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Rehabilitation in Intensive Care

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Textbook of Pulmonary Rehabilitation

Abstract

Critical illness is associated with short- and long-term morbidity (weakness, weaning failure, impaired functional status and quality of life). Rehabilitation has become a key component in the management of patients with critical illness. Assessment is focused on cardiorespiratory stability, level of consciousness and cooperation, physical deconditioning (muscle weakness, joint stiffness, impaired functional exercise capacity, physical inactivity) and respiratory impairments (retained airway secretions, atelectasis and respiratory muscle weakness) to identify targets for rehabilitation. Evidence-based targets for rehabilitation are therefore muscular re-conditioning, airway clearance, with the aim to prevent atelectasis and to avoid (re-)intubation and/or weaning failure. In particular, early physical activity and mobilization are essential in the prevention, attenuation or reversion of physical deconditioning related to critical illness. A variety of modalities for assessment and treatment are evidence based and must be implemented depending on the stage of critical illness, comorbid conditions and cooperation of the patient. The physiotherapist should be responsible for implementing mobilization plans and exercise prescription and should make recommendations for progression of the rehabilitation strategies jointly with medical and nursing staff.

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References

  1. Eisner MD, Thompson T, Hudson LD, Luce JM, Hayden D, Schoenfeld D, et al. Efficacy of low tidal volume ventilation in patients with different clinical risk factors for acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med. 2001;164(2):231–6.

    Article  CAS  PubMed  Google Scholar 

  2. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA. 2014;311(13):1308–16.

    Article  CAS  PubMed  Google Scholar 

  3. Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, et al. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet. 2016;388(10052):1377–88.

    Article  PubMed  Google Scholar 

  4. Herridge MS. Recovery and long-term outcome in acute respiratory distress syndrome. Crit Care Clin. 2011;27(3):685–704.

    Article  PubMed  Google Scholar 

  5. Borges RC, Carvalho CR, Colombo AS, da Silva Borges MP, Soriano FG. Physical activity, muscle strength, and exercise capacity 3 months after severe sepsis and septic shock. Intensive Care Med. 2015;41(8):1433–44.

    Article  CAS  PubMed  Google Scholar 

  6. Hermans G, Van Mechelen H, Clerckx B, Vanhullebusch T, Mesotten D, Wilmer A, et al. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis. Am J Respir Crit Care Med. 2014;190(4):410–20.

    Article  PubMed  Google Scholar 

  7. Wieske L, Dettling-Ihnenfeldt DS, Verhamme C, Nollet F, van Schaik IN, Schultz MJ, et al. Impact of ICU-acquired weakness on post-ICU physical functioning: a follow-up study. Crit Care. 2015;19:196.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Convertino VA. Value of orthostatic stress in maintaining functional status soon after myocardial infarction or cardiac artery bypass grafting. J Cardiovasc Nurs. 2003;18(2):124–30.

    Article  PubMed  Google Scholar 

  9. Dittmer DK, Teasell R. Complications of immobilization and bed rest. Part 1: Musculoskeletal and cardiovascular complications. Can Fam Physician. 1993;39:1428–32. 35-7

    PubMed Central  PubMed  CAS  Google Scholar 

  10. Teasell R, Dittmer DK. Complications of immobilization and bed rest. Part 2: other complications. Can Fam Physician. 1993;39:1440–2. 5-6

    PubMed Central  PubMed  CAS  Google Scholar 

  11. Parry SM, Puthucheary ZA. The impact of extended bed rest on the musculoskeletal system in the critical care environment. Extrem Physiol Med. 2015;4:16.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Gruther W, Benesch T, Zorn C, Paternostro-Sluga T, Quittan M, Fialka-Moser V, et al. Muscle wasting in intensive care patients: ultrasound observation of the M. Quadriceps femoris muscle layer. J Rehabil Med. 2008;40(3):185–9.

    Article  PubMed  Google Scholar 

  13. Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310(15):1591–600.

    Article  CAS  PubMed  Google Scholar 

  14. Segers J, Hermans G, Charususin N, Fivez T, Vanhorebeek I, Van den Berghe G, et al. Assessment of quadriceps muscle mass with ultrasound in critically ill patients: intra- and inter-observer agreement and sensitivity. Intensive Care Med. 2015;41(3):562–3.

