Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial

Brummel, Nathan E.; Girard, Timothy D.; Ely, E. Wesley; Pandharipande, Pratik P.; Morandi, Alessandro; Hughes, Christopher; Graves, Amy J.; Shintani, Ayumi; Murphy, Edel; Work, Brittany; Pun, Brenda T.; Boehm, Leanne M.; Gill, Thomas M.; Dittus, Robert S.; Jackson, James C.

doi:10.1007/s00134-013-3136-0

Cited by 192 publications

(229 citation statements)

References 43 publications

Supporting

Mentioning

216

Contrasting

Unclassified

Order By: Relevance

“…Research bias was avoided when the outcome measures were performed by a physical therapist blinded to group allocation. 21,23 In contrast, some studies were exposed to potential bias related to the inability to blind healthcare workers, participants and outcome assessors. 11,19,20,22,23 This may have influenced interventions and the results of functional measures.…”

Section: Strengths and Limitations Of The Included Studiesmentioning

confidence: 93%

“…Studies were further limited by small sample size and single sites. 19,20,[22][23][24] This may impact upon the ability to generalise the results to all critically ill populations. Small sample size may have been insufficient to show between-group differences in secondary outcomes for some studies 24 whilst loss of subjects further diminished sample size.…”

Section: Strengths and Limitations Of The Included Studiesmentioning

confidence: 98%

See 1 more Smart Citation

Early rehabilitation in the intensive care unit: An integrative literature review

Sosnowski

Lin

Mitchell

et al. 2015

Australian Critical Care

View full text Add to dashboard Cite

show abstract

Section: Strengths and Limitations Of The Included Studiesmentioning

confidence: 93%

Section: Strengths and Limitations Of The Included Studiesmentioning

confidence: 98%

Early rehabilitation in the intensive care unit: An integrative literature review

Sosnowski

Lin

Mitchell

et al. 2015

Australian Critical Care

View full text Add to dashboard Cite

show abstract

“…We evaluated effect of early‐stage rehabilitation on PICS‐related outcomes used our meta‐analysis (8 studies; Brunmmel et al .,441 Burtin et al .,442 Dantas et al .,443 Denehy et al .,444 Jones et al .,445 Kayamabu et al .,446 Pattanshetty et al .,447 and Schweickert et al 231436, 448.…”

Section: Cq18: Icu‐acquired Weakness (Icu‐aw) and Post‐intensive Carementioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

View full text Add to dashboard Cite

Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

show abstract

“…The RETURN study found a significant improvement in cognitive function following a 12-week programme of rehabilitation compared with the 'usual care' package of sporadic rehabilitation, 65 whereas the Activity and Cognitive Therapy (ACT) in the ICU trial demonstrated the feasibility of providing combined cognitive and physical rehabilitation for mechanically ventilated patients whilst on the ICU. 67 Interestingly, physical rehabilitation has also been shown to improve psychological symptoms following discharge from the ICU. 68 Unfortunately, however, despite on-going research, a recent systematic review has failed to demonstrate the cost-effectiveness of rehabilitation interventions following intensive care discharge.…”

mentioning

confidence: 99%

The psychological and neurocognitive consequences of critical illness. A pragmatic review of current evidence

Clancy

Edginton

Casarin

et al. 2015

Journal of the Intensive Care Society

View full text Add to dashboard Cite

Mortality rates alone are no longer a sufficient guide to quality of care. Due to medical advances, patients are surviving for longer following critical illness and major surgery; therefore, functional outcomes and long-term quality of life are of increasing consequence. Post-operative cognitive dysfunction has been acknowledged as a complication following anaesthesia for many years, and interest in persistent cognitive dysfunction following a critical illness is growing. Psychological and neurocognitive sequelae following discharge from intensive care are acknowledged to occur with sufficient significance to have recently coined the term 'the post-intensive care syndrome'. Rehabilitation following critical illness has been highlighted as an important goal in recently published national UK guidelines, including the need to focus on both physical and non-physical recovery. Neuropsychological and cognitive consequences following anaesthesia and critical illness are significant. The exact pathophysiological mechanisms linking delirium, cognitive dysfunction and neuropsychological symptoms following critical illness are not fully elucidated but have been studied elsewhere and are outside the scope of this article. There is limited evidence as yet for specific peri-operative preventative strategies, but early management and rehabilitation strategies following intensive care discharge are now emerging. This article aims to summarise the issues and appraise current options for management, including both neuroprotective and neurorehabilitative strategies in intensive care. KeywordsIntensive care, critical illness, rehabilitation, cognitive dysfunction, delirium, post-traumatic stress disorder Over the last decade, there has been an increase in the complexity of patients presenting to intensive care, due in part to the severity of co-morbidities at presentation and an increasingly elderly population. Despite this, mortality rates are improving; the long-term consequences of critical illness are thus becoming ever more relevant. The risk factors and pathogenesis of delirium and post-cognitive dysfunction have been reviewed thoroughly elsewhere. This article summarises the relevant findings in these areas and deliberately focuses on the psychological and neurocognitive sequelae following critical illness including depression, anxiety, post-traumatic stress disorder and cognitive dysfunction; reviewing the evidence for incidence, pathophysiology and management. Psychological and neurocognitive consequences of critical illnessThe neuropsychological sequelae that occur following a critical care admission are numerous and can be highly distressing for patients and their families. Symptoms that occur include intrusive memories, delusions, delirium, panic episodes and nightmares. Conditions such as depression, anxiety, post-traumatic stress disorder (PTSD) and cognitive dysfunction are increasingly recognised among patients who survive an intensive care admission and are described collectively as the 'post-intensive care...

show abstract

Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial

Cited by 192 publications

References 43 publications

Early rehabilitation in the intensive care unit: An integrative literature review

Early rehabilitation in the intensive care unit: An integrative literature review

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016)

The psychological and neurocognitive consequences of critical illness. A pragmatic review of current evidence

Contact Info

Product

Resources

About