Lung-Injured Patients Do Not Need a Specialized Rehabilitation Program: ICUAW as a Case Study

Abstract

An episode of critical illness is transformative. Patients suffer important new nerve, brain, and muscle injury. The spectrum of morbidity varies according to individual risks, but prevalent disabilities transcend diagnostic groupings. In the context of intensive care unit–acquired weakness (ICUAW), each patient who enters the ICU will begin to degrade muscle through upregulation of different proteolytic pathways, and, although the inciting stimulus, or its magnitude, may differ somewhat across patients, the result is the same. This argues for an approach to rehabilitation that is etiologically neutral and based on an understanding of molecular pathophysiology that can be mapped to functional outcome and tailored to individual need.

Keywords

ICU-acquired weakness - rehabilitation - muscle biology - critical illness - outcomes

• References

• 1 Levine S, Nguyen T, Taylor N , et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med 2008; 358 (13) 1327-1335
• 2 De Jonghe B, Sharshar T, Lefaucheur JP , et al; Groupe de Réflexion et d'Etude des Neuromyopathies en Réanimation. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA 2002; 288 (22) 2859-2867
• 3 Ali NA, O'Brien Jr JM, Hoffmann SP , et al; Midwest Critical Care Consortium. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med 2008; 178 (3) 261-268
• 4 Herridge MS, Tansey CM, Matté A , et al; Canadian Critical Care Trials Group. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364 (14) 1293-1304
• 5 McHugh LG, Milberg JA, Whitcomb ME, Schoene RB, Maunder RJ, Hudson LD. Recovery of function in survivors of the acute respiratory distress syndrome. Am J Respir Crit Care Med 1994; 150 (1) 90-94
• 6 Angus DC, Musthafa AA, Clermont G , et al. Quality-adjusted survival in the first year after the acute respiratory distress syndrome. Am J Respir Crit Care Med 2001; 163 (6) 1389-1394
• 7 Weinert CR, Gross CR, Kangas JR, Bury CL, Marinelli WA. Health-related quality of life after acute lung injury. Am J Respir Crit Care Med 1997; 156 (4 Pt 1) 1120-1128
• 8 Stucki G. International Classification of Functioning, Disability, and Health (ICF): a promising framework and classification for rehabilitation medicine. Am J Phys Med Rehabil 2005; 84 (10) 733-740
• 9 Whyte J, Barrett AM. Advancing the evidence base of rehabilitation treatments: a developmental approach. Arch Phys Med Rehabil 2012; 93 (8, Suppl): S101-S110
• 10 Levine S, Budak MT, Dierov J, Singhal S. Inactivity-induced diaphragm dysfunction and mitochondria-targeted antioxidants: new concepts in critical care medicine. Crit Care Med 2011; 39 (7) 1844-1845
• 11 Hussain SN, Mofarrahi M, Sigala I , et al. Mechanical ventilation-induced diaphragm disuse in humans triggers autophagy. Am J Respir Crit Care Med 2010; 182 (11) 1377-1386
• 12 Picard M, Jung B, Liang F , et al. Mitochondrial dysfunction and lipid accumulation in the human diaphragm during mechanical ventilation. Am J Respir Crit Care Med 2012; 186 (11) 1140-1149
• 13 Batt J, Dos Santos CC, Cameron JI, Herridge MS. Intensive care unit-acquired weakness: clinical phenotypes and molecular mechanisms. Am J Respir Crit Care Med 2013; 187 (3) 238-246
• 14 Herridge MS, Cheung AM, Tansey CM , et al; Canadian Critical Care Trials Group. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 2003; 348 (8) 683-693
• 15 Herridge MS, Tansey CM, Matté A , et al; Canadian Critical Care Trials Group. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364 (14) 1293-1304
• 16 Needham DM, Dennison CR, Dowdy DW , et al. Study protocol: The Improving Care of Acute Lung Injury Patients (ICAP) study. Crit Care 2006; 10 (1) R9
• 17 Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 2010; 304 (16) 1787-1794
• 18 Unroe M, Kahn JM, Carson SS , et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med 2010; 153 (3) 167-175