    Article  PubMed  Google Scholar 

  15. Hermans G, Agten A, Testelmans D, Decramer M, Gayan-Ramirez G. Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study. Crit Care. 2010;14(4):R127.

    Article  PubMed Central  PubMed  Google Scholar 

  16. De Jonghe B, Bastuji-Garin S, Durand MC, Malissin I, Rodrigues P, Cerf C, et al. Respiratory weakness is associated with limb weakness and delayed weaning in critical illness. Crit Care Med. 2007;35(9):2007–15.

    Article  PubMed  Google Scholar 

  17. Ali NA, O’Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, et al. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008;178(3):261–8.

    Article  PubMed  Google Scholar 

  18. Marchioni A, Fantini R, Antenora F, Clini E, Fabbri L. Chronic critical illness: the price of survival. Eur J Clin Invest. 2015;45(12):1341–9.

    Article  PubMed  Google Scholar 

  19. Rehabilitation After Critical Illness. National Institute for Health and Clinical Excellence: Guidance. London: Rehabilitation After Critical Illness; 2009.

    Google Scholar 

  20. Major ME, Kwakman R, Kho ME, Connolly B, McWilliams D, Denehy L, et al. Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge. Crit Care. 2016;20(1):354.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  21. Hodgson CL, Turnbull AE, Iwashyna TJ, Parker A, Davis W, Bingham CO 3rd, et al. Core domains in evaluating patient outcomes after acute respiratory failure: international multidisciplinary clinician consultation. Phys Ther. 2017;97(2):168–74.

    Article  PubMed  Google Scholar 

  22. Corrado A, Roussos C, Ambrosino N, Confalonieri M, Cuvelier A, Elliott M, et al. Respiratory intermediate care units: a European survey. Eur Respir J. 2002;20(5):1343–50.

    Article  CAS  PubMed  Google Scholar 

  23. Jolley SE, Moss M, Needham DM, Caldwell E, Morris PE, Miller RR, et al. Point prevalence study of mobilization practices for acute respiratory failure patients in the United States. Crit Care Med. 2017;45(2):205–15.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Bakhru RN, Wiebe DJ, McWilliams DJ, Spuhler VJ, Schweickert WD. An environmental scan for early mobilization practices in U.S. ICUs. Crit Care Med. 2015;43(11):2360–9.

    Article  PubMed  Google Scholar 

  25. Koo KK, Choong K, Cook DJ, Herridge M, Newman A, Lo V, et al. Early mobilization of critically ill adults: a survey of knowledge, perceptions and practices of Canadian physicians and physiotherapists. CMAJ Open. 2016;4(3):E448–54.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Harrold ME, Salisbury LG, Webb SA, Allison GT, Australia, Scotland ICUPC. Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers. Crit Care. 2015;19:336.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400–7.

    PubMed  Google Scholar 

  28. Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36(4):1119–24.

    Article  PubMed  Google Scholar 

  29. Martin UJ, Hincapie L, Nimchuk M, Gaughan J, Criner GJ. Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation. Crit Care Med. 2005;33(10):2259–65.

    Article  PubMed  Google Scholar 

  30. Nava S. Rehabilitation of patients admitted to a respiratory intensive care unit. Arch Phys Med Rehabil. 1998;79(7):849–54.

    Article  CAS  PubMed  Google Scholar 

  31. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014;18(6):658.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139–45.

    Article  PubMed  Google Scholar 

  33. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373(9678):1874–82.

    Article  PubMed  Google Scholar 

  34. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36(8):2238–43.

    Article  PubMed  Google Scholar 

  35. Burtin C, Clerckx B, Robbeets C, Ferdinande P, Langer D, Troosters T, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009;37(9):2499–505.

    Article  PubMed  Google Scholar 

  36. Chiang LL, Wang LY, Wu CP, Wu HD, Wu YT. Effects of physical training on functional status in patients with prolonged mechanical ventilation. Phys Ther. 2006;86(9):1271–81.

    Article  PubMed  Google Scholar 

  37. Ambrosino N, Venturelli E, Vagheggini G, Clini E. Rehabilitation, weaning and physical therapy strategies in chronic critically ill patients. Eur Respir J. 2012;39(2):487–92.

