Rehabilitation
Rehabilitation tests early mobilisation, sedation and delirium management, ICU-acquired weakness and post-intensive care syndrome.
Core rules
- ABCDEF bundle: Assess and treat pain, Both spontaneous awakening and breathing trials, Choice of sedation, Delirium monitoring, Early mobility, Family engagement.
- ICU-acquired weakness is symmetric proximal weakness after critical illness. Risk factors include sepsis, steroids, hyperglycaemia and immobility.
- Post-intensive care syndrome (PICS) includes physical, cognitive and psychological impairment after ICU discharge.
- Delirium: use CAM-ICU or ICDSC. Antipsychotics do not shorten delirium and are not routine.
- Mobilisation safety: consider FiO2, vasopressor dose, ICP and active bleeding; stop if unstable.
Worked example
A patient on norepinephrine 0.1 µg/kg/min, FiO2 0.4, RASS −1 and no active bleeding can sit on the edge of the bed with a physiotherapist. If MAP falls below 60 mmHg or the dose escalates, pause and reassess. The aim is progressive activity, not all-or-nothing mobilisation.
Traps
- Equating deep sedation with safety.
- Missing hypoactive delirium because the patient is quiet.
- Starting rehabilitation only after extubation.
- Ignoring cognitive and psychological PICS domains.