Physical Rehabilitation and Critical Illness

Survivors of critical illness suffer a range of physical, psychological and social problems known together as the post-ICU syndrome. Physical weakness is common, long lasting, and interferes with quality of life for many ICU survivors. Physical weakness observed close to the time of ICU discharge is likely be caused by the disordered physiology and immobility associated with critical illness. These factors may be less important in the long term, where pre-existing frailty may be more important. A large number of trials have tested physical interventions (exercise, passive and active mobilization, and neuromuscular electrical stimulation) delivered during and after critical illness. At this time, the evidence suggests that early mobilization can improve important short-term outcomes (such as length of stay, duration of mechanical ventilation, functional independence, and mobility), and may increase days out of hospital alive at 180 days. Effects on other long-term outcomes (such as quality of life) have not been shown. No physical interventions delivered after ICU discharge have demonstrated effectiveness. This article describes the physical problems experienced by ICU survivors, and provides an up to date review of critical care physical intervention trials.