Today, ICU survival has gradually increased thanks to technical and technological advances focused on providing vital support to critically ill patients.

While traditionally the quality measurement in our enviroment has focused on mortality, there has recently been a change in vision: the functional status and quality of life after admission to the ICU are also important. This is why it has been observed that, despite the favorable evolution of patients in terms of survival, there is an increasing number of patients with physical, psychological and mental difficulties that lead to an state of disadaptation in order to return to their social, family and labor context prior to ICU admission. This situation of weakness and difficulties in recovering of critical patients should be managed early in the ICU with the aim of promoting a better adaptation in terms of health, well-being and functionality.

Physically level, a non-negligible number of patients admitted to the ICU for different causes develop muscle weakness during admission, a phenomenon known as intensive Care Unit acquired weakness (ICUAW). The main risk factor is immobility.

In order to improve the incidence of this entity we have developed an early mobilization program focused on critical patients connected to a respirator. It is based on a set of planned movements with a defined progression, starting with the movements that the patient is able to do, with the aim of returning to the initial status before the ICU admission. These movements include head elevation, postural changes, passive and later active exercises in bed, sitting on the edge of the bed, sitting in the chair and wandering. We also progressively introduce activities of everyday life. For this, we have formed a multidisciplinary group with all those professionals who serve the ICU patient: physiotherapists, rehabilitators, intensivists, nurses, auxiliaries and porters.

With this project we try to make the ICU stay of our patients more bearable with the objective that it resembles as much as possible, within our limitations, to a daily lost and surprisingly missed.

Finally we would like to share a few words from our students of Medicine who collaborated in our project and made the work of end of degree:

“We have discovered the Medicine that tries to open to other approaches of the human being, broader, more ambitious, leaving to consider the patient only as a set of organs or as a disease, and taking as he/she is: a person, our equal -not identical- someone who, on many occasions, gets us to put a mirror in front of our eyes that brings back an intense and painful image of ourselves”.

By Paula Perelló and Mónica Magret

ICU of Hospital Universitari Joan XXIII, Tarragona