ICU · Rehabilitation

Pulmonary rehabilitation and functional recovery after ICU admission

Also known as Pulmonary rehabilitation after critical illness · Post-ICU rehabilitation · Exercise training after critical illness · Respiratory muscle training · Early mobilisation in ICU · Post-intensive care syndrome - physical domain · ICU-acquired weakness rehabilitation · Inspiratory muscle training

Pulmonary and functional rehabilitation after critical illness targets the physical deconditioning, respiratory and limb-muscle weakness, and reduced exercise tolerance that persist long after the acute insult resolves. It is the active treatment arm of the PHYSICAL DOMAIN of the post-intensive care syndrome (PICS). Components: (1) early mobilisation begun IN the ICU (passive range of motion → active-assisted → active → sitting → standing → walking); (2) exercise training — aerobic (walking, cycling, arm ergometry) plus resistance (8-10 muscle groups); (3) respiratory/inspiratory muscle training (incentive spirometry, threshold IMT); (4) education, psychological support, nutritional counselling. Assessment tools: MRC sum score (ICU-acquired weakness), handgrip dynamometry, 6-minute walk test (6MWT), PFIT-s / FSS-ICU / CPAX, Barthel/FIM. ICU-acquired weakness (CIP/CIM) affects about a quarter of patients ventilated more than 7 days (25.3% in the landmark cohort) and is the dominant reversible physical deficit. Evidence is mixed and nuanced: Schweickert 2009 (Lancet) and Burtin 2009 showed early mobilisation improves function, but the larger TEAM trial (Hodgson, NEJM 2022) found routine aggressive early active mobilisation did NOT improve 180-day outcomes and caused more adverse events — practice has shifted to SELECTIVE, goal-directed mobilisation. Timing: begin in ICU → continue on ward → formal pulmonary rehab programme 4-8 weeks post-discharge for 6-12 weeks. In ARDS survivors, physical function remained below normal predicted levels at 5 years; structured rehabilitation is essential.