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Title: Recent Advances in Pulmonary Rehabilitation for Patients in the Intensive Care Unit (ICU)
Authors: Sato, Ryuhei  kyouindb  KAKEN_id  orcid (unconfirmed)
Ebihara, Satoru
Kohzuki, Masahiro
Author's alias: 佐藤, 隆平
Keywords: Pulmonary rehabilitation
Intensive care unit (ICU)
Early mobilization
Issue Date: 21-Jun-2017
Publisher: Openventio
Journal title: Pulmonary Research and Respiratory Medicine – Open Journal (PRRMOJ)
Volume: Special Edition
Issue: 2
Start page: S51
End page: S54
Abstract: Pulmonary rehabilitation is important to prevent complications in critically ill patients in the intensive care unit (ICU) who are on mechanical ventilation. However, the effectiveness and adverse events related to pulmonary rehabilitation for patients in the ICU are largely unclear because of the diversity of diseases and various levels of severity in this situation. This review aims to clarify the evidence currently available for pulmonary rehabilitation in critically ill adult patients requiring mechanical ventilation, with a focus on positioning and early mobilization. Prone positioning (PP) does not seem to benefit adults with hypoxemia mechanically ventilated in the ICU. However, it improved survival among patient subgroups like those enrolled within 48 h of meeting the trial entry criteria, those treated with PP for ≥16 h per day, and those with severe hypoxemia at trial entry. PP using the protective lung ventilation strategy for patients with acute respiratory distress syndrome was associated with reduced mortality. On the other hand, PP may cause pressure sores and tracheal tube obstruction. The semi-recumbent position may prevent ventilator-associated pneumonia with no adverse events. Early mobilization (EM) enhances mobility status and muscle strength and increases days of life and out of the hospital for up to 6 months; it also shortens the duration of delirium. The main adverse events with EM are hemodynamic changes and desaturation. Therefore, medical staff should carry out pulmonary rehabilitation for patients in the ICU, given the effectiveness and adverse events. Future studies should identify diseases that would benefit from pulmonary rehabilitation and optimize the method.
Rights: ©2017 Sato R. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI(Published Version): 10.17140/PRRMOJ-SE-2-107
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