PHTY300 Lecture Notes - Lecture 5: Skeletal Muscle, Hyperglycemia, Polyneuropathy
Document Summary
Phty 300 wk 5 lectures - rehabilitation in icu. Muscle function and bedrest: prolonged best rest causes: Decreased muscle mass, especiall in lower extremities: short term immobility may impair microvascular function and induce insulin resistance, which potentiates injuries to muscles and nerves in the critically ill. Increases pro-inflammatory cytokines cause further muscle damage and loss: postural hypotension and tachycardia, prolonged physical inactivity can result in generalized pain and changes in mood, which may limit physical function. Mulit-organ failure: treatments for critical illness may have an effect on muscle function. Paralysis (neuromuscular blocking agents, nmba) and sedation. Trends in management: decrease sedation, avoid corticosteroids and nmba, adequate nutrition, early mobilization. Mobilization in icu: practicalities and risk assessment. Training protocol: high intensity (50% mip, 6 sets of 6 breaths, daily, 2 weeks. Increased qol (one measure only: more in hospital deaths (non respiratory causes) Reasons for ventilatory support: pump support hypercapnic respiratory failure, lung support hypoxaemic respiratory failure.
