Table 2 Summary of the statement, 12 recommendations, and four therapy options for the rehabilitation of critically ill patients with post-intensive care syndrome
From: Guideline on multimodal rehabilitation for patients with post-intensive care syndrome
Statement | |
|---|---|
It is important to screen critically ill patients with a length of stay ≥ 48 h for risk factors to develop PICS and symptoms of PICS during the stay in intensive care, after discharge, during and at the end of rehabilitation, as well as in out-patient care. The choice of the optimal assessment depends on various factors such as the phase of the disease, the setting, the symptomatology, risk factors of the patient and the availability of further diagnostics | |
Recommendations and therapy options for PICS Rehabilitation | |
Rehabilitation of physical health | |
1. Early mobilization ought to be started within the first few days in the ICU, adapted to the patient's resilience and general condition. (A) | |
2. Supplemental use of ergometers (bed cycling) in addition to early mobilization can be considered. (0) | |
3. Wheelchair cycle ergometer training can be used in addition to the standard physical therapy to improve muscle strength and cardiovascular fitness. (0) | |
4. Strength training can be used as an adjunct to standard physical therapy to increase walking speed. (0) | |
5. Electrical stimulation of the ventral thigh musculature can be used to strengthen the muscles. (0) | |
6. Training of the inspiratory muscles using an inhalation trainer should be used to increase the strength of the inspiratory muscles and the quality of life in the short term as an adjunct to standard physical therapy. (B) | |
7. As dysphagia is frequent in patients with tracheostomy, standardized swallowing assessment should be performed before oral nourishment is initiated. (B) | |
Rehabilitation of cognitive health | |
8. Computer-based learning of attention functions and/or therapy aiming at improvement of cognition should be performed with critically ill patients and in further rehabilitation. (B) | |
9. Interventions for delirium prophylaxis ought to include multimodal sensory, cognitive and emotional stimulation (mobilization, purposeful stimulation and engagement, aids for orientation, contact to family members). (A) | |
10. Interventions for stress reduction (pain, anxiety, sleep, noise), improvement of communication and family care should be applied. (B) | |
11. A prophylactic treatment with Haloperidol for ventilated patients should not be implemented, as there is no effect in comparison to placebo regarding the incidence, severity, duration or outcome of delirium. (B-) | |
Rehabilitation of psychological health | |
12. Critically ill patients with adaptation disorders such as anxiety and depression benefit from psychological interventions. These should be offered already in the ICU and/or early rehabilitation and if possible also to relatives. (B) | |
13. Post-traumatic stress reactions should be treated by interventions such as psychoeducation and psychotherapy. (B) | |
14. Access to professional support and aftercare should be offered in the first 12 months after discharge aiming at mental stabilization. (B) | |
15. ICU diaries ought to be implemented for reducing the risks of symptoms of anxiety, depression, and PTSD in critically ill patients after discharge from the ICU. (A) | |
16. In post-ICU care, ICU diaries ought to be worked on with health care professionals. (A) |