YOĞUN BAKIM ÜNİTELERİNDE BAKIMA YÖNELİK REHABİLİTASYON

Öz

Günümüzde tıbbın ilerlemesi, hemşirelik bakım kalitesinin artmasıyla birlikte yoğun bakım hastaların sağkalım oranlarını önemli ölçüde iyileştirmiştir. Yoğun bakımda uzun süren tedavi süreci, hastalarda egzersiz toleransı, fonksiyonel durum ve sağlıkla ilişkili yaşam kalitesinde azalmaya yol açar. Yoğun bakım ünitesinden (YBÜ) taburcu olduktan sonra hastalarda genel kondisyon kaybı, kas zayıflığı, dispne, depresyon ve anksiyete gibi bir çok problemin ortaya çıktığı görülmektedir. Sonuç olarak, hastalık iyileştikten çok sonra hastaların yoğun bakımda geçirmiş olduğu süreç işlev bozukluklarına yol açabilir. İşte tam da burada kayıpları en aza indirmek için hastalara yatışından itibaren fonksiyonel rehabilite edici tedaviler ve bakım protokolleri uygulanmalıdır.

Anahtar Kelimeler

• Yoğun bakım
• Rehabilitasyon
• Hemşirelik

REHABILITATION FOR CARE IN INTENSIVE CARE UNITS

Öz

Today, with the advancement of medicine and the increase in the quality of nursing care, intensive care has significantly improved the survival rates of patients. Prolonged treatment in the intensive care unit (ICU) leads to deterioration in patients' physical capacity, functional status, and health-related quality of life. After discharge from the ICU, patients experience many problems, such as loss of general condition, muscle weakness, dyspnea, depression, and anxiety. Consequently, the process that patients go through in the ICU can lead to functional disorders long after the disease has healed. This is exactly where functional rehabilitation treatments and care protocols should be applied to patients from their hospitalization to minimize losses.

Anahtar Kelimeler

• Intensive care
• Rehabilitation
• Nursing

Kaynakça

1. Castilho, T., Itaborahy, B. D. H., Hoepers, A., de Brito, J. N., Ana, A. C., & Schivinski, C. I. S. (2020). Effects of inspiratory muscle training and breathing exercises in children with asthma: A systematic review. Journal of Human Growth and Development, 30(2), 291–300. https://doi.org/10.7322/JHGD.V30.10381
2. Chiang, L. L., Wang, L. Y., Wu, C. P., Wu, H. D., & Wu, Y. T. (2006). Effects of physical training on functional status in patients with prolonged mechanical ventilation. Physical Therapy, 86(9), 1271–1281. https://doi.org/10.2522/ptj.20050036
3. Corner, E. J., Murray, E. J., & Brett, S. J. (2019). Qualitative, grounded theory exploration of patients’ experience of early mobilisation, rehabilitation and recovery after critical illness. BMJ Open, 9(2). https://doi.org/10.1136/bmjopen-2018-026348
4. Da Conceição, T. M. A., Gonzáles, A. I., De Figueiredo, F. C. X. S., Rocha Vieira, D. S., & Bündchen, D. C. (2017). Safety criteria to start early mobilization in intensive care units. Systematic review. Revista Brasileira de Terapia Intensiva, 29(4), 509–519. https://doi.org/10.5935/0103-507X.20170076
5. Davydow, D. S., Zatzick, D., Hough, C. L., & Katon, W. J. (2013). In-hospital acute stress symptoms are associated with impairment in cognition 1 year after intensive care unit admission. Annals of the American Thoracic Society, 10(5), 450–457. https://doi.org/10.1513/AnnalsATS.201303-060OC
6. Donner, C., Ambrosino, N., & Goldstein, R. S. (2020). Pulmonary Rehabilitation (2nd Editio). London: Taylor & Francis Group, LLC. https://doi.org/https://doi.org/10.1201/9781351015592
7. Dunn, H., Quinn, L., Corbridge, S. J., Eldeirawi, K., Kapella, M., & Collins, E. G. (2017). Mobilization of prolonged mechanical ventilation patients: An integrative review. Heart & Lung, 46(4), 221–233. https://doi.org/https://doi.org/10.1016/j.hrtlng.2017.04.033
8. Franklin, E., & Anjum, F. (2023). Incentive Spirometer and Inspiratory Muscle Training. Treasure Island (FL).

