Muscle retraining in ICU patients.

The general aim of an ICU respiratory rehabilitation programme is to improve the patient's measured quality of life. It can be done by applying advanced therapeutic modalities in order to improve the remaining functions and to decrease the patient's dependency as well as the risks associated with an ICU admission. A number of physiological changes involve all the body systems as a consequence of a bed-rest period and play an important role in the weaning failure of ventilated patients. Inactivity muscle mass declines from the first week of ICU admission, as well as the muscle's ability to perform aerobic exercise. The respiratory muscles strength and endurance decreases, also the ventilatory pump and the cardiovascular response to exercise may be alterated. Disorientation, and disfunction of the Central Nervous System may occur. The aim of this review is to analyse the usefulness of skeletal and respiratory muscle training in improving strength, endurance and decreasing dyspnea at rest and during exercise and the role of rehabilitation in obtaining maximal functional capacity of ICU patients.

Muscle retraining in the ICU patients.

One of the most common causes of an ICU admission is a severe episode of acute respiratory failure due either to an exacerbation of chronic pulmonary disease or its ex-novo development after a surgical procedure, trauma or medical complications. These patients usually report, at admission to the ICU, a sedentary life before the acute episode, because the evolution of the disease is characterized by a progressive decline not only in respiratory function (e.g. FEV1), but also in the functional status, due to the effects of lack of exercise, drug administration, malnutrition and, later on, gas exchange abnormalities. Together with specific vital organ support, such as mechanical ventilation, patients admitted to an ICU may require other complex and integrated interventions in order to maintain the spared function and to prevent further damage. These interventions include nutritional and psychological support, counselling, nursing, prevention (e.g. to preserve skin integrity) and in particular a complete physiotherapic program, that may range from simple help to maintain a correct posture to complete recovery of walking autonomy.