Week 2

Question 1

Critical illness is often associated with a stay in the ____

Answer 1

Critical illness is often associated with a stay in the ICU

Question 2

What are some additional illnesses that a patient coming out of the ICU be diagnosed with?

Answer 2

ICU acquired weakness (ICU-AW), critical illness polyneuropathy (CIP,CIPN), critical illness myopathy (CIM), Post-ICU Syndrome (PICS)

Question 3

What does it mean when a patient fails to be weaned off mechanical ventilation?

Answer 3

It mean that the patient is critically ill

Question 4

What are the other patient diagnosis that are considered to be critically ill?

Answer 4

• Sepsis
• Multi-system organ dysfunction
• Multi-trauma

Question 5

What does it mean when a patient is stabilizing but worse?

Answer 5

It means that their main medical issue is resolving, but more medical issues are present and functional impairments become apparent

Question 6

Often times when a patient is stabilizing but is worse, they often get diagnoses of ICU-AW, CIPN/CIP, CIM, what does this often mean for them?

Answer 6

Nerves and muscles are impaired such that functional

impairments and limitations have reached critical levels and are out of proportion with the pre-admission baseline

Question 7

What is the pathogenesis of critical illness polyneuropathy(CIP) or critical illness myopathy?

Answer 7

Circulatory, cellular level, and metabolic changes
• Impaired oxygen delivery due to total body microcirculatory
issues
• Impaired mitochondrial function which leads to reduced ATP, energy
production
• Diaphramatic weakness from ventilation (combined
sedation)
• Immobility leading to muscle wasting

Question 8

What are the key findings in patients with critical illness polyneuropathy(CIP) or critical illness myopathy?

Answer 8

Muscle Weakness
• Often rapid onset
• Failure to wean from mechanical ventilation
• Motor and sensory impairment

Question 9

What are the motor and sensory impairments seen in patients with critical illness polyneuropathy(CIP)?

Answer 9

Symmetrical, distal and diaphragm more impacted than proximal

Question 10

What are the motor and sensory impairments seen in patients with critical illness myoneuropathy(CIM)?

Answer 10

Symmetrical, motor only, proximal more than distal

Question 11

How is critical illness polyneuropathy(CIP) or critical illness myopathy diagnosed?

Answer 11

Weaning difficulty, clinical presentation, imaging, labs, tissue studies

Question 12

How can critical illness polyneuropathy(CIP) or critical illness myopathy be prevented?

Answer 12

Blood glucose control, electrolyte and nutritional balance, accelerated vent. weaning

Question 13

What is the prognosis of critical illness polyneuropathy(CIP) or critical illness myopathy?

Answer 13

• Not great (22% die in hospital, 33 % die within 6 months)
• Institutionalization
• The younger the patient, the better

Question 14

What is the best way to treat critical illness polyneuropathy(CIP) or critical illness myopathy?

Answer 14

Prevent and Treat
• Early Rehab (in ICU- sedation must be controlled)
• Focus on functional limitations, respiratory capacity, and cardiac reserve
• Facilitate communication
• Risk versus benefit

Question 15

What is Multiple Organ Dysfunction Syndrome (MODS)?

Answer 15

Progressive failure of more than 2 organs systems over 24

hours which is typically a complication of critical illness

Question 16

What are the causes of Multiple Organ Dysfunction Syndrome (MODS)?

Answer 16

• Most commonly caused by sepsis, but infection not required

* Also caused by acute respiratory distress syndrome (ARDS), sever inflammatory processes, shock, and traumatic injury

Question 17

What is the clinical presentation of Multiple Organ Dysfunction Syndrome (MODS)?

Answer 17

• Low grade fever
• Tachycardia
• Dyspnea
• Systemic inflammatory response
• Altered mental status

Question 18

What are the organs that are usually affected by Multiple Organ Dysfunction Syndrome (MODS)?

Answer 18

• Lungs typically first organ to fail leading to acute respiratory distress syndrome
• Followed by GI bacteremia, liver, and kidney failure
• Ultimately cardiovascular collapse can occur

Question 19

What are the management methods of Multiple Organ Dysfunction Syndrome (MODS)?

Answer 19

• Prevention and early detection
• Pharmacologic: anti-biotics, inotropic agents
• Supplemental oxygen and ventilation
• Fluid replacement and nutritional support

Question 20

What is the prognosis of Multiple Organ Dysfunction Syndrome (MODS)?

Answer 20

60-90% mortality approaching 100% with 3 or more organ involvement and sepsis plus >65 y/o

Question 21

What is the role of PT in the management of Multiple Organ Dysfunction Syndrome (MODS)?

Answer 21

• Usually only seen in critical care or a burn unit
• Severe protein catabolism of skeletal muscle
- Lean body mass depleted
- Need skin precautions and skin care
• Risk often outweighs benefit
• Very little in the literature about MODS

Question 22

According to the Expert consensus and recommendations on safety criteria for active mobilization of
mechanically ventilated critically ill adults by hodgson, what was the safe criteria for in and out of be mobilization if there are no other contraindications for patients in the ICU?

Answer 22

Oxygen saturation more than 90% and a respiratory rate less
than 30 breaths/minute were considered safe criteria for in- and out-of-bed mobilization if there were no other
contraindications

Question 23

According to Rehabilitation during mechanical ventilation: Review of the recent literature by George Ntoumenopoulos, what are the factors that are associated with the development of the physical and psychological complications seen in patients on mechanical ventilation?

Answer 23

The requirement for intubation and mechanical ventilation, sedation, systemic inflammation and immobility

Question 24

As far as the dosage of passive limb movement required, Burtin
et al. (2009) demonstrated that even 20 minutes per day
of in-bed cycling (cycle ergometry device that can be used passively, with active patient participation or with active resistance) led to significant improvements in _____ compared to routine physiotherapy.

Answer 24

As far as the dosage of passive limb movement required, Burtin
et al. (2009) demonstrated that even 20 minutes per day
of in-bed cycling (cycle ergometry device that can be used passively, with active patient participation or with active resistance) led to significant improvements in six-minute walk, static quadriceps strength and physical well being at hospital discharge (Burtin et al., 2009) compared to routine physiotherapy.

Question 25

What is a functional test with much greater validation in the ICU?

Answer 25

The physical function in intensive care test (PFIT)