Table 1 At a glance summary of physical impairment and effect of exercise therapy in ICU
From: From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome
What is known | |
 Muscle dysfunction | Rapid loss of peripheral and respiratory muscle function and mass. VIDD can occur in 40–50% of mechanically ventilated patients |
 Aetiology/risk factors | Multifactorial aetiology includes immobility/muscle unloading, pre-existing comorbidities, age, disease (e.g. sepsis) and its severity, and multiple complex pathophysiological mechanisms (e.g. systemic inflammation, medication (e.g. corticosteroid, sedatives, and neuromuscular blockade), nutritional deficiencies, and direct muscle injury) |
 Assessment tools | In ICU: Medical Research Council (MRC) Sum-Score, ICU Mobility Scale (IMS), Clinical Frailty Score, Functional Status Score for the Intensive Care Unit (FSS-ICU) Post-discharge: EQ-5D-5L, WHO Disability Assessment Schedule (WHODAS), MRC Sum-Score, Barthel Index (BI) for Activities of Daily Living, gait speed, 6-minute walk test (6MWT) |
 Heterogenous | Development and recovery of muscle weakness and decreased physical function are heterogeneous and difficult to predict |
 Long-term outcomes | Many patients experience ongoing and persistent muscle weakness and atrophy recalcitrant to interventions, resulting in reduced quality of life and increased dependency for activities of daily living |
Current research/knowledge gaps | |
 Pathophysiological mechanisms | Pathophysiological mechanisms causing/contributing to the initial muscle loss and ongoing muscle weakness are poorly understood |
 Potential effects of ET and research gaps | Potential to decrease muscle atrophy, reduce delirium, mechanical ventilation, and ICU length of stay, and improve functional capacity at hospital discharge |
Limited evidence of ET’s impacts on biomechanical and cellular factors that affect muscle strength and function during/after critical illness | |
Therefore, limited evidence to guide optimal therapy and interventions to prevent and improve this muscle weakness | |
 Optimised ET delivery | The optimal dose, type, and timing of ET delivery to maximise effectiveness is currently unknown |
 Long-term impacts of ET | The longer-term impact of optimised and individualised ET on patient outcomes needs to be further explored |