Category: Clinical Sciences/Health Conditions
The mortality rate associated to ICU is well studied, as its predictors. However, functional prognosis of patients admitted for prolonged time in ICU is not described nor the high functional incapacity due to its iatrogenesis. With this work we demonstrate the important role of PRM in the recovery of the functional status of these patients.
We present the case ofa 39 years old male, previously autonomous in ADL with irrelevant medical history. He was taken to the ER after being found unconscious at home. Due to a left hemispheric acute subdural hematoma, he was submitted to craniotomy drainage. He was admitted in an ICU where he developed a septic shock with multi-organ dysfunction. After 362 days of hospitalization, having had several complications, requiring multiple cycles of antibiotic therapy and medical treatment adjustment, with disastrous consequences (peripheral and central deconditioning, chronic respiratory failure, partial amputation of the hands and transtibial bilateral, among others) the patient was clinically stable and was transferred to a rehabilitation center and submitted to an intensive rehabilitation program.
The medical support in ICU, its aggressive treatment, the antibiotic therapy, and multiorgan support saves many lifes. As this medical support is improving, the mortality rates associated to ICU care are decreasing. However, this aggressive approach is associated to iatrogenesis. Patients in need of a prolonged time in ICU hospitalization, present most of the times multiple comorbidities, complex clinical – functional settings and a high level of dependency and a require, often while inpatient, an interdisciplinary holistic approach.
The authors present a paradigmatic picture of this situation. A great investment was made to save this patient life, but this led to a devastating functional incapacity. This case presents the importance of the rehabilitation after ICU hospitalization.