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Physical therapy in icu

Gabriele Di Gesaro, Eluisa La Franca, Calogero Falletta, Alessandra Caronia, Sonia Dell'Oglio, Pamela Licata, Cettina Ruperto, Claudia Visconti, Carmelo Cinnirella, Giacomo Chiarandà, Francesco Clemenza
INTRODUCTION: Heart failure (HF) is a main issue of modern healthcare system. Patient affected are continuously growing in number and age; therefore, an integrated management between different parts of healthcare system is crucial to optimize outcome and sustainability. So far, little is known about clinical pathways of HF patients in Sicily. METHODS: On initiative of the Regional HF Group of the Italian Association of Hospital Cardiologists (ANMCO), we decided to census all the Cardiology Unit of Sicily...
January 2019: Recenti Progressi in Medicina
Ericka L Fink, Sue R Beers, Amy J Houtrow, Rudolph Richichi, Cheryl Burns, Lesley Doughty, Roberto Ortiz-Aguayo, Catherine A Madurski, Cynthia Valenta, Maddie Chrisman, Lynn Golightly, Michelle Kiger, Cheryl Patrick, Amery Treble-Barna, Dorothy Pollon, Craig M Smith, Patrick Kochanek
OBJECTIVES: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients. DESIGN: Randomized controlled trial. SETTING: Three tertiary care PICUs in the United States. PATIENTS: Fifty-eight children between the ages of 3-17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours...
January 30, 2019: Pediatric Critical Care Medicine
Michael J Berry, Nathan J Love, D Clark Files, Rita N Bakhru, Peter E Morris
PURPOSE: To examine relationships between self-report and performance-based measures of physical function in ICU patients randomized to standardized rehabilitation therapy (SRT) or usual care (UC). METHODS: Physical function was assessed in 257 ICU patients using self-report (physical functioning scale of the SF-36 (SF-36 PFS)) and the functional performance inventory-short form (FPI-SF) as well as performance-based measures (Short Physical Performance Battery (SPPB)) and muscular strength (MS)...
January 21, 2019: Journal of Critical Care
Harish Lavu, Neal S McCall, Jordan M Winter, Richard A Burkhart, Michael Pucci, Benjamin E Leiby, Theresa P Yeo, Shawnna Cannaday, Charles J Yeo
BACKGROUND: This study was designed to determine whether a standardized recovery pathway could reduce post-pancreaticoduodenectomy (PD) hospital length of stay (LOS) to 5 days without increasing complication or readmission rates. STUDY DESIGN: PD patients (high-risk patients excluded) were enrolled in an IRB approved, prospective, randomized controlled trial (NCT02517268) comparing a 5-day recovery pathway (WARP) to our traditional 7-day pathway (Control). WARP interventions included early discharge planning, shortened ICU stay, modified postoperative dietary and drain management algorithm, rigorous physical therapy with in-hospital gym visit, standardized rectal suppository administration, and close telehealth follow-up post discharge...
January 17, 2019: Journal of the American College of Surgeons
Bethany Young, Megan Moyer, William Pino, David Kung, Eric Zager, Monisha A Kumar
BACKGROUND/OBJECTIVE: In November 2014, our Neurointensive Care Unit began a multi-phased progressive early mobilization initiative for patients with subarachnoid hemorrhage and an external ventricular drain (EVD). Our goal was to transition from a culture of complete bed rest (Phase 0) to a physical and occupational therapy (PT/OT)-guided mobilization protocol (Phase I), and ultimately to a nurse-driven mobilization protocol (Phase II). We hypothesized that nurses could mobilize patients as safely as an exclusively PT/OT-guided approach...
January 18, 2019: Neurocritical Care
Martin Sundström-Rehal, Nicolas Tardif, Olav Rooyackers
PURPOSE OF REVIEW: The intended purpose of nutritional and exercise interventions during ICU stay is often to limit the muscle loss associated with critical illness. Unfortunately, direct measurements of muscle protein turnover or potential surrogates have often been neglected in clinical trials. RECENT FINDINGS: We discuss the potential advantages and drawbacks of common outcome measures for assessing changes in muscle structure and function over time, and how temporal changes in patient physiology require consideration...
March 2019: Current Opinion in Clinical Nutrition and Metabolic Care
Roberta Pineda, Jessica Roussin, Elizabeth Heiny, Joan Smith
OBJECTIVE:  The main objective of this article is to define perceptions of health care professionals regarding current use of sensory-based interventions in the neonatal intensive care unit (NICU). METHODS:  A multidisciplinary group of NICU health care professionals ( n  = 108) defined the types of sensory-based interventions used in their NICU, the postmenstrual age (PMA) sensory-based interventions are administered, conditions under which sensory-based interventions are used, and personnel who administer sensory-based interventions...
