Organization of Rehabilitation in the ICU

These interventions could easily be adapted and applied to a rehabilitative model of care for all ICU patients. Outcomes of early rehabilitation in patients with TBI were reported by Mammi et al. (10) to reduce care costs and LOS without affecting outcome. 

Many of the rehabilitation strategies for critically ill patients are organized in facilities for long-term mechanical ventilation (LTMV) or within specialized respiratory ICUs. Patients are transferred to these facilities when their LOS in ICU exceeds a set criterion (often 21 days) or when the patient is perceived as difficult to wean. Several investigators have 

In the United Kingdom, there are few specialized facilities for LTMV, as a result, patients may need to be managed for protracted periods within the ICU. The core team usually consists of the intensivist, nurse, and PT, with dieticians, pharmacists, and microbiologists making up the peripheral ICU team on a part-time basis (Fig. 3). The rehabilitation process should exist within a practical framework, coordinated by enthusiastic, knowledgeable, experienced, and motivated professionals. 

Stuck et al. (2) has suggested that the principles of early rehabilitation can be classified into (1) nonspecialized rehabilitation and (2) specialized rehabilitation. 

This classification is a useful distinction that can be applied to the conceptual rehabilitation model and framework (Figs. 4 and 5). The core ICU team undertakes the acute and intermediate phase of nonspecialized rehabilitation. The long-term phase is specialized rehabilitation and again undertaken by the core ICU team but in collaboration with other relevant specialist practitioners, such as speech and language and occupational therapy, to optimize the patients rehabilitation potential. 

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Health care providers often see rehabilitation as something that takes place post-ICU after an acute episode of illness and is organized by a specialized rehabilitation facility. However, there is often little opportunity to send post-ICU patients to a specialized rehabilitation facility at the time they require such an intervention. Figure 1 shows data from two general ICUs in the south of England from 2004 to 2005, noting the time that 13 patients spent waiting for placement in a rehabilitation facility. These patients had already spent more than 21 days in the ICU ... 

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