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Global consensus on the care for intensive care patients

PhD candidate Mel Major of the European School of Physiotherapy, Amsterdam University of Applied Sciences recently reached consensus

8 Dec 2016 09:07 | Communication

An exercise programme for muscle strength and endurance, a balanced nutrition programme, respiratory muscle strength training, and above all: the physiotherapist as the coordinator for both physical and psychological care. These are the primary ingredients in the care approach for former intensive care patients, about which scientific consensus has been reached for the first time.

Physiotherapy lecturer/researcher and PhD candidate Mel Major of the European School of Physiotherapy, Amsterdam University of Applied Sciences recently reached this consensus with her colleagues throughout the world. Based on this shared guideline, hospitals can establish effective follow-up care programmes in cooperation with the primary healthcare sector.

Each year, more than 85,000 people in the Netherlands wind up in an intensive care unit (ICU). Being admitted to the ICU can be a major ordeal for patients. The majority of patients who survive a stay in the ICU report that they continue to experience physical and psychological symptoms such as depression and post-traumatic stress disorder (PTSD), and cognitive problems such as memory loss, up to five years later. A number of years ago, the term ‘post-intensive care syndrome’ (PICS) was coined for this combination of problems. In the Netherlands, around 25,000 ICU patients are discharged from hospital with PICS symptoms each year.   

Despite the serious effects a stay in the ICU can have on patients, there has not yet been a broadly supported follow-up care programme to properly supervise this group of patients and deal with the problems they encounter. “For patients who wind up in intensive care due to a life-threatening illness and develop severe muscle weakness or fatigue as a result, there is no protocol to help care providers determine what their role or the best care is,” says Major.

Scientific consensus

This is set to change, now that Major has achieved scientific consensus on the most effective physiotherapeutic follow-up care for these ICU patients. She and her fellow researchers have drawn up a protocol for the approach to care, based on expert opinions and a review of the literature.  “An important step,” says Major, “because now at least there is clarity about the most effective follow-up care.”

For her consensus study Major consulted the world’s ten leading experts in the field of intensive care and post-intensive care rehabilitation. The panel comprised representatives of various disciplines and included physicians, physiotherapists and nurses. Based on this scientific study, Major and her fellow researchers drew up the follow-up care protocol, containing the most effective physiotherapeutic interventions and measurement methods for treating this group of former ICU patients.

Balanced nutrition programme

Naturally, the new model for the approach to follow-up care includes an exercise programme for muscle strength and endurance. But what stands out, according to Major, is the recommended inclusion of a balanced nutrition programme. Not much has been done in this area for former ICU patients previously. So collaboration with nutritionists is essential.

Another recommendation from the protocol is training of respiratory muscle strength after the ICU admission. This is something that does not yet take place at this time: “Following artificial respiration, ICU patients do receive training in the ICU itself, but not once they have left the ICU. Yet this could make a big difference, and it concerns a relatively simple procedure with patients receiving a small device to train their respiratory muscles at home. This enables the physiotherapist to measure whether respiratory muscle strength has improved.”

Pivotal role

The protocol also describes the essential transfer of information from the hospital to the general practitioner and the primary care physiotherapist. When setting up the follow-up care programme, there should be one care provider who gathers the relevant transfer information from the hospital and coordinates the follow-up care programme. “The physiotherapist is ideally suited to this pivotal role,” says Major. “Physiotherapists already work with complex patients, such as patients with diabetes or pulmonary emphysema. And they already work in close cooperation with nutritionists and psychologists.” Therefore, in Major’s opinion, the physiotherapist should play a central and coordinating role in the follow-up care programme, engaging the other care providers in order to provide the proper support to the patient.

Read the scientific publication by Mel Major and her colleagues in the journal Critical Care