Does enhanced physical rehabilitation following intensive care unit discharge improve outcomes in patients who received mechanical ventilation? A systematic review and meta-analysis

Abstract

ObjectiveWe aimed to determine whether enhanced physical rehabilitation following intensive care unit (ICU) discharge improves activities-of-daily-living function, quality of life (QOL) and mortality among patients who received mechanical ventilation in the ICU.DesignSystematic review and meta-analysis using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Data sourcesMEDLINE, Embase, CENTRAL, PEDro and WHO International Clinical Trials Registry Platform searched through January 2019.Eligibility criteria for selecting studiesWe included randomised controlled trials assessing the effect of post-ICU rehabilitation designed to either commence earlier and/or be more intensive than the protocol employed in the control group. Only adults who received mechanical ventilation for >24 hours were included.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias. Standard mean differences (SMDs) with 95% CIs were calculated for QOL, and pooled risk ratios (RRs) with 95% CIs are provided for mortality. We assessed heterogeneity based on I² and the certainty of evidence based on the GRADE approach.ResultsTen trials (enrolling 1110 patients) compared physical rehabilitation with usual care or no intervention after ICU discharge. Regarding QOL, the SMD (95% CI) between the intervention and control groups for the physical and mental component summary scores was 0.06 (–0.12 to 0.24) and −0.04 (−0.20 to 0.11), respectively. Rehabilitation did not significantly decrease long-term mortality (RR 1.05, 95% CI 0.66 to 1.66). The analysed trials did not report activities-of-daily-living data. The certainty of the evidence for QOL and mortality was moderate.ConclusionsEnhanced physical rehabilitation following ICU discharge may make little or no difference to QOL or mortality among patients who received mechanical ventilation in the ICU. Given the wide CIs, further studies are needed to confirm the efficacy of intensive post-ICU rehabilitation in selected populations.PROSPERO registration numberCRD42017080532.

Functional ability and quality of life in critical illness survivors with intensive care unit acquired weakness: A secondary analysis of a randomised controlled trial

“…Fourth, while it seemed that patients with ICUAW recovered, this observational study can draw no conclusions about possible interventions. Given that post-ICU rehabilitation presently lacks evidence to improve quality of life [46], the pathways of recovery need further investigation. A prospective mixed-methods cohort study might reveal possible interventions to target for future studies.…”

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“…As of 15 May 2020, 4 405 680 coronavirus 2019 (COVID- 19) cases have been reported worldwide [1]. Although figures are increasing, it seems the virus aggression is lowering, significantly reducing the pressure on the intensive care unit (ICU) beds.…”

“…Although PICS is a well-established finding in non-COVID-19 ARDS patients, its treatment is still under development [16,17]. Randomised controlled trials to date have not shown significant effects of post-ICU rehabilitation and exercise interventions [18][19][20]. Although patient's characteristics were considered to impact on the outcome of functional exercise performance in a secondary analysis of studies by DENEHY and co-workers [21,22], the programme content might be a more critical determinant of the lack of effectiveness.…”

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