Document Type : Research articles
Authors
1
Assistant lecturer Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University
2
Professor Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University
3
Professor Critical Care Medicine, Faculty of Medicine, Alexandria University
4
Assistant professor Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University
Abstract
Background: Intensive care unit-acquired weakness (ICUAW) is an acute neuromuscular
impairment that occurs frequently in the context of critical illness. ICUAW is associated with
prolonged MV, increased length of ICU stay, increased healthcare-related costs, long-term
disability, higher ICU, and hospitalization mortality. ICUAW prevention depends mainly on
nursing preventive measures, including early rehabilitation, which includes positioning and
motion exercises (active, passive, and active-assisted) for each joint combined with
neuromuscular electrical stimulant NMEs. Objective: Determine the effect of early
rehabilitation 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 the
CRRT unit at the Alexandria Main University, Egypt. Subjects: A convenient sample of 80
adult patients who were newly admitted to the previously mentioned ICUs. The sample was
divided 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 the
implementation of the early rehabilitation intervention, on day sixth, there was a marked
increase in ICUAW among control patients at 85%, with a lower severity according to a mean
MRC score of 43.00 ± 4.95 compared to just 15% occurrence in the study group with a higher
severity according to a mean MRC score of 55.88 ± 5.93. This difference was highly
statistically significant (χ2=39.29 p=<0.001). Conclusion: Critically ill patients who are
subjected to early rehabilitation interventions exhibit lower ICU-acquired weakness scores
than those who are not subjected. Also, the frequency of ICUAW occurrence was higher in
patients who did not receive early rehabilitation intervention. So, early rehabilitation is a
protective factor against the occurrence and severity of ICUAW. Recommendations:
Implement early NMES sessions for half an hour combined with early passive ROM exercises
for half an hour for upper and lower extremity joints from the first 24 hours of admission for
one hour till patients discharge from the ICU. Assess the muscle strength of all admitted
patients to the ICU using a muscle strength scale and hand grip scale as a routine by nurses
and medical staff.
Keywords
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