Implementation and Challenges of Early-Phase Physiotherapy During Cardiovascular Intensive Care

Progress in intensive care for cardiovascular disease, including catheter-based therapies and mechanical circulatory support, has improved patient survival. Conversely, the numbers of patients with severe disease and older patients with multimorbidities have increased, resulting in complications during management in the intensive care unit (ICU). In addition to ICU-acquired weakness and delirium, postintensive care syndrome (PICS) has recently been recognized, defined as a prolonged impairment in physical, cognitive, and mental status. Physiotherapy is an important treatment option to prevent and ameliorate PICS. Recently, the goals of early-phase physiotherapy have shifted beyond short-term outcomes, such as reducing the length of ICU and hospital stays and recovery of physical function, to include long-term outcomes, such as return to social activity and reduced rehospitalization. Thus, appropriate physiotherapy management and intervention during the ICU are potentially crucial, because high-quality phase I cardiovascular rehabilitation leads to a seamless approach to the next phase of rehabilitation. This review summarizes current clinical issues, the implementation of assessment and treatment strategies in acute-phase physiotherapy, and future perspectives and challenges in cardiovascular intensive care.