Physical morbidity represents the deterioration of the general physical condition and it occurs as a result of illness and/or injury. When this condition is combined with acute diseases and limited mobility it is followed by a large number of complications that usually occur in patients treated in Intensive Care Units (ICU). Its treatment demands a comprehensive approach and early rehabilitation of the critically ill patients aimed at achieving the highest possible level of functionality within the boundaries of what is permitted by the illness/injury and its treatment. However, the prolonged period of immobilization of the critically ill is followed by shorter and/or longer periods of sequelae during and after treatment. The most common sequelae include physical deficits or psycho-emotional problems associated with PICS (post intensive care syndrome). General recommendations for early rehabilitation in the ICU undoubtedly point to the need of introducing physical therapy interventions as soon as possible, that is, as soon as the patient?s medical condition permits it. The primary goal of early rehabilitation of the critically ill during their stay in the ICU is to maximize the restoration of physical, psycho-emotional and social functions by implementing a personalized approach that reflects the needs of the patient.
Esophageal resection with reconstruction is complex surgical procedure with high rate of postoperative morbidity, with decreasing mortality rate during last decades, particularly in high-volume hospitals. Numerous preoperative, intraoperative and postoperative factors have contribute to incidence and type of complications. Intraoperative haemorrhage and tracheobronchial lesions could be avoid by good surgical judgement and operative technique. Pulmonary complications are often, with multifactorial etiology, and they are the main cause of postoperative mortality after esophagectomy. Dehiscence of esophageal anastomosis could be fatal, and only high index of suspicion and early diagnosis lead to successful treatment. In majority of such cases conservative measures are successful, however, conduit necrosis is indication for surgical reoperation. Vocal cord palsy due to intraoperative injury of recurrent laryngeal nerves is not rare and increases pulmonary complications rate. New onset of arrhythmia could be associate with other surgical complications. Postesophagectomy chylothorax is life-threatening complication due to rapid development of immunosuppression and septic complications, and early ligation of thoracic duct is often mandatory. Intrathoracic herniation of intrabdominal viscera is rare, and ischemic spinal cord lesions are very rare after esophagectomy. Majority of perioperative complications could be prevented or solved, decreasing mortality rate of esophagectomy.
Evolution of intensive care medicine in the last few decades and integrating teamwork has a major impact on increasing the rate of survival of patients. All the attention of the responsible team is not only aimed at treating the underlying disease, but also to decrease complications associated with prolonged stay in the ICU. The most common complications are: deconditioning, muscle weakness, polyneuropathy, myopathy, thromboembolic complications, decubital wound, artculation stiffness, cognitive disorders, depression, anxiety and a global reduction in quality of life. Physical therapy has its place in the earliest stages of treatment of mechanically ventilated patients. The aim of this article is to review the evidence for the use of rehabilitation in ICU in the adult mechanically ventilated patients. Early and systematically structured rehabilitation programs have been shown to be both safe and feasible for critical care populations.
Central venous pressure is a very common clinical measurement, but it is frequently misunderstood and misused. As with all hemodynamic measurements, it is important to understand its basic principles. Use of CVP for the estimating of cardiac preload and volume status requires an understanding of its determinants. Actually, CVP and cardiac output are determined by the interaction of two function curves: the cardiac function curve and the return curve. There are no data to support the widespread practice of using central venous pressure (CVP) to guide fluid therapy. But, CVP is readily available in many patients. The fact that an isolated measurement of CVP does not predict the response to a fluid bolus does not reduce its importance as a hemodynamic variable. CVP may be usefull taken in the context of the whole clinical picture and over time.
Introduction. Subarachnoid haemorrhage (SAH) can be followed by cardiac abnormalities. We describe a patient with Takotsubo cardiomyopathy and neurogenic pulmonary edema (NPE) after aneurysmal SAH. Case report. A previously healthy, postmenopausal woman, suffered from aneurysmal SAH with consequent hydrocephalus. After external ventricular drainage, craniotomy and clipping of the posterior inferior cerebellar artery aneurysm, the patient developed acute heart failure and NPE. Transthoracic echocardiogram showed the left ventricular apical ballooning and hypercontractile basal segments. On chest radiography, bilateral pulmonary infiltrates were seen. Seventeen days after the SAH attack, the patient was discharged from hospital. Postponed coronary angiography revealed no signs of coronary artery disease. Conclusion. This case and review of the relevant literature suggest that Takotsubo cardiomyopathy and neurogenic pulmonary edema are not uncommon after aneurysmal SAH.