    Article  CAS  PubMed  Google Scholar 

  38. Dock W. The evil sequelae of complete bed rest. JAMA. 1944;125:5.

    Article  Google Scholar 

  39. Dripps RWW, R.M. Nursing care of surgical patients. Am J Nurs. 1941;41:4.

    Google Scholar 

  40. Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy For Critically Ill Patients. Intensive Care Med. 2008;34(7):1188–99.

    Article  CAS  PubMed  Google Scholar 

  41. Castro-Avila AC, Seron P, Fan E, Gaete M, Mickan S. Effect of early rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis. PLoS One. 2015;10(7):e0130722.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  42. Connolly B, O’Neill B, Salisbury L, Blackwood B. Enhanced recovery after critical illness Programme G. Physical rehabilitation interventions for adult patients during critical illness: an overview of systematic reviews. Thorax. 2016;71(10):881–90.

    Article  PubMed  Google Scholar 

  43. Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin. 2007;23(1):35–53.

    Article  PubMed  Google Scholar 

  44. Parry SM, Granger CL, Berney S, Jones J, Beach L, El-Ansary D, et al. Assessment of impairment and activity limitations in the critically ill: a systematic review of measurement instruments and their clinimetric properties. Intensive Care Med. 2015;41(5):744–62.

    Article  PubMed  Google Scholar 

  45. Fergusson D, Hutton B, Drodge A. The epidemiology of major joint contractures: a systematic review of the literature. Clin Orthop Relat Res. 2007;456:22–9.

    Article  PubMed  Google Scholar 

  46. Clavet H, Hebert PC, Fergusson D, Doucette S, Trudel G. Joint contracture following prolonged stay in the intensive care unit. CMAJ. 2008;178(6):691–7.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Hermans G, Clerckx B, Vanhullebusch T, Segers J, Vanpee G, Robbeets C, et al. Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve. 2012;45(1):18–25.

    Article  PubMed  Google Scholar 

  48. De Jonghe B, Sharshar T, Lefaucheur JP, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: a prospective multicenter study. JAMA. 2002;288(22):2859–67.

    Article  PubMed  Google Scholar 

  49. Fan E, Cheek F, Chlan L, Gosselink R, Hart N, Herridge MS, et al. An official American Thoracic Society Clinical Practice Guideline: the diagnosis of intensive care unit-acquired weakness in adults. Am J Respir Crit Care Med. 2014;190(12):1437–46.

    Article  PubMed  Google Scholar 

  50. Bohannon RW. Norm references are essential if therapists are to correctly identify individuals who have physical limitations. J Orthop Sports Phys Ther. 2005;35(6):388.

    PubMed  Google Scholar 

  51. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69–74.

    CAS  PubMed  Google Scholar 

  52. Vanpee G, Segers J, Van Mechelen H, Wouters P, Van den Berghe G, Hermans G, et al. The interobserver agreement of handheld dynamometry for muscle strength assessment in critically ill patients. Crit Care Med. 2011;39(8):1929–34.

    Article  PubMed  Google Scholar 

  53. Bohannon RW. Reference values for extremity muscle strength obtained by hand-held dynamometry from adults aged 20–79 years. Arch Phys Med Rehabil. 1997;78(1):26–32.

    Article  CAS  PubMed  Google Scholar 

  54. Allen GM, Gandevia SC, McKenzie DK. Reliability of measurements of muscle strength and voluntary activation using twitch interpolation. Muscle Nerve. 1995;18(6):593–600.

    Article  CAS  PubMed  Google Scholar 

  55. American Thoracic Society/European Respiratory Society. ATS/ERS Statement on respiratory muscle testing. Am J Respir Crit Care Med. 2002;166(4):518–624.

    Article  Google Scholar 

  56. Marini JJ, Smith TC, Lamb V. Estimation of inspiratory muscle strength in mechanically ventilated patients: the measurement of maximal inspiratory pressure. J Crit Care. 1986;1:6.

    Article  Google Scholar 

  57. Goligher EC, Fan E, Herridge MS, Murray A, Vorona S, Brace D, et al. Evolution of diaphragm thickness during mechanical ventilation. Impact of inspiratory effort. Am J Respir Crit Care Med. 2015;192(9):1080–8.

    Article  PubMed  Google Scholar 

  58. Fantini R, Mandrioli J, Zona S, Antenora F, Iattoni A, Monelli M, et al. Ultrasound assessment of diaphragmatic function in patients with amyotrophic lateral sclerosis. Respirology. 2016;21(5):932–8.

