Effectiveness of rehabilitation interventions in adults with multi-organ dysfunction syndrome: A rapid review.

BACKGROUND: Multiple organ dysfunction syndrome, defined as altered organ function in critically ill patients, is a possible consequence of COVID-19. Investigating the current evidence is therefore crucial in this pandemic, as early rehabilitation could be effective for the functioning of patients with multiple organ failure. This rapid review assesses the effectiveness of rehabilitation interventions in adults with multiple organ dysfunction syndrome. METHODS: A rapid review was conducted including only randomised control trials, published until 30 November 2020. All databases were investigated and the results synthesized narratively, evaluating the risk of bias and quality of evidence in all included studies. RESULTS: A total of 404 records were identified through database searches. After removal of duplicates 346 articles remained. After screening, 3 studies (90 participants) met the inclusion criteria. All studies reported positive effects of neuromuscular electrical stimulation on muscle mass preservation compared with no treatment or standard physio-therapy. CONCLUSION: The lack of evidence on the effectiveness of rehabilitation interventions does not allow any firm conclusion to be drawn. Neuromuscular electrical stimulation might be a possible rehabilitation intervention to prevent muscle volume loss and improve function in patients with multiple organ dysfunction syndrome. However, further studies are needed to support these preliminary findings.

Recovery from critical illness-induced organ failure: the role of autophagy.

Autophagy is a catabolic process by which cells can dispose of damaged content and intracellular microorganisms. Recent evidence implicates autophagy as a crucial repair process necessary to recover from critical illness-induced organ failure. Withholding parenteral nutrition in the acute phase of critical illness activates autophagy and enhances recovery. Several registered drugs have autophagy-stimulating properties, but all lack specificity and none has been investigated in critically ill patients for this purpose.

Muscle weakness in septic patients requiring mechanical ventilation: protective effect of transcutaneous neuromuscular electrical stimulation.

PURPOSE: The aim of this study was to evaluate the effect of transcutaneous neuromuscular electrical stimulation (NMES) on muscle strength in septic patients requiring mechanical ventilation (MV). METHODS: Sixteen septic patients requiring MV and having 1 or more organ failure other than respiratory dysfunction were enrolled within 48 hours from admission to the intensive care unit. Neuromuscular electrical stimulation was administered twice a day on brachial biceps and vastus medialis (quadriceps) of 1 side of the body until MV withdrawal. Blinded investigators measured arm and thigh circumferences, biceps thickness by ultrasonography, and muscle strength after awakening with Medical Research Council scale. RESULTS: Two patients died before strength evaluation and were excluded from the analysis. Neuromuscular electrical stimulation was applied for 13 days (interquartile range, 7-30 days). Biceps (P = .005) and quadriceps (P = .034) strengths were significantly higher on the stimulated side at the last day of NMES. Improvement was mainly observed in more severe and weaker patients. Circumference of the nonstimulated arm decreased at the last day of NMES (P = .015), whereas no other significant differences in limb circumferences or biceps thickness were observed. CONCLUSION: Neuromuscular electrical stimulation was associated with an increase in strength of the stimulated muscle in septic patients requiring MV. Neuromuscular electrical stimulation may be useful to prevent muscle weakness in this population.

Red Ulises: aproximación al tratamiento integral post-UCI de los pacientes que han padecido fallo multiorgánico grave / Ulises network: an approach to integral post-ICU treatment of patients with multiple organ dysfunction syndrome

La incorporación del concepto «continuidad asistencial» como elemento de calidad en los procesos asistenciales en pacientes de Unidad de Cuidados Intensivos (UCI) que sobreviven al fallo multiorgánico grave lleva a replantear el modelo de UCI de los últimos años. En este artículo se argumentan las bases que llevaron a plantear un estudio multicéntrico de base hospitalaria, prospectivo, aleatorizado tipo «intervención»/«control», con el fin de observar el impacto de una intervención interdisciplinar sobre los resultados asistenciales, a medio plazo, en los pacientes de UCI afectos de un fracaso multiorgánico durante la fase de recuperación post-UCI

The concept of continuity of care by intensivists as an element of quality control in the medical care of Intensive Care Unit (ICU) patients surviving multiple organ dysfunction syndrome has led to a rethinking of the ICU model in recent years. We discuss the rationale to design and implement a hospital-based, prospective, randomized, multicenter Intervention/Control study in order to estimate the impact of an interdisciplinary intervention during the post-ICU recovery phase on medium-term medical outcomes in ICU patients with multiple organ dysfunction

Does acute organ dysfunction predict patient-centered outcomes?

BACKGROUND: Long-term patient-centered outcomes after acute illness may be associated with baseline health status, the development of acute organ dysfunction (AOD), or both. STUDY OBJECