Early Mobilization Flashcards
Chronic critical illness patients are distinguished by a syndrome of significant, characteristic derangement of: (4)
Metabolism
Neuroendocrine
Neuropsychiatric
Immunologic function
Profound debilitation and continued multiple organ system dysfunction contributes to _____
PMV: prolonged mechanical ventilation
PMV is generally defined as….
The need for mechanical ventilation for LONGER THAN 21 DAYS
OR when the tracheostomy occurs (7-14 days)
Multiple risk factors for post ICU mortality include: (5)
Age Comorbidity Severity of illness Duration of ICU delirium Sepsis
PICS is?
Post intensive care syndrome
PICS is the term used to describe the ________
Constellation of complications that endure past ICU stay
List 6 long term complications of ICU stay
Pulmonary Neuromuscular Physical Function Psychiatric symptoms Cognitive QOL
Pulmonary long term complications include:
Diffusion capacity: generally mild but can persist for >5 years
Long term complications: Neuromuscular include:
CINM, disuse atrophy: can extend to over 5 years, CIP may recover more slowly than CIM
Long term complications: physical function:
ADL dysfunction: may be seen for 1-2 years
Long term complications: Psychiatric symptoms
Depression, PTSD, anxiety
Can persist for over 1 year
Long term complications: Cognitive
Impairments in memory, attention, executive function: residual effects for up to 6 years
Long term complications: QOL
Physical deficits
Improves over 1 year but can persist for over 5 years
ICU-AW stands for
Intensive care unit acquired weakness
_______ is clinically detected weakness in critically ill patients in whom there is no plausible etiology other than critical illness
ICU AW
ICU AW is further classified into _____, _____, or ______
Critical illness myopathy (CIM)
Critical illness polyneuropathy (CIP)
Critical illness neuromyopathy (CINM) Combo of CIP and CIM
Which one of these affects the nervous system? CIP, CIM?
CIP
CIM can be further sub-classified into what 3 categories?
Cachectic myopathy
Thick filament myopathy
Necrotizing myopathy
How do you distinguish between CIP and CIM?
Electrophysiological testing in involved tissues
What develops first? Myopathy or polyneuropathy?
Myopathy- earlier and more frequent
ICU AW is the presence of 1, 2, 5 ; and sometimes either 3 or 4. What are 1, 2 and 5?
- Weakness after onset of critical illness
- Weakness involves prox and distal muscles, symmetrical, flaccid and sparing the CNs. Limbs and resp. Muscles
- Cause of weakness NOT related to underlying critical illness
What can be used in place of MRC when looking at clinical features of ICU AW?
What are the values?
Hand dynamometry
<11 kg force for men
<7 kg force for women
Pathophysiologically important mechanisms for weakness include
Immobility
Local inflammation
Systemic inflammation
What causes pro-inflammatory during critical illness?
Cytokines shift
Increased production of reactive O2 species
Decrease in anti-oxidative defenses
True or false: disuse atrophy and ICU AW are the same?
False
Patients with ICU AW will demonstrate weakness ________ to detectable muscle wasting
PRIOR
Disuse atrophy can demonstrate muscle atrophy and loss of muscle strength by how much percent in the first week?
5%
What is associated with SPECIFIC structural and metabolic changes in muscle?
Disuse atrophy