Rehabilitation so much to offer, often too late. Desiree Cox Practice Manager Life St Dominic s Rehabilitation Unit East London

Transcription

1 Rehabilitation so much to offer, often too late Desiree Cox Practice Manager Life St Dominic s Rehabilitation Unit East London

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3 OUTLINE The ICU Environment The psychological effects Can Rehabilitation help in the ICU? ICU rehabilitation safety and feasibility ICU rehabilitation benefits Early Rehabilitation Transfer out of the ICU In-patient rehabilitation process

4 FEAR OF DEATH

5 The ICU Environment Disruptive noise levels Lack of natural environment Restricted social engagement with loved ones Disruption of daynight patterns Lack of natural sleep

6 The Psychological Effects Fear Panic Loss of control Powerlessness Loneliness Depersonalisation

7 Can rehabilita6on help in the ICU? How does rehabilita6on help in the ICU? Is it feasible and safe? What are the benefits of rehabilita6on in the ICU?

8 Yes it can! A whole-body rehabilitation approach in the earliest days of critical illness Interruption sedation Physical and occupational therapy Well tolerated and safe Improved functional outcomes at discharge Reduced delirium More ventilator-free days Shortened length of stay (ICU and Hospital) WD Schweickert et al Early Physical and occupational therapy in mechanically ventilated, critically ill patients: a randomized controlled trial.

9 Safe and feasible A systematic review was conducted in 2014 Safe mobilization recommendations of mechanically ventilated patients. 4 groups of recommendations Respiratory Cardiovascular Neurological Medical, Surgical and other.

10 Traffic Light system C L Hodgson et al Expert consensus and recommenda:ons on safety criteria for ac:ve mobiliza:on of mechanically ven:lated cri:cally ill adults.

11 Pa6ent Journeys

12 Mrs S Elderly lady GBS, ICU for 9 months, Hospital 12 months Now: Stiff and contracted hands Weak respiratory muscles (Prolonged ventilation need) Limited active upper limb movement bilaterally No current lower limb active movement WAS REHABILITATION TOO LATE?

13 Mr M Young active male RAF MVA, T12 SCI incomplete Now: Commenced rehabilitation 1 year post injury Limited lower limb active movement (L> R) Walking with caliper and crutches COULD REHABILITATION HAVE COMMENCED EARLIER?

14 Improvised parallel bars

15 Mr N Young active male C5/6 complete SCI, MVA (RAF) 9 months in a local orthopedic hospital Came into rehab with: Fixed contractures in the upper limbs, pressure sore on his ankles, malnourished, dehydrated, depressed, anemic, incontinent and infections (UTI, chest).

16 Mr N Motorized wheelchair is being investigated Has received new and appropriate manual wheelchair as well as pressure relieving mattress Family had education and care giver training for proper patient care at home. Supra-pubic catheter in-situ and a successful bowel program Skin Intact Has had orthopedic consultations for upper limb releases COULD THE EARLIER COMMENCEMENT OF REHAB HAVE MADE A DIFFERENCE?

17 What are the benefits of rehabilita6on commencing in the ICU? Early mobilisation Early cognitive rehabilitation Early swallowing assessment Assessment and issue of assistive devices Splints, Pressure garments, AFO s Prevention of secondary complications Patient and family education Building of trust between patient and multidisciplinary team This creates the feeling of I m on the road to RECOVERY

18 AOer ICU Where to now?

19 Early Transfer Out of the ICU Research shows that ICU stays >4 days Increased risk of PTSD, anxiety and depression Negatively impacts on their physical and psychological recovery in the long-term Admission to a Rehabilitation Unit

20 Benefits of the in-patient Rehabilitation Stimulating and supportive environment Psychosocial support Daily routines Return to day-night patterns Activities of daily Living Mobilisation Diet Speech therapy Education of patient and their family on expectations Continued care and rehabilitation, already commenced in ICU.

21 Benefits of the in-patient Rehabilitation continued Aqua therapy Regaining a sleep pattern Independence with ADLs Nutritional support Access to community activities Routine development (Bowel and Bladder program, exercise regime)

22 Conclusion Rehabilitation is : To promote well being Recover physically, emotionally and mentally To improve a patients quality of life This philosophy should be embraced and implemented from beginning to end of each patient s individual Road to Recovery.

23 Global trends show an increase of 50% of inpatients requiring critical care by 2030 Need for cognitive therapy during and post ICU Harness skill of the interdisciplinary team Reduce or prevent residual cognitive impairment Develop evidence-based protocols

24 Global trends show an increase of 50% of inpatients requiring critical care by 2030 Need for cognitive therapy during and post ICU Harness skill of the interdisciplinary team Reduce or prevent residual cognitive impairment Develop evidence-based protocols

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