RESUMEN
Obesity has become increasingly prevalent in the intensive care unit, presenting a significant challenge for healthcare systems and professionals, including rehabilitation teams. Caring for critically ill patients with obesity involves addressing complex issues. Despite the well-established and safe practice of early mobilization during critical illness, in rehabilitation matters, the diverse clinical disturbances and scenarios within the obese patient population necessitate a comprehensive understanding. This includes recognizing the importance of metabolic support, both non-invasive and invasive ventilatory support, and their weaning processes as essential prerequisites. Physiotherapists, working collaboratively with a multidisciplinary team, play a crucial role in ensuring proper assessment and functional rehabilitation in the critical care setting. This review aims to provide critical insights into the key management and rehabilitation principles for obese patients in the intensive care unit.
RESUMEN
During the coronavirus disease 2019 (COVID-19) pandemic, clinical staff learned how to manage patients enduring extended stays in an intensive care unit (ICU). COVID-19 patients requiring critical care in an ICU face a high risk of experiencing prolonged intensive care (PIC). The use of invasive mechanical ventilation in individuals with severe acute respiratory distress syndrome can cause numerous complications that influence both short-term and long-term morbidity and mortality. Those risks underscore the importance of proactively addressing functional complications. Mitigating secondary complications unrelated to the primary pathology of admission is imperative in minimizing the risk of PIC. Therefore, incorporating strategies to do that into daily ICU practice for both COVID-19 patients and those critically ill from other conditions is significantly important.
RESUMEN
Ultrasound is a pluripotential tool that has been shown to be useful in the diagnostic study and evolutionary control of different pathologies. The use of protocols (BLUE, FALLS, PINK) has shown high diagnostic precision in entities such as pneumonía, pulmonary embolism, pneumothorax, heart failure, diaphragmatic or musculoskeletal evaluation. Its exponential growth has positioned the technique as the preferred option for non-invasive and bedside evaluation. This article proposes a simplified and non-systematic review, of quick and easy reading, of the reasons why ultrasound has become, in recent years, a standard of care for critically ill patients.
La ecografía es una herramienta pluripotencial que ha mostrado ser útil en el estudio diagnóstico y control evolutivo de distintas patologías. El empleo de protocolos (BLUE, FALLS, PINK) ha mostrado una alta precisión diagnóstica en entidades como neumonía, embolismo pulmonar, neumotórax, insuficiencia cardíaca, evaluación diafragmática o músculo-esquelética. Su crecimiento exponencial ha posicionado a la técnica como la opción de preferencia para la evaluación no invasiva y a pie de cama. Este artículo propone una revisión simplificada y no sistemática, de lectura rápida y sencilla, de las razones por las cuales la ecografía se ha convertido, en los últimos años, en un estándar de cuidado para los pacientes críticamente enfermos.
Asunto(s)
Humanos , Ultrasonografía/métodos , Unidades de Cuidados Intensivos , Cuidados CríticosRESUMEN
The patient with tracheostomy could has a functional progression as soon as possible if the clinical stability allow the intervention in the critical ill patient. It is important to remove the mechanical ventilation quickly and safety. Every day is needed to make evaluation and interventions for progress thinking in a tracheostomy protocol decannulation.
El paciente con traqueostomía puede ser progresado de manera funcional desde el primer día que se realice dicho procedimiento siempre y cuando la estabilidad del paciente lo permita. Es necesario realizar evaluaciones e intervenciones con el objetivo de desvincular de la ventilación mecánica lo antes posible y poder comenzar con el protocolo de decanulación de manera personalizada y segura para evitar el fracaso de la misma.
Asunto(s)
Humanos , Respiración Artificial , Traqueostomía/métodos , Algoritmos , Desconexión del Ventilador/métodos , Protocolos Clínicos , Enfermedad Crítica , Unidades de Cuidados IntensivosRESUMEN
Invasive mechanical ventilation is a frequent therapy in critically ill patients in critical care units. To achieve favorable outcomes, patient and ventilator interaction must be adequate. However, many clinical situations could attempt against this principle and generate a mismatch between these two actors. These asynchronies can lead the patient to worst outcomes; that is why it is vital to recognize and treat these entities as soon as possible. Early detection and recognition of the different asynchronies could favor the reduction of the days of mechanical ventilation, the days of hospital stay, and intensive care and improve clinical results.
RESUMEN
Resumen: La movilización temprana (MT) es la implementación de ejercicio físico en los pacientes ingresados en la Unidad de Cuidados Intensivos (UCI) observándose beneficios importantes como reducción de neumonías asociadas con ventilación mecánica (NAVM), trombosis venosa profunda, úlceras por presión, debilidad adquirida en la UCI (DAUCI). Además, tiene un impacto financiero al reducir los días de estancia hospitalaria y en la UCI. Cabe mencionar que la MT impacta en el desenlace posterior al alta hospitalaria reduciendo la aparición de síndrome postcuidados intensivos (PICS).
Abstract: Early mobilization (EM) is the implementation of physical exercise in patients admitted to the Intensive Care Unit (ICU), with important benefits being observed such as reduction of ventilator-associated pneumonia, deep vein thrombosis, pressure ulcers and ICU-acquired weakness (ICU-AW). It also has a financial impact by reducing hospital length of stay and in the ICU. Also, EM has an important role in the outcome once the patient leaves the hospital reducing the post-intensive care syndrome (PICS).
Resumo: A mobilização precoce (MP) é a implementação de exercícios físicos em pacientes internados em Unidade de Terapia Intensiva (UTI), observando benefícios importantes como redução da pneumonia associada à ventilação mecânica (PAV), trombose venosa profunda, úlceras por pressão, fraqueza adquirida no UTI (DAUCI). Além disso, tem impacto financeiro ao reduzir os dias de internação e internação na UTI. Vale ressaltar que a MT tem impacto no desfecho após a alta hospitalar por reduzir o aparecimento da Síndrome de Terapia Pós-Intensiva (PICS).