Long-Term Rehabilitation for Intensive Care Unit-acquired Weakness with Orthostatic Hypotension Following Severe Pneumonia：A Case Report

Satoshi Endo; Michio Kobayashi; Takafumi Tani; Shohei Toyama; Ryota Seo; Masayoshi Obana

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Long-Term Rehabilitation for Intensive Care Unit-acquired Weakness with Orthostatic Hypotension Following Severe Pneumonia：A Case Report

VernacularTitle:Long-Term Rehabilitation for Intensive Care Unit-acquired Weakness with Orthostatic Hypotension Following Severe Pneumonia：A Case Report
Author: Satoshi ENDO ¹ ; Michio KOBAYASHI ² ; Takafumi TANI ³ ; Shohei TOYAMA ² ; Ryota SEO ⁴ ; Masayoshi OBANA ²
Author Information

1. Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo
2. Department of Emergency and Critical Care Medicine, Japanese Red Cross Ishinomaki Hospital
3. Department of Rehabilitation, Tokyo Metropolitan Health and Medical Treatment Corporation Ebara Hospital
4. Department of Rehabilitation, Japanese Red Cross Ishinomaki Hospital
Keywords: intensive care unit-acquired weakness; critical illness polyneuropathy; orthostatic hypotension; exercise strength; nerve conduction studies
From:The Japanese Journal of Rehabilitation Medicine 2018;55(6):508-515
CountryJapan
Language:Japanese
Abstract: A 66-year-old man was admitted to our intensive care unit because of severe pneumonia. He was treated with mechanical ventilation, antibiotics, and corticosteroids, but muscle weakness developed rapidly. His muscle strength declined to a Medical Research Council scale sum score of 18/60；thus, a diagnosis of intensive care unit-acquired weakness (ICU-AW) was made. The results of nerve conduction studies were compatible with critical illness polyneuropathy. Mechanical ventilation was required for 95 days because of continuous respiratory failure. Rehabilitation began at 48 hours after hospitalization and was continued to prevent immobilization even when he was mechanically ventilated. However, orthostatic hypotension developed and inhibited mobility training. Physical and occupational therapies provided muscle strengthening exercises followed by a progressive mobility program that assisted him to raise his head, sit on the edge of the bed, and stand up. The intervention was performed within safety criteria of vital signs and the rating of perceived exertion (RPE) Borg scale between 11 and 13. It resulted in the attenuation of orthostatic hypotension and the recovery of muscle strength. He finally achieved independence in activities of daily living and the ability to walk without help after 271 days of admission. This case report suggests that long-term rehabilitation within safety criteria of vital signs and RPE Borg scale between 11 and 13 is safe and feasible without overuse weakness for ICU-AW with orthostatic hypotension.