    Article  PubMed  Google Scholar 

  59. Parry SM, Denehy L, Beach LJ, Berney S, Williamson HC, Granger CL. Functional outcomes in ICU—what should we be using? An observational study. Crit Care. 2015;19:127.

    Article  PubMed Central  PubMed  Google Scholar 

  60. Chan KS, Aronson Friedman L, Dinglas VD, Hough CL, Morris PE, Mendez-Tellez PA, et al. Evaluating physical outcomes in acute respiratory distress syndrome survivors: validity, responsiveness, and minimal important difference of 4-meter gait speed test. Crit Care Med. 2016;44(5):859–68.

    Article  PubMed Central  PubMed  Google Scholar 

  61. Singh SJ, Puhan MA, Andrianopoulos V, Hernandes NA, Mitchell KE, Hill CJ, et al. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1447–78.

    Article  PubMed  Google Scholar 

  62. Herridge MS, Tansey CM, Matte A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–304.

    Article  CAS  PubMed  Google Scholar 

  63. Gosselink R, Clerckx B, Robbeets C, Vanhullenbusch T, Vanpee G, Segers J. Physiotherapy in the intensive care unit. Neth J Int Care. 2011;15:9.

    Google Scholar 

  64. Fink MP, Helsmoortel CM, Stein KL, Lee PC, Cohn SM. The efficacy of an oscillating bed in the prevention of lower respiratory tract infection in critically ill victims of blunt trauma. A prospective study. Chest. 1990;97(1):132–7.

    Article  CAS  PubMed  Google Scholar 

  65. Friedrich O, Reid MB, Van den Berghe G, Vanhorebeek I, Hermans G, Rich MM, et al. The sick and the weak: neuropathies/myopathies in the critically ill. Physiol Rev. 2015;95(3):1025–109.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  66. Llano-Diez M, Renaud G, Andersson M, Marrero HG, Cacciani N, Engquist H, et al. Mechanisms underlying ICU muscle wasting and effects of passive mechanical loading. Crit Care. 2012;16(1):R209.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Griffiths RD, Palmer TE, Helliwell T, MacLennan P, MacMillan RR. Effect of passive stretching on the wasting of muscle in the critically ill. Nutrition. 1995;11(5):428–32.

    CAS  PubMed  Google Scholar 

  68. Williams PE. Use of intermittent stretch in the prevention of serial sarcomere loss in immobilised muscle. Ann Rheum Dis. 1990;49(5):316–7.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  69. Kwan MW, Ha KW. Splinting programme for patients with burnt hand. Hand Surg. 2002;7(2):231–41.

    Article  PubMed  Google Scholar 

  70. Hinderer SR, Dixon K. Physiologic and clinical monitoring of spastic hypertonia. Phys Med Rehabil Clin N Am. 2001;12(4):733–46.

    Article  CAS  PubMed  Google Scholar 

  71. Clini EM, Crisafulli E, Antoni FD, Beneventi C, Trianni L, Costi S, et al. Functional recovery following physical training in tracheotomized and chronically ventilated patients. Respir Care. 2011;56(3):306–13.

    Article  PubMed  Google Scholar 

  72. Camargo Pires-Neto R, Fogaca Kawaguchi YM, Sayuri Hirota A, Fu C, Tanaka C, Caruso P, et al. Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects--a case series. PLoS One. 2013;8(9):e74182.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  73. Thelandersson A, Nellgard B, Ricksten SE, Cider A. Effects of early bedside cycle exercise on intracranial pressure and systemic hemodynamics in critically Ill patients in a neurointensive care unit. Neurocrit Care. 2016;25(3):434–9.

    Article  PubMed  Google Scholar 

  74. Gibson JN, Smith K, Rennie MJ. Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesis. Lancet. 1988;2(8614):767–70.

    Article  CAS  PubMed  Google Scholar 

  75. Strasser EM, Stattner S, Karner J, Klimpfinger M, Freynhofer M, Zaller V, et al. Neuromuscular electrical stimulation reduces skeletal muscle protein degradation and stimulates insulin-like growth factors in an age- and current-dependent manner: a randomized, controlled clinical trial in major abdominal surgical patients. Ann Surg. 2009;249(5):738–43.

