care, keeping ICU diaries, and psychological care. Cognitive health can improve with prevention of delirium, early multimodal treatment of delirium, and/or attention training. Health care professionals must be sensitized and trained to recognize PICS.
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ISSN:1364-8535
1466-609X
1364-8535
1466-609X
1366-609X
DOI:10.1186/s13054-023-04569-5