Intensive Care Medicine has recently published the article “Implementing early physical rehabilitation and mobilisation in the ICU: institutional, clinician, and patient considerations. This is a multidisciplinary work developed by a physiotherapist in Australia, a nurse in Germany and a doctor in the United States.
We are increasing knowledge about post-UCI syndrome and there is an increasing and general interest in rehabilitation and early mobilization, light sedation and compliance with the ABCDEF bundle, since it has already evidenced the improve in functional recovery, reducing delirium and better outcomes.
Conducting early mobilization is a challenge for all, especially in resource-limited settings (where interprofessional work and family integration in patient care are clues). It is therefore essential to identify the modifiable barriers: the institutional issues (e.g. the ratio), the clinical problems (e.g. the interprofessional communication deficit) and the difficulties of each patient.
To help us systematically identify barriers, standardized tools can be used, with regular reassessment of their overcoming. The authors propose the following scheme that affects measures in the team and the patient:
– About the team: identify the barriers and seek the pertinent solutions, motivate, educate and carry out coordinated interprofessional communication sessions
– On the patient: to evaluate the previous situation and the functional status, the physiological condition, the conditions of safety and viability of the intervention, to have objectives of mobility, communication and family integration, to perform the intervention and to evaluate the progress
Finally, the authors point to where things are going: to determine the timing, duration, intensity and frequency of the rehabilitation and evaluate the role of other interventions such as nutritional optimization. Understanding the recovery trajectory and analyzing which patients can benefit most is necessary to maximize the resources and establish adequate expectations.
From Proyecto HU-CI we want to thank and congratulate the authors!