    Article  PubMed  Google Scholar 

  76. Williams N, Flynn M. A review of the efficacy of neuromuscular electrical stimulation in critically ill patients. Physiother Theory Pract. 2014;30(1):6–11.

    Article  PubMed  Google Scholar 

  77. Maffiuletti NA, Roig M, Karatzanos E, Nanas S. Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review. BMC Med. 2013;11:137.

    Article  PubMed Central  PubMed  Google Scholar 

  78. Segers J, Hermans G, Bruyninckx F, Meyfroidt G, Langer D, Gosselink R. Feasibility of neuromuscular electrical stimulation in critically ill patients. J Crit Care. 2014;29(6):1082–8.

    Article  PubMed  Google Scholar 

  79. Zanotti E, Felicetti G, Maini M, Fracchia C. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulation. Chest. 2003;124(1):292–6.

    Article  PubMed  Google Scholar 

  80. Perme C, Chandrashekar R. Early mobility and walking program for patients in intensive care units: creating a standard of care. Am J Crit Care. 2009;18(3):212–21.

    Article  PubMed  Google Scholar 

  81. Needham DM. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA. 2008;300(14):1685–90.

    Article  CAS  PubMed  Google Scholar 

  82. Probst VS, Troosters T, Coosemans I, Spruit MA, Pitta Fde O, Decramer M, et al. Mechanisms of improvement in exercise capacity using a rollator in patients with COPD. Chest. 2004;126(4):1102–7.

    Article  PubMed  Google Scholar 

  83. Chang AT, Boots R, Hodges PW, Paratz J. Standing with assistance of a tilt table in intensive care: a survey of Australian physiotherapy practice. Aust J Physiother. 2004;50(1):51–4.

    Article  PubMed  Google Scholar 

  84. Goldman JM, Rose LS, Williams SJ, Silver JR, Denison DM. Effect of abdominal binders on breathing in tetraplegic patients. Thorax. 1986;41(12):940–5.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  85. van 't Hul A, Gosselink R, Hollander P, Postmus P, Kwakkel G. Acute effects of inspiratory pressure support during exercise in patients with COPD. Eur Respir J. 2004;23(1):34–40.

    Article  Google Scholar 

  86. Porta R, Vitacca M, Gile LS, Clini E, Bianchi L, Zanotti E, et al. Supported arm training in patients recently weaned from mechanical ventilation. Chest. 2005;128(4):2511–20.

    Article  PubMed  Google Scholar 

  87. Vogiatzis I, Nanas S, Roussos C. Interval training as an alternative modality to continuous exercise in patients with COPD. Eur Respir J. 2002;20(1):12–9.

    Article  PubMed  CAS  Google Scholar 

  88. Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013;144(3):825–47.

    Article  PubMed  Google Scholar 

  89. Hulzebos EH, Helders PJ, Favie NJ, De Bie RA, Brutel de la Riviere A, van Meeteren NL. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA. 2006;296(15):1851–7.

    Article  CAS  PubMed  Google Scholar 

  90. Jenkins SC, Soutar SA, Loukota JM, Johnson LC, Moxham J. Physiotherapy after coronary artery surgery: are breathing exercises necessary? Thorax. 1989;44(8):634–9.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  91. Pasquina P, Tramer MR, Walder B. Prophylactic respiratory physiotherapy after cardiac surgery: systematic review. BMJ. 2003;327(7428):1379.

    Article  PubMed Central  PubMed  Google Scholar 

  92. Patman S, Sanderson D, Blackmore M. Physiotherapy following cardiac surgery: is it necessary during the intubation period? Aust J Physiother. 2001;47(1):7–16.

    Article  CAS  PubMed  Google Scholar 

  93. Celli BR, Rodriguez KS, Snider GL. A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis. 1984;130(1):12–5.

    CAS  PubMed  Google Scholar 

  94. Roukema JA, Carol EJ, Prins JG. The prevention of pulmonary complications after upper abdominal surgery in patients with noncompromised pulmonary status. Arch Surg. 1988;123(1):30–4.

    Article  CAS  PubMed  Google Scholar 

  95. Pasquina P, Tramer MR, Granier JM, Walder B. Respiratory physiotherapy to prevent pulmonary complications after abdominal surgery: a systematic review. Chest. 2006;130(6):1887–99.