9. GOLD(Global Initiative for Chronic Obstructive Lung Disease), (2020). Global Strategy For The Dıagnosıs, Management, And Preventıon Of Chronıc Obstructıve Pulmonary Dısease (Report). USA.
10. Gosselink, R., & Clini, E. (2018). Rehabilitation in Intensive Care. In E. Clini, A. E. Holland, F. Pitta, & T. Troosters (Eds.), Textbook of Pulmonary Rehabilitation (pp. 349–365). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-65888-9_26
11. Griffiths, T. L., Phillips, C. J., Davies, S., Burr, M. L., & Campbell, I. A. (2001). Cost effectiveness of an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax, 56(10), 779–784. https://doi.org/10.1136/thorax.56.10.779
12. Gutierrez-Arias, R., Hinojosa-Riadi, J., Sandoval-Cañío, A., Santana-Garrido, H., Valdovinos-Guerrero, N., & Seron, P. (2023). Effectiveness of Respiratory Muscle Training in Adults With Pulmonary Hypertension. A Systematic Review and Meta-Analysis. Heart, Lung and Circulation, 32(3), 315–329. https://doi.org/https://doi.org/10.1016/j.hlc.2022.11.010
13. Henderson, W. R., Griesdale, D. E. G., Dominelli, P., & Ronco, J. J. (2014). Does prone positioning improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome? Canadian Respiratory Journal, 21(4), 213–215. https://doi.org/10.1155/2014/472136
14. Hill, K., Goldstein, R., Gartner, E. J., & Brooks, D. (2008). Daily Utility and Satisfaction With Rollators Among Persons With Chronic Obstructive Pulmonary Disease. Archives of Physical Medicine and Rehabilitation, 89(6), 1108–1113. https://doi.org/https://doi.org/10.1016/j.apmr.2007.11.032
15. Jang, M. H., Shin, M. J., & Shin, Y. B. (2019). Pulmonary and physical rehabilitation in critically ill patients. Acute and Critical Care, 34(1), 1–13. https://doi.org/10.4266/acc.2019.00444
16. Kämppi, M. (2017). Smart Rollator. Helsinki Metropolia University of Applied Sciences.
17. Keens, T. G., Krastins, I. R. B., Wannamaker, E. M., Levison, H., Crozier, D. N., & Bryan, A. C. (1977). Ventilatory Muscle Endurance Training in Normal Subjects and Patients with Cystic Fibrosis. American Review of Respiratory Disease, 16(5).
18. Kim, D. (2018). Rehabilitation and intensive care unit. Acute and Critical Care, 33(1), 43–45. https://doi.org/10.4266/acc.2018.00080
19. Kılıc, L., & Pehlivan, E. (2020). Pulmonary Rehabilitation in the Intensive Care Unit. Güncel Göğüs Hastalıkları Serisi, 7(1), 144–159. https://doi.org/10.5152/gghs.2019.016
20. Levine, S., Nguyen, T., Taylor, N., Friscia, M. E., Budak, M. T., Rothenberg, P., … Shrager, J. B. (2008). Rapid Disuse Atrophy of Diaphragm Fibers in Mechanically Ventilated Humans. New England Journal of Medicine, 358(13), 687–696.
21. Pathmanathan, N., Beaumont, N., & Gratrix, A. (2015). Respiratory physiotherapy in the critical care unit. Continuing Education in Anaesthesia, Critical Care and Pain, 15(1), 20–25. https://doi.org/10.1093/bjaceaccp/mku005
22. Pisani, M. A., Friese, R. S., Gehlbach, B. K., Schwab, R. J., Weinhouse, G. L., & Jones, S. F. (2015). Sleep in the intensive care unit. American Journal of Respiratory and Critical Care Medicine, 191(7), 731–738. https://doi.org/10.1164/rccm.201411-2099CI
23. Rochester, C. L. (2009). Rehabilitation in the intensive care unit. Seminars in Respiratory and Critical Care Medicine, 30(6), 656–669. https://doi.org/10.1055/s-0029-1242635
24. Satti, A. G., Derr, M., & Fornek, Ma. L. (2016). Rehabilitation in the Intensive Care Unit. In G. J. Criner (Ed.), Critical Care Study Guide (Second Edi, pp. 1193–1205). USA: Springer. https://doi.org/10.1007/978-0-387-77452-7
25. Schujmann, D. S., Lunardi, A. C., & Fu, C. (2018). Progressive mobility program and technology to increase the level of physical activity and its benefits in respiratory, muscular system, and functionality of ICU patients: Study protocol for a randomized controlled trial. Trials, 19(1), 1–10. https://doi.org/10.1186/s13063-018-2641-4
26. Shei, R. J., Paris, H. L. R., Wilhite, D. P., Chapman, R. F., & Mickleborough, T. D. (2016). The role of inspiratory muscle training in the management of asthma and exercise-induced bronchoconstriction. Physician and Sportsmedicine, 44(4), 327–334. https://doi.org/10.1080/00913847.2016.1176546
27. Swaminathan, N., Praveen, R., & Surendran, P. (2019). The role of physiotherapy in intensive care units: a critical review. Physiotherapy Quarterly, 27(4), 1–5. https://doi.org/10.5114/pq.2019.87739
28. WHO. (2017). Rehabilitation in Health Systems. Switzerland: World Health Organization. Retrieved from https://www.who.int/publications/i/item/9789241549974