Effect of Early Rehabilitation Interventions on ICU-Acquired Weakness Prevention in Critically Ill Patients

Abstract

Background: Intensive care unit-acquired weakness (ICUAW) is an acute neuromuscularimpairment that occurs frequently in the context of critical illness. ICUAW is associated withprolonged MV, increased length of ICU stay, increased healthcare-related costs, long-termdisability, higher ICU, and hospitalization mortality. ICUAW prevention depends mainly onnursing preventive measures, including early rehabilitation, which includes positioning andmotion exercises (active, passive, and active-assisted) for each joint combined withneuromuscular electrical stimulant NMEs. Objective: Determine the effect of earlyrehabilitation intervention on ICU-Acquired weakness prevention in critically ill patients.Settings: The study was carried out in four adult ICUs, namely unit II, unit III, unit IV, and theCRRT unit at the Alexandria Main University, Egypt. Subjects: A convenient sample of 80adult patients who were newly admitted to the previously mentioned ICUs. The sample wasdivided into two equal groups (40 patients each in the group). Tools: Three tools were used.Tool one: “Intensive care unit acquired weakness associated factors assessment". Tool Two:"Physiological parameters and laboratory investigation assessment record". Tool Three:"Effect of early rehabilitation interventions assessment". Results: Following theimplementation of the early rehabilitation intervention, on day sixth, there was a markedincrease in ICUAW among control patients at 85%, with a lower severity according to a meanMRC score of 43.00 ± 4.95 compared to just 15% occurrence in the study group with a higherseverity according to a mean MRC score of 55.88 ± 5.93. This difference was highlystatistically significant (χ2=39.29 p=<0.001). Conclusion: Critically ill patients who aresubjected to early rehabilitation interventions exhibit lower ICU-acquired weakness scoresthan those who are not subjected. Also, the frequency of ICUAW occurrence was higher inpatients who did not receive early rehabilitation intervention. So, early rehabilitation is aprotective factor against the occurrence and severity of ICUAW. Recommendations:Implement early NMES sessions for half an hour combined with early passive ROM exercisesfor half an hour for upper and lower extremity joints from the first 24 hours of admission forone hour till patients discharge from the ICU. Assess the muscle strength of all admittedpatients to the ICU using a muscle strength scale and hand grip scale as a routine by nursesand medical staff.