Early rehabilitation for critically ill patients

In recent years, early rehabilitation has become an important goal in order to improve the outcome of patients in the intensive care unit (ICU). Although neuromuscular sequelae have been described long ago, prolonged bed rest and inactivity result in muscle loss and weakness. The deleterious effects of inflammatory factors on muscle as well as the beneficial effects of exercise are now better understood. Revalidation must be initiated as early as possible in order to allow the patient's active collaboration, while sedation must be avoided as much as possible. However, even comatose or non-collaborative patients can be passively mobilized to avoid joint contractures. Active mobilization is beneficial and technical supports can be added to improve exercises. Before initiating treatment, physiotherapists must assess the respiratory, haemodynamic, and neurological functions of the patients to ensure feasibility and safety of these procedures. Then, they define timing, intensity and frequency of exercises. These programs often require the collaboration of a motivated multidisciplinary team as well as a larger number of physiotherapists in the ICU.