Week 2 Flashcards
Critical illness is often associated with a stay in the ____
Critical illness is often associated with a stay in the ICU
What are some additional illnesses that a patient coming out of the ICU be diagnosed with?
ICU acquired weakness (ICU-AW), critical illness polyneuropathy (CIP,CIPN), critical illness myopathy (CIM), Post-ICU Syndrome (PICS)
What does it mean when a patient fails to be weaned off mechanical ventilation?
It mean that the patient is critically ill
What are the other patient diagnosis that are considered to be critically ill?
- Sepsis
- Multi-system organ dysfunction
- Multi-trauma
What does it mean when a patient is stabilizing but worse?
It means that their main medical issue is resolving, but more medical issues are present and functional impairments become apparent
Often times when a patient is stabilizing but is worse, they often get diagnoses of ICU-AW, CIPN/CIP, CIM, what does this often mean for them?
Nerves and muscles are impaired such that functional
impairments and limitations have reached critical levels and are out of proportion with the pre-admission baseline
What is the pathogenesis of critical illness polyneuropathy(CIP) or critical illness myopathy?
Circulatory, cellular level, and metabolic changes
• Impaired oxygen delivery due to total body microcirculatory
issues
• Impaired mitochondrial function which leads to reduced ATP, energy
production
• Diaphramatic weakness from ventilation (combined
sedation)
• Immobility leading to muscle wasting
What are the key findings in patients with critical illness polyneuropathy(CIP) or critical illness myopathy?
Muscle Weakness
• Often rapid onset
• Failure to wean from mechanical ventilation
• Motor and sensory impairment
What are the motor and sensory impairments seen in patients with critical illness polyneuropathy(CIP)?
Symmetrical, distal and diaphragm more impacted than proximal
What are the motor and sensory impairments seen in patients with critical illness myoneuropathy(CIM)?
Symmetrical, motor only, proximal more than distal
How is critical illness polyneuropathy(CIP) or critical illness myopathy diagnosed?
Weaning difficulty, clinical presentation, imaging, labs, tissue studies
How can critical illness polyneuropathy(CIP) or critical illness myopathy be prevented?
Blood glucose control, electrolyte and nutritional balance, accelerated vent. weaning
What is the prognosis of critical illness polyneuropathy(CIP) or critical illness myopathy?
- Not great (22% die in hospital, 33 % die within 6 months)
- Institutionalization
- The younger the patient, the better
What is the best way to treat critical illness polyneuropathy(CIP) or critical illness myopathy?
Prevent and Treat
• Early Rehab (in ICU- sedation must be controlled)
• Focus on functional limitations, respiratory capacity, and cardiac reserve
• Facilitate communication
• Risk versus benefit
What is Multiple Organ Dysfunction Syndrome (MODS)?
Progressive failure of more than 2 organs systems over 24
hours which is typically a complication of critical illness
What are the causes of Multiple Organ Dysfunction Syndrome (MODS)?
- Most commonly caused by sepsis, but infection not required
* Also caused by acute respiratory distress syndrome (ARDS), sever inflammatory processes, shock, and traumatic injury
What is the clinical presentation of Multiple Organ Dysfunction Syndrome (MODS)?
- Low grade fever
- Tachycardia
- Dyspnea
- Systemic inflammatory response
- Altered mental status
What are the organs that are usually affected by Multiple Organ Dysfunction Syndrome (MODS)?
- Lungs typically first organ to fail leading to acute respiratory distress syndrome
- Followed by GI bacteremia, liver, and kidney failure
- Ultimately cardiovascular collapse can occur
What are the management methods of Multiple Organ Dysfunction Syndrome (MODS)?
- Prevention and early detection
- Pharmacologic: anti-biotics, inotropic agents
- Supplemental oxygen and ventilation
- Fluid replacement and nutritional support
What is the prognosis of Multiple Organ Dysfunction Syndrome (MODS)?
60-90% mortality approaching 100% with 3 or more organ involvement and sepsis plus >65 y/o
What is the role of PT in the management of Multiple Organ Dysfunction Syndrome (MODS)?
• Usually only seen in critical care or a burn unit
• Severe protein catabolism of skeletal muscle
- Lean body mass depleted
- Need skin precautions and skin care
• Risk often outweighs benefit
• Very little in the literature about MODS
According to the Expert consensus and recommendations on safety criteria for active mobilization of
mechanically ventilated critically ill adults by hodgson, what was the safe criteria for in and out of be mobilization if there are no other contraindications for patients in the ICU?
Oxygen saturation more than 90% and a respiratory rate less
than 30 breaths/minute were considered safe criteria for in- and out-of-bed mobilization if there were no other
contraindications
According to Rehabilitation during mechanical ventilation: Review of the recent literature by George Ntoumenopoulos, what are the factors that are associated with the development of the physical and psychological complications seen in patients on mechanical ventilation?
The requirement for intubation and mechanical ventilation, sedation, systemic inflammation and immobility
As far as the dosage of passive limb movement required, Burtin
et al. (2009) demonstrated that even 20 minutes per day
of in-bed cycling (cycle ergometry device that can be used passively, with active patient participation or with active resistance) led to significant improvements in _____ compared to routine physiotherapy.
As far as the dosage of passive limb movement required, Burtin
et al. (2009) demonstrated that even 20 minutes per day
of in-bed cycling (cycle ergometry device that can be used passively, with active patient participation or with active resistance) led to significant improvements in six-minute walk, static quadriceps strength and physical well being at hospital discharge (Burtin et al., 2009) compared to routine physiotherapy.
What is a functional test with much greater validation in the ICU?
The physical function in intensive care test (PFIT)
