Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients 2023 (J-ReCIP 2023)

Area of Science:

• Critical Care Medicine
• Rehabilitation Therapy
• Evidence-Based Practice

Background:

• Standardized, high-quality rehabilitation for critically ill patients is a significant clinical challenge.
• The Japanese Society of Intensive Care Medicine (JSICM) previously issued expert consensus on early ICU rehabilitation in 2017.
• There is a need for globally unique Clinical Practice Guidelines (CPGs) specifically for critically ill patient rehabilitation, employing the GRADE methodology.

Purpose of the Study:

• To develop and disseminate evidence-based Clinical Practice Guidelines (CPGs) for early rehabilitation in intensive care units (ICUs).
• To enhance clinical understanding and support evidence-based decision-making for improved patient outcomes.
• To establish best practices in early ICU rehabilitation for critically ill populations.

Main Methods:

• A rigorous systematic review was conducted using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.
• Development involved a multidisciplinary Guideline Development Group with 73 members, including diverse healthcare professionals and a former ICU patient.
• Eight clinical areas were identified, leading to 14 clinical questions (CQs), with public consultation and GRADE recommendations formulated.

Main Results:

• Ten GRADE recommendations and commentary on four background questions were established for early ICU rehabilitation.
• The guidelines address eight key clinical areas relevant to critically ill patient rehabilitation.
• Visual clinical flows were created to clarify the positioning and application of each clinical question.

Conclusions:

• The newly developed CPGs provide a comprehensive framework for evidence-based early rehabilitation in ICUs.
• These guidelines represent a novel approach, being the first globally to focus on critically ill patient rehabilitation using the GRADE method.
• The CPGs are intended to be a valuable resource for multidisciplinary teams to optimize rehabilitation strategies and enhance patient recovery in critical care settings.