The Role of Muscle Training and Rehabilitation During Weaning

Abstract

The intensive care unit is a very different environment from the rehabilitative centers or services where pulmonary rehabilitation is usually performed. Indeed, whereas in the former setting most patients are desperately ill or recovering from an acute episode [1], in the latter the patients usually have chronic stable disease and are often treated as outpatients. One of the most common reasons for admission to an ICU is a severe episode of acute respiratory failure due either to an exacerbation of chronic pulmonary disease or its aggravation after a surgical procedure, trauma, or medical complications. Weaning from mechanical ventilation is often a major clinical problem in the subset of patients affected by COPD or chronic restrictive diseases [2]. These patients usually report, at admission to the ICU, leading a sedentary life before the acute episode; the evolution of the disease is characterized by a progressive decline, not only in respiratory function (e.g., FEV₁), but also in the functional status [3], due to the effects of lack of exercise, drug administration (e.g., steroids) [4], malnutrition [5] and, later on, gas-exchange abnormalities. Together with specific vital organ support, such as mechanical ventilation, patients admitted to an ICU may require other complex and integrated interventions in order to maintain the spared function and to prevent further damage [6]. These interventions include nutritional and psychological support, counseling, nursing, prevention (e.g., to preserve skin integrity), and in particular a complete rehabilitation program that may range from simple help to maintain a correct posture to complete recovery of walking autonomy.