• 19 de Letter MA, Schmitz PI, Visser LH , et al. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med 2001; 29 (12) 2281-2286
• 20 Hough CL. Neuromuscular sequelae in survivors of acute lung injury. Clin Chest Med 2006; 27 (4) 691-703 , abstract x
• 21 Latronico N, Peli E, Botteri M. Critical illness myopathy and neuropathy. Curr Opin Crit Care 2005; 11 (2) 126-132
• 22 Barnato AE, Albert SM, Angus DC, Lave JR, Degenholtz HB. Disability among elderly survivors of mechanical ventilation. Am J Respir Crit Care Med 2011; 183 (8) 1037-1042
• 23 Hopkins RO, Weaver LK, Collingridge D, Parkinson RB, Chan KJ, Orme Jr JF. Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med 2005; 171 (4) 340-347
• 24 Hopkins RO, Weaver LK, Pope D, Orme JF, Bigler ED, Larson-LOHR V. Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med 1999; 160 (1) 50-56
• 25 Dowdy DW, Eid MP, Sedrakyan A , et al. Quality of life in adult survivors of critical illness: a systematic review of the literature. Intensive Care Med 2005; 31 (5) 611-620
• 26 Chelluri L, Im KA, Belle SH , et al. Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med 2004; 32 (1) 61-69
• 27 Barnato AE, Albert SM, Angus DC, Lave JR, Degenholtz HB. Disability among elderly survivors of mechanical ventilation. Am J Respir Crit Care Med 2011; 183 (8) 1037-1042
• 28 Jackson JC, Girard TD, Gordon SM , et al. Long-term cognitive and psychological outcomes in the awakening and breathing controlled trial. Am J Respir Crit Care Med 2010; 182 (2) 183-191
• 29 Ehlenbach WJ, Hough CL, Crane PK , et al. Association between acute care and critical illness hospitalization and cognitive function in older adults. JAMA 2010; 303 (8) 763-770
• 30 Mikkelsen ME, Christie JD, Lanken PN , et al. The adult respiratory distress syndrome cognitive outcomes study: long-term neuropsychological function in survivors of acute lung injury. Am J Respir Crit Care Med 2012; 185 (12) 1307-1315
• 31 Chelluri L, Im KA, Belle SH , et al. Long-term mortality and quality of life after prolonged mechanical ventilation. Crit Care Med 2004; 32 (1) 61-69
• 32 Cameron JI, Herridge MS, Tansey CM, McAndrews MP, Cheung AM. Well-being in informal caregivers of survivors of acute respiratory distress syndrome. Crit Care Med 2006; 34 (1) 81-86
• 33 Azoulay E, Pochard F, Kentish-Barnes N , et al; FAMIREA Study Group. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 2005; 171 (9) 987-994
• 34 Van Pelt DC, Schulz R, Chelluri L, Pinsky MR. Patient-specific, time-varying predictors of post-ICU informal caregiver burden: the caregiver outcomes after ICU discharge project. Chest 2010; 137 (1) 88-94
• 35 Douglas SL, Daly BJ, Kelley CG, O'Toole E, Montenegro H. Impact of a disease management program upon caregivers of chronically critically ill patients. Chest 2005; 128 (6) 3925-3936
• 36 Pochard F, Darmon M, Fassier T , et al; French FAMIREA study group. Symptoms of anxiety and depression in family members of intensive care unit patients before discharge or death. A prospective multicenter study. J Crit Care 2005; 20 (1) 90-96
• 37 Foster M, Chaboyer W. Family carers of ICU survivors: a survey of the burden they experience. Scand J Caring Sci 2003; 17 (3) 205-214
• 38 Choi J, Sherwood PR, Schulz R , et al. Patterns of depressive symptoms in caregivers of mechanically ventilated critically ill adults from intensive care unit admission to 2 months postintensive care unit discharge: a pilot study. Crit Care Med 2012; 40 (5) 1546-1553
• 39 Choi J, Donahoe MP, Zullo TG, Hoffman LA. Caregivers of the chronically critically ill after discharge from the intensive care unit: six months' experience. Am J Crit Care 2011; 20 (1) 12-22 , quiz 23
• 40 Cameron JI, Gignac MA. “Timing It Right”: a conceptual framework for addressing the support needs of family caregivers to stroke survivors from the hospital to the home. Patient Educ Couns 2008; 70 (3) 305-314