December 21, 2018: American Journal of Perinatology
Sheetal Gandotra, James Lovato, Douglas Case, Rita N Bakhru, Kevin Gibbs, Michael Berry, D Clark Files, Peter E Morris
RATIONALE: Survivorship from critical illness has improved, however factors mediating the functional recovery of persons experiencing a critical illness remain incompletely understood. OBJECTIVES: To identify groups of acute respiratory failure (ARF) survivors with similar patterns of physical function recovery following discharge and to determine the characteristics associated with group membership in each physical function trajectory group. METHODS: We performed a secondary analysis of a randomized controlled trial, using group-based trajectory modelling to identify distinct subgroups of patients with similar physical function recovery patterns after ARF...
December 20, 2018: Annals of the American Thoracic Society
Manon Queralt, Camille Lamazere
For some time, hypnosis and physical therapy techniques have had the wind in their sails. Numerous media reports extol their benefits for patients. However, in concrete terms, how do these techniques impact on the everyday life of a team and can hypnosis find its place in nursing care in an intensive care unit? This article provides some answers through the experience of a nurse and the work of a whole team.
November 2018: Revue de L'infirmière
W Druml
Fever, arbitrarily defined as a core body temperature >38.3 °C, is present in 20-70 % of intensive care unit patients. Fever caused by infections is a physiologic reset of the thermostatic set-point and is associated with beneficial consequences, but may have negative sequelae with temperatures >39.5 °C. Fever of non-infectious and neurologic origin affects about 50 % of patients with elevated body temperature, presents as a pathologic loss of thermoregulation, and may be associated with untoward side effects at temperatures above 38...
November 28, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Suzanne Forsyth Herling, Ingrid E Greve, Eduard E Vasilevskis, Ingrid Egerod, Camilla Bekker Mortensen, Ann Merete Møller, Helle Svenningsen, Thordis Thomsen
BACKGROUND: Delirium is defined as a disturbance in attention, awareness and cognition with reduced ability to direct, focus, sustain and shift attention, and reduced orientation to the environment. Critically ill patients in the intensive care unit (ICU) frequently develop ICU delirium. It can profoundly affect both them and their families because it is associated with increased mortality, longer duration of mechanical ventilation, longer hospital and ICU stay and long-term cognitive impairment...
November 23, 2018: Cochrane Database of Systematic Reviews
Oliver J Schofield-Robinson, Sharon R Lewis, Andrew F Smith, Joanne McPeake, Phil Alderson
BACKGROUND: The intensive care unit (ICU) stay has been linked with a number of physical and psychological sequelae, known collectively as post-intensive care syndrome (PICS). Specific ICU follow-up services are relatively recent developments in health systems, and may have the potential to address PICS through targeting unmet health needs arising from the experience of the ICU stay. There is currently no single accepted model of follow-up service and current aftercare programmes encompass a variety of interventions and materials...
November 2, 2018: Cochrane Database of Systematic Reviews
Evangelia Koutsioumpa, Demosthenes Makris, Athina Theochari, Dimitra Bagka, Stathis Stathakis, Efstratios Manoulakas, Markos Sgantzos, Epaminondas Zakynthinos
BACKGROUND: Critical illness polyneuropathy or myopathy is a severe disorder that may adversely affect patients in the intensive care unit, resulting in reduced mobilization, decline in muscle mass, and prolonged recovery periods. OBJECTIVE: To examine whether the application of trans-cutaneous electrical neuromuscular stimulation (TENMS) reduces the incidence or severity of myopathy related to critical illness in intensive care unit patients. METHODS: A total of 80 patients aged 18 years or older with an intensive care unit stay of 96 hours or more and receipt of mechanical ventilation for 96 hours or more were initially enrolled in a prospective, open-label randomized controlled trial in a university hospital...
November 2018: American Journal of Critical Care: An Official Publication, American Association of Critical-Care Nurses
Selina M Parry, Lee-Anne S Chapple, Marina Mourtzakis
Muscle wasting occurs rapidly within days of an admission to the intensive care unit (ICU). Concomitant muscle weakness and impaired physical functioning can ensue, with lasting effects well after hospital discharge. Early physical rehabilitation is a promising intervention to minimize muscle weakness and physical dysfunction. However, there is an often a delay in commencing active functional exercises (such as sitting on the edge of bed, standing and mobilizing) due to sedation, patient alertness, and impaired ability to cooperate in the initial days of ICU admission...
