A COMPREHENSIVE APPROACH TO THE MANAGEMENT OF CRITICALLY ILL

Abstract

The study of long-term treatment outcomes of patients in the intensive care unit (ICU) is necessary for the rapid recovery of a critically ill patient. Training of ICU staff in basic rehabilitation techniques for early rehabilitation and resocialization of patients allows promoting improvements in postresuscitation immunosuppression, polyneuropathy, polymyopathy, and cognitive dysfunction. The introduction of rehabilitation in the ICU enables avoiding the concept of syndrome-treatment of critically ill patients, solving the problem of “a chronic ICU patient”, reducing the number of complications of the underlying disease and chronic pathologies associated with the patient's critical condition. The algorithms for the recovery of critically ill patients are proposed to be introduced from the first day of the hospitalization, when the first pathophysiological recovery patterns begin to form. The role of resocialization in the framework of this approach to the rehabilitation of critically ill patients, the “open ICU” model and deontological aspects of the communication between medical staff and an ICU patient are put forward. The prevention of delirium after cardiac arrest contributes greatly to the further prevention of post-resuscitation cognitive dysfunction, decreases depression and prevents oversedation. A new phenotype of a chronic critically ill patient, the “patient after a critical condition,” is introduced with the discussion of the pathophysiological patterns involved in its formation. The relevance of this review is confirmed by the growing interest to the integration between ICU staff and patient`s family, thus emerging the role of social aspect of the rehabilitation in critically ill patients. The novelty of this research is imposed by advanced approaches to the early rehabilitation of ICU survivors which are currently neglected from the routine ICU practice.