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The ICU Liberation Bundle (A-F) can help rehabilitation practitioners and respiratory care practitioners (RCPs) assess the broad, long-term goals of patients while zooming in on the immediate steps needed to achieve short-term goals. Physical therapists (PTs), occupational therapists (OTs), speech language pathologists (SLPs), and RCPs all have a role in using the ICU Liberation Bundle when caring for patients in the intensive care unit (ICU).
A stay in the ICU can be a traumatizing experience for patients and families. The vulnerability and dependence patients experience when tethered to life-sustaining equipment in the disorienting ICU environment disconnects them from their known identity. Patients can have weakness, reduced aerobic capacity, pain, fatigue, and disorganized thinking within days of an ICU admission. This new debilitated reality can linger for years after the patient leaves the ICU,1 sometimes in the form of post-intensive care syndrome (PICS). The mission of rehabilitation practitioners and RCPs for any patient is to optimize strength, cognitive capability, and autonomy. The end goal is functional independence. Clinical researchers, patients, and families can have different perspectives when it comes to outcomes goals.
A 2018 study of survivors of acute respiratory distress syndrome (ARDS), their family members, and clinical researchers found that patients and families rated cognitive, pulmonary, and physical functions the most important outcomes for researchers to measure.2
Clinical researchers, on the other hand, rated survival as the top priority to measure. ARDS survivors rated survival as the lowest priority.3 No doubt disease elimination and survival are crucial focuses for clinicians. But addressing our patients’ goals in a comprehensive way requires the full coordination of rehabilitative efforts early and consistently.
The Society of Critical Care Medicine and the American Thoracic Society both recommend early mobilization for ICU patients to reduce iatrogenic ICU trauma and disability. However, no shared or standardized definitions for ICU early mobility intervention choices, dosing, and intensity exist.4 While protocols for identifying and eliminating diseases such as sepsis and ARDS are effective, facilitating functional recovery for both mind and body is a progressive, collaborative process among clinicians, patients, and caregivers.
Published descriptive and randomized controlled studies of patient mobility interventions have attempted to create generalizable protocols for mobility that rely primarily on bed and low-level activity. When taken together in the form of systematic reviews or meta-analyses, they appear to have little influence on improving long-term patient outcomes.5 The heterogeneity of ICU patients, combined with the complexity of addressing the whole patient in a meaningful way to restore functional independence, requires an individualized treatment strategy that rehabilitation practitioners and RCPs are uniquely qualified to deliver. Perhaps the ideal way to demonstrate this is with a complex ICU patient example.
Consider a 56-year-old patient in the ICU recovering from severe ARDS due to influenza with sepsis. The patient requires mechanical ventilation and had required paralytics with deep sedation. On ICU admission day 6, the patient wakes up to a Richmond Agitation-Sedation Scale score of –1 when all sedation has been turned off. Using the ICU Liberation Bundle A-F elements as our guide, how should the team of rehabilitation practitioners and RCPs formulate patient care toward meaningful recovery?
When treating each patient, the patient’s needs and capabilities can be assessed as follows:
Posted: 4/6/2021 | 0 comments
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