Clinician Article

Interventions to improve the physical function of ICU survivors: a systematic review.

  • Calvo-Ayala E
  • Khan BA
  • Farber MO
  • Ely EW
  • Boustani MA
Chest. 2013 Nov;144(5):1469-1480. doi: 10.1378/chest.13-0779. (Review)
PMID: 23949645
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  • Intensivist/Critical Care
    Relevance - 6/7
    Newsworthiness - 6/7
  • Physical Medicine and Rehabilitation
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 5/7
    Newsworthiness - 5/7


BACKGROUND: ICU admissions are ever increasing across the United States. Following critical illness, physical functioning (PF) may be impaired for up to 5 years. We performed a systematic review of randomized controlled trials evaluating the efficacy of interventions targeting PF among ICU survivors. The objective of this study was to identify effective interventions that improve long-term PF in ICU survivors.

METHODS: MEDLINE, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence-Based Database (PEDro) were searched between 1990 and 2012. Two reviewers independently evaluated studies for eligibility, critically appraised the included studies, and extracted data into standardized evidence tables.

RESULTS: Fourteen studies met the inclusion criteria. Interventions included exercise/physical therapy (PT), parenteral nutrition, nurse-led follow-up, spontaneous awakening trials, absence of sedation during mechanical ventilation, and early tracheotomy. Nine studies failed to demonstrate efficacy on PF of the ICU survivors. However, early physical exercise and PT-based interventions had a positive effect on long-term PF.

CONCLUSIONS: The only effective intervention to improve long-term PF in critically ill patients is exercise/PT; its benefit may be greater if started earlier. Further research in this area comparing different interventions and timing is needed.

Clinical Comments

Intensivist/Critical Care

This is a systematic review of the effectiveness of several interventions that may modify recovery from ICU. Long-term impairment post ICU is sufficiently common to warrant attention. Unfortunately, no therapy was found to modify the course as noted except physical therapy.

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