Whole-body rehabilitation in long-term ventilation

Advances in critical care and mechanical ventilation have improved long-term survival of critically ill patients, some of whom develop the need for prolonged mechanical ventilator assistance. The rehabilitation of these individuals is aimed at restoring function, facilitating independence from mechanical ventilation, and in some cases returning them to the community. To accomplish these goals, rehabilitation programs require a multidisciplinary approach that includes physicians, respiratory therapists, nurses, physical and occupational therapists, nutrionists, speech therapists, and social services workers in a concerted effort. Chronic mechanical ventilation patients are often complicated by multiple comorbidities and by complex physiologic and psychological interactions. A careful selection and an individualized assessment are therefore paramount in identifying and achieving long-term goals. Special attention has to be paid to aggressive respiratory and nonrespiratory muscle rehabilitation, early ambulation, nutritional repletion, and psychological support. Careful evaluation and treatment by members of a multidisciplinary team may foster the patients' independence and ability to tolerate spontaneous ventilation, ultimately resulting in an improvement in their quality of life.