Patient Care Vignette
A 25-year-old man named KD was injured in a high-speed motorcycle collision. He was wearing a helmet that the Emergency Medical Services personnel removed. He was initially unresponsive at the scene but started to awaken during ambulance transport to the nearest hospital, a trauma center. KD arrived in the Emergency Department confused and with difficulty breathing. A breathing tube was placed and he was evaluated for injuries. Multiple displaced rib fractures, lung injuries, a pelvis fracture, a liver injury, and a wrist fracture were found. He needed to have chest tubes to evacuate air that had leaked out of his lungs, his wrist was splinted, and he was transferred to the ICU for ongoing care.
As a result of KD’s injuries, his hospital care was complex and involved multiple operations. Therefore, the planned initial Physical Therapy and Occupational Therapy (PT/OT) sessions were delayed while he underwent multiple trips to the operating room. Initial PT/OT evaluations were performed more than 10 days into KD’s hospital stay. PT/OT clinicians remained engaged in his care throughout the ICU stay, working on range of motion and strength despite he being intubated and mechanically ventilated. He slowly recovered from his injuries and was able to be weaned from mechanical ventilation. With removal of his breathing tube and de-escalation of acute care interventions, the KD’s rehabilitation needs expanded.
In addition to PT/OT care, KD was also evaluated for ongoing nutrition support needs. During most of his hospital stay, he received nutrition via a feeding tube placed in his mouth (an orogastric tube). When the breathing tube was removed, the orogastric tube was also removed. The clinical team wanted to assess whether he could safely swallow food. A speech and language pathologist (SLP) assessed KD’s ability to swallow in a coordinated fashion. The SLP determined that he had some dysfunction including aspiration of thin liquids. He needed a modified diet so that he could safely swallow. The SLP prescribed a full liquid diet with thickened liquids and daily swallowing exercises. The clinical team worked with the SLP and the dietitian to provide foods that met these textural requirements while still being palatable to KD.
Following a 64-day admission, KD was discharged to an acute inpatient rehabilitation facility. He remained in an inpatient program until his discharge home 2 months later. He received outpatient therapy for several months focusing on endurance and strength to facilitate independence with activities of daily living and his eventual ability to return to work as an auto mechanic. His rehabilitation was key in returning to work as he also financially supports his elderly parents.
Active and aggressive rehabilitative services are vital contributors to critical illness recovery. The tools, technologies, and protocols used in therapy continue to evolve, but early and continued interventions are key. Prospective studies consistently demonstrate the benefits of rehabilitative services for acutely ill patients, including patients who are intubated and mechanically ventilated. Indeed, therapy can ...