Physiotherapy Rehabilitation Following a Stay in ICU

¶ … physiotherapy rehabilitation following a stay in ICU A stay in the Intensive care unit can be a set back to the full recovery of a patient calling for a need to carry out a rehabilitation program. According to Bersten, Soni, & Oh (2009), after a patient is discharged from the intensive care unit, there is requirement for a care plan that is multidisciplinary in order to achieve the best possible recovery for the patient.

No matter the rehabilitation program that health care providers may choose to adopt, prior assessment of the patient is critical to help them in making the most informed decisions on the appropriate approach to apply (Porter, and Tidy, 2008). This paper will look at the evidence of an aged patient who developed sepsis after a surgery to remove bowel. Most patients that recover from long-term sepsis are able to regain normalcy in life. However, some patients may suffer from long-term effects that include permanent organ damage.

Some evidence indicates that the occurrence of severe sepsis may destabilize the immune system of a patient. The susceptibility of elderly patients to inflammatory infections necessitates the exercise of care so that any infection that might cause sepsis be curtailed. Reintroduction of gravitational force helps in improving oxygen transport particularly in patients that are critically ill.

The loss of function in critically sick patients that presents itself in form of poor muscle protein synthesis, poor microvascular functions and diaphragmatic dysfunction can be cured through the application of a well structured therapy program that will help in their recovery and as thus rehabilitation should start as soon as possible (Baudouin, 2008). Main theory Corticosteroids are said to be very important in the treatment of septic shock and sepsis in general.

The therapeutic role of this treatment stemmed from the theory that an exaggerated host infection, which is usually inflammatory, often result from a case of septic shock or severe sepsis. Sepsis is formally defined as an inflammatory response syndrome that is systematic in nature, and may present itself in form of symptoms that include leukocytosis, tachypnea, fever and tachycardia.

Clinically observed infections may include community acquired pneumonia, infected wound oozing pus or in worst case scenarios a bowel that is ruptured to the point that it exposes its contents in the peritoneum (Gao, Melody, Daniels, Giles, Fox 2005). The grading system for sepsis has since been modified to encompass septic shock, severe sepsis and refractory septic shock. In addition to the aforementioned clinical symptoms, severe sepsis may also include a sign of organ hypoperfusion. Patients with sepsis infection will require assistance to carry out their daily activities.

Simple daily activities that include walking and dressing may look simple to a healthy man but not a healthy man. This is not the case in a patient with sepsis. These patients are often found to suffer from reduced strength, loss of muscle mass and a decline in the number of mitochondria (Gao et al. 2005). Such patients are often advised to take sufficient bed rest.

Examples of evidence Some contradicting evidence from a study conducted by a critical care expert at the John Hopkins Hospital indicate; long-term sedation and prolonged bed rest may be resulting into a delay in physical recovery, and may also afford the patients some poor quality life upon discharge. Looking at an earlier case of critically injured patients in World War II, moving these patients around proved to be the best physiotherapy remedy as opposed to confining them to prolonged bed rest. Early mobilization is the desired mode of treatment.

However, this should be done in a planned fashion so as to avoid over doing it. Alternate theory An alternate theory points at adrenal insufficiency as the main challenge for severe patients Sepsis develop when inflammations occur. This inflammation is accompanied by worsening physical and cognitive functions. Adrenal insufficiency causes some physical enervation, a condition that necessitates physiotherapy. Patients need to be exposed to exercises that will help them avoid or reduce the challenges that accompany the adrenal insufficiency condition.

Evidence Low blood pressure and inflammatory reactions might be the root cause for brain damage which causes cognitive problems. Patients with sepsis may also develop Alzheimer's disease, which is characterised by their being delirious. Such patients ought to be exposed to exercises that will build their cognitive skills and help them live fulfilled lives (Bersten, et al. 2009, p. 13).

The place of a physiotherapist in helping a with low blood pressure will be to centre most of the exercises around ensuring that sufficient blood reaches the adrenal cortex and the brain at large. 2nd alternative theory In some cases, patients who have been in the Intensive Care Unit may recover within a short period, say one month without going through the physiotherapy process (Vincent, 2012). These are people who can go through the ICU and be able to recover or cope with the psychological problems associated with critical illnesses.

In such instances, there will be no need for physiotherapy, but the health care providers need to be cautious so as not to underestimate a patient's physical, social and psychological condition. Underlying issues The recovery rates and periods of patients who have been to the Intensive Care Unit may vary from one patient to another even when subjected to a similar physiotherapy module. Evidence has shown that younger patients are likely to regain faster than older patients who have been subjected to the same process.

In addition, patients who have spent a shorter period at the Intensive care unit will pull through quicker compared to the ones who have spent a significant amount of time at the unit. Therefore, younger patients who have spent less time at the intensive care unit will recover faster than older patients who have spent longer periods at the unit (Vincent, 2012). A physiotherapist needs to understand this issue for him or her to gain success in the recovery plan of the patient.

Some patients are likely to suffer from lack of memory on their life history after critical illness, which may be a hindrance to the recovery process. If this issue is not addressed, the rehabilitation programme may fail as the patients may not comprehend what transpired in their lives while they were at their lowest point in their health (Vincent, 2012). Health care givers should carry out a comprehensive assessment and help the patients to recover their memories while going on with other physiotherapy exercises to enable them recover fully.