Pulmonary Rehabilitation

It is widely recognized that the intensive care unit (ICU) is a different environment setting from those in which pulmonary rehabilitation (PR) services are performed. Pulmonary rehabilitation usually involves patients who have chronic stable disease, who most often are treated as outpatients, while the ICU is occupied with critically ill patients who have multiple dynamic medical or surgical problems. However, some patients admitted to the ICU also suffer from body deconditioning, neuropathy, myopathy, body weakness, increase length of ICU stay, prolonged ventilatory support, delayed weaning and prolonged pulmonary rehabilitation post-ICU (Schweickert & Hall, 2007). MacIntyre has pointed out that there are approximately 40% of ICU patients receive ventilatory support due to acute illness comlicating chronic disease and also the frquency of mechanical ventilation seems to be increasing (MacIntyre et al., 2005). In addition, some patients who require prolong mechanical ventilation become ventilator dependent. In the ICU, the need for pulmonary rehabilitation has become clear for all ventilated patients or non-ventilated patients. Starting pulmonary rehabilitation in the intensive care unit (ICU) is an important instrument to optimize resource utilization, prevent and treat some of the ICU complications and to facilitate, improve long term recovery and decrease the patient’s dependency on mechanical ventilator. In this paper, I will review the strategies of starting pulmonary rehabilitation in the ICU.

Definition

“Pulmonary rehabilitation is an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systemic manifestations of the disease” (Carlin, 2009; L. Nici et al., 2006). This definition focuses on important number of factors that may influence the patient’s health and healthcare resources. These factors are multidisciplinary approach, individualized treatment of the patient, and attention to physical, social and healthcare cost (Ries, 2008).

The scope of pulmonary rehabilitation

All patients with stable chronic lung disease who is disabled by respiratory diseases are candidate for pulmonary rehabilitation (Ries, 2008). The intensive care unit (ICU) is extremely specilaised, busy and expensive area comparing to pulmonary rehabilitation program as outpatient. However, critically ill patients who admitted to the intensive care unit (ICU) most often suffer from sever manifestations of deconditioning and immobility. The causes for the intensive care units (ICU) admissions are varied and the