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Review
. 2023 Jul 31;27(1):301.
doi: 10.1186/s13054-023-04569-5.

Guideline on multimodal rehabilitation for patients with post-intensive care syndrome

Caroline Renner  1 , Marie-Madlen Jeitziner  2   3 , Monika Albert  4 , Sabine Brinkmann  5 , Karin Diserens  6 , Imanuel Dzialowski  7 , Maria-Dorothea Heidler  8 , Martina Lück  9 , Ricki Nusser-Müller-Busch  10 , Peter S Sandor  11 , Andreas Schäfer  12 , Bettina Scheffler  13 , Claus Wallesch  14 , Gudrun Zimmermann  15 , Peter Nydahl  16   17
Affiliations
Review

Guideline on multimodal rehabilitation for patients with post-intensive care syndrome

Caroline Renner et al. Crit Care. .

Abstract

Background: Intensive Care Unit (ICU) survivors often experience several impairments in their physical, cognitive, and psychological health status, which are labeled as post-intensive care syndrome (PICS). The aim of this work is to develop a multidisciplinary and -professional guideline for the rehabilitative therapy of PICS.

Methods: A multidisciplinary/-professional task force of 15 healthcare professionals applied a structured, evidence-based approach to address 10 scientific questions. For each PICO-question (Population, Intervention, Comparison, and Outcome), best available evidence was identified. Recommendations were rated as "strong recommendation", "recommendation" or "therapy option", based on Grading of Recommendations, Assessment, Development and Evaluation principles. In addition, evidence gaps were identified.

Results: The evidence resulted in 12 recommendations, 4 therapy options, and one statement for the prevention or treatment of PICS.

Recommendations: early mobilization, motor training, and nutrition/dysphagia management should be performed. Delirium prophylaxis focuses on behavioral interventions. ICU diaries can prevent/treat psychological health issues like anxiety and post-traumatic stress disorders. Early rehabilitation approaches as well as long-term access to specialized rehabilitation centers are recommended. Therapy options include additional physical rehabilitation interventions. Statement: A prerequisite for the treatment of PICS are the regular and repeated assessments of the physical, cognitive and psychological health in patients at risk for or having PICS.

Conclusions: PICS is a variable and complex syndrome that requires an individual multidisciplinary, and multiprofessional approach. Rehabilitation of PICS should include an assessment and therapy of motor-, cognitive-, and psychological health impairments.

Keywords: Critical care; Guidelines; Intensive care; PICS; Physical therapy; Post-intensive care syndrome; Psychological therapy; Rehabilitation.

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Conflict of interest statement

A formal conflict of interest policy was developed a priori and enforced throughout the process by members of the DGNR. All authors have disclosed that they do not have any potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Impact of the post intensive care syndrome
Fig. 2
Fig. 2
Summary of the literature search according to the 10 research questions (search period: January 2009 to December 31, 2021)
See this image and copyright information in PMC

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Supplementary concepts