December 2018: Nutrition in Clinical Practice
Rebekah A Yataco, Scott M Arnold, Suzanne M Brown, W David Freeman, C Carmen Cononie, Michael G Heckman, Luke W Partridge, Craig M Stucky, Laurie N Mellon, Jennifer L Birst, Kristien L Daron, Martha H Zapata-Cooper, Danton M Schudlich
BACKGROUND/OBJECTIVE: Early mobilization of critically ill patients has been shown to improve functional outcomes. Neurosurgery patients with an external ventricular drain (EVD) due to increased intracranial pressure often remain on bed rest while EVD remains in place. The prevalence of mobilizing patients with EVD has not been described, and the literature regarding the safety and feasibility of mobilizing patients with EVDs is limited. The aim of our study was to describe the outcomes and adverse events of the first mobilization attempt in neurosurgery patients with EVD who participated in early functional mobilization with physical therapy or occupational therapy...
October 24, 2018: Neurocritical Care
Eve Grillo Carvalho, Henrique Guarino Colli Peluso, Lorena Luana Batista, Cissa Santos Moreira, Juliana Suzano Moraes Protti, Maria Cristina Bento Soares, Aline de Freitas Suassuna Autran, Amanda Rocha Soares Almeida, Denise Cristina Rodrigues, Lívia Verônica Grillo Romano Bernardes, Luciana Pimenta de Paula
INTRODUCTION: The posterior reversible encephalopathy (PRES) syndrome encompasses a set of clinical-radiological findings associated with severe systemic arterial hypertension. This case report proposes to discuss the identification, diagnosis, and management of PRES in the pediatric population. CASE PRESENTATION: Female patient, 10 years old, admitted to the emergency room with complaint of oliguria and generalized edema. At the initial physical exam, the only alteration present was anasarca...
September 21, 2018: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
Suzi Laine Longo Dos Santos Bacci, Janser Moura Pereira, Amanda Cristina da Silva Chagas, Lais Ribeiro Carvalho, Vivian Mara Gonçalves de Oliveira Azevedo
BACKGROUND: Weaning a patient from mechanical ventilation is a complex procedure that involves clinical and contextual aspects. Mechanical ventilation also depends on the characteristics of health professionals who work in intensive care. OBJECTIVE: This study described the organizational aspects associated with the physical therapist's performance in the weaning procedure from mechanical ventilation and extubation in neonatal, pediatric and mixed (neonatal and pediatric) intensive care units in Brazil...
September 12, 2018: Brazilian Journal of Physical Therapy
Saad Al-Nassan, Faris Alshammari, Shaden Al-Bostanji, Zaid Modhi Mansour, Mohannad Hawamdeh
OBJECTIVE: A national survey was conducted to determine the current status of physical therapy practice in the intensive care units (ICUs) of Jordanian hospitals. METHODS: An online survey was sent via email to physical therapists working at Jordanian hospitals. Questions of the survey addressed the physical therapy demographics, staffing, education, training, and barriers of practice. The responses were compared among four different hospital sectors in the country...
September 19, 2018: Physiotherapy Research International: the Journal for Researchers and Clinicians in Physical Therapy
Krysta S Wolfe, Bhakti K Patel, Erica L MacKenzie, Shewit P Giovanni, Anne S Pohlman, Matthew M Churpek, Jesse B Hall, John P Kress
BACKGROUND: Vasoactive medications are commonly used in the treatment of critically ill patients, but their impact on the development of ICU-acquired weakness is not well described. The objective of this study is to evaluate the relationship between vasoactive medication use and the outcome of ICU-acquired weakness. METHODS: This is a secondary analysis of mechanically ventilated patients (N = 172) enrolled in a randomized clinical trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of ICU-acquired weakness on hospital discharge...
October 2018: Chest
Megan Whelan, Heleen van Aswegen, Evelyn Corner
Background: Critically ill patients following traumatic injury or major surgery are at risk of loss of skeletal muscle mass, which leads to decreased physical function. Early rehabilitation in an intensive care unit (ICU) is thought to preserve or restore physical functioning. The Chelsea critical care physical assessment (CPAx) is a measurement tool used to assess physical function in the ICU. Objectives: To determine whether the use of the CPAx tool as part of physiotherapy patient assessment, in two adult trauma and surgical ICU settings where early patient mobilisation forms part of standard physiotherapy practice, had an impact on ICU and hospital length of stay (LOS) through delivery of problem-oriented treatment plans...
2018: South African Journal of Physiotherapy
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