    Article  PubMed  Google Scholar 

  96. Overend TJ, Anderson CM, Lucy SD, Bhatia C, Jonsson BI, Timmermans C. The effect of incentive spirometry on postoperative pulmonary complications: a systematic review. Chest. 2001;120(3):971–8.

    Article  CAS  PubMed  Google Scholar 

  97. Gosselink R, Schrever K, Cops P, Witvrouwen H, De Leyn P, Troosters T, et al. Incentive spirometry does not enhance recovery after thoracic surgery. Crit Care Med. 2000;28(3):679–83.

    Article  CAS  PubMed  Google Scholar 

  98. Aguilo R, Togores B, Pons S, Rubi M, Barbe F, Agusti AG. Noninvasive ventilatory support after lung resectional surgery. Chest. 1997;112(1):117–21.

    Article  CAS  PubMed  Google Scholar 

  99. Pasquina P, Merlani P, Granier JM, Ricou B. Continuous positive airway pressure versus noninvasive pressure support ventilation to treat atelectasis after cardiac surgery. Anesth Analg. 2004;99(4):1001–8.

    Article  PubMed  Google Scholar 

  100. Morrow B, Zampoli M, van Aswegen H, Argent A. Mechanical insufflation-exsufflation for people with neuromuscular disorders. Cochrane Database Syst Rev. 2013;12:CD010044.

    Google Scholar 

  101. Bach JR, Sinquee DM, Saporito LR, Botticello AL. Efficacy of mechanical insufflation-exsufflation in extubating unweanable subjects with restrictive pulmonary disorders. Respir Care. 2015;60(4):477–83.

    Article  PubMed  Google Scholar 

  102. Ireland CJ, Chapman TM, Mathew SF, Herbison GP, Zacharias M. Continuous positive airway pressure (CPAP) during the postoperative period for prevention of postoperative morbidity and mortality following major abdominal surgery. Cochrane Database Syst Rev. 2014;8:CD008930.

    Google Scholar 

  103. Hodgson C, Denehy L, Ntoumenopoulos G, Santamaria J, Carroll S. An investigation of the early effects of manual lung hyperinflation in critically ill patients. Anaesth Intensive Care. 2000;28(3):255–61.

    CAS  PubMed  Google Scholar 

  104. Patman S, Jenkins S, Stiller K. Manual hyperinflation—effects on respiratory parameters. Physiother Res Int. 2000;5(3):157–71.

    Article  CAS  PubMed  Google Scholar 

  105. Hodgson C, Ntoumenopoulos G, Dawson H, Paratz J. The Mapleson C circuit clears more secretions than the Laerdal circuit during manual hyperinflation in mechanically-ventilated patients: a randomised cross-over trial. Aust J Physiother. 2007;53(1):33–8.

    Article  PubMed  Google Scholar 

  106. Albert SP, DiRocco J, Allen GB, Bates JH, Lafollette R, Kubiak BD, et al. The role of time and pressure on alveolar recruitment. J Appl Physiol (1985). 2009;106(3):757–65.

    Article  Google Scholar 

  107. Singer M, Vermaat J, Hall G, Latter G, Patel M. Hemodynamic effects of manual hyperinflation in critically ill mechanically ventilated patients. Chest. 1994;106(4):1182–7.

    Article  CAS  PubMed  Google Scholar 

  108. Yang KL, Tobin MJ. A prospective study of indexes predicting the outcome of trials of weaning from mechanical ventilation. N Engl J Med. 1991;324(21):1445–50.

    Article  CAS  PubMed  Google Scholar 

  109. Bach JR, Saporito LR. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure. A different approach to weaning. Chest. 1996;110(6):1566–71.

    Article  CAS  PubMed  Google Scholar 

  110. Ely EW, Baker AM, Dunagan DP, Burke HL, Smith AC, Kelly PT, et al. Effect on the duration of mechanical ventilation of identifying patients capable of breathing spontaneously. N Engl J Med. 1996;335(25):1864–9.

    Article  CAS  PubMed  Google Scholar 

  111. Penuelas O, Frutos-Vivar F, Fernandez C, Anzueto A, Epstein SK, Apezteguia C, et al. Characteristics and outcomes of ventilated patients according to time to liberation from mechanical ventilation. Am J Respir Crit Care Med. 2011;184(4):430–7.

    Article  PubMed  Google Scholar 

  112. Goldstone J, Moxham J. Assisted ventilation. 4. Weaning from mechanical ventilation. Thorax. 1991;46(1):56–62.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  113. Jung B, Moury PH, Mahul M, de Jong A, Galia F, Prades A, et al. Diaphragmatic dysfunction in patients with ICU-acquired weakness and its impact on extubation failure. Intensive Care Med. 2016;42(5):853–61.

    Article  PubMed  Google Scholar 

  114. Vassilakopoulos T, Zakynthinos S, Roussos C. The tension-time index and the frequency/tidal volume ratio are the major pathophysiologic determinants of weaning failure and success. Am J Respir Crit Care Med. 1998;158(2):378–85.

    Article  CAS  PubMed  Google Scholar 

  115. Gayan-Ramirez G, Testelmans D, Maes K, Racz GZ, Cadot P, Zador E, et al. Intermittent spontaneous breathing protects the rat diaphragm from mechanical ventilation effects. Crit Care Med. 2005;33(12):2804–9.

    Article  PubMed  Google Scholar 

  116. Nava S, Gregoretti C, Fanfulla F, Squadrone E, Grassi M, Carlucci A, et al. Noninvasive ventilation to prevent respiratory failure after extubation in high-risk patients. Crit Care Med. 2005;33(11):2465–70.

    Article  PubMed  Google Scholar 

  117. Gosselink R, Langer D. Recovery from ICU-acquired weakness; do not forget the respiratory muscles! Thorax. 2016;71(9):779–80.

    Article  PubMed  Google Scholar 

  118. Elkins M, Dentice R. Inspiratory muscle training facilitates weaning from mechanical ventilation among patients in the intensive care unit: a systematic review. J Physiother. 2015;61(3):125–34.

    Article  PubMed  Google Scholar 

  119. Holliday JE, Hyers TM. The reduction of weaning time from mechanical ventilation using tidal volume and relaxation biofeedback. Am Rev Respir Dis. 1990;141(5 Pt 1):1214–20.

    Article  CAS  PubMed  Google Scholar 

  120. Hall JB, Wood LD. Liberation of the patient from mechanical ventilation. JAMA. 1987;257(12):1621–8.

    Article  CAS  PubMed  Google Scholar 

  121. Esteban A, Alia I, Ibanez J, Benito S, Tobin MJ. Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure Collaborative Group. Chest. 1994;106(4):1188–93.

    Article  CAS  PubMed  Google Scholar 

  122. Pavlovic D, Wendt M. Diaphragm pacing during prolonged mechanical ventilation of the lungs could prevent from respiratory muscle fatigue. Med Hypotheses. 2003;60(3):398–403.

    Article  PubMed  Google Scholar 

  123. DiMarco AF, Onders RP, Ignagni A, Kowalski KE. Inspiratory muscle pacing in spinal cord injury: case report and clinical commentary. J Spinal Cord Med. 2006;29(2):95–108.

    Article  PubMed Central  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences-KU Leuven, Cardiovascular and Respiratory Research Unit, University Hospitals Leuven, Leuven, Belgium

    Rik Gosselink

  2. Department of Medical and Surgical Sciences, University of Modena, Azienda Ospedaliero Universitaria di Modena Policlinico, Modena, Italy

    Enrico Clini

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  1. Enrico Clini
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Correspondence to Rik Gosselink .

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Editors and Affiliations

  1. Department of Medical and Surgical Sciences, University of Modena, Azienda Ospedaliero Universitaria di Modena Policlinico, Modena, Italy

    Enrico Clini

  2. Alfred Health and Institute for Breathing and Sleep, La Trobe University, Melbourne, Australia

    Anne E. Holland

  3. State University of Londrina, Londrina, Paraná, Brazil

    Fabio Pitta

  4. Department of Rehabilitation Sciences, KU Leuven, Respiratory Division and Rehabilitation, University Hospital Leuven, Leuven, Belgium

    Thierry Troosters

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Gosselink, R., Clini, E. (2018). Rehabilitation in Intensive Care. In: Clini, E., Holland, A., Pitta, F., Troosters, T. (eds) Textbook of Pulmonary Rehabilitation. Springer, Cham. https://doi.org/10.1007/978-3-319-65888-9_26

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  • DOI: https://doi.org/10.1007/978-3-319-65888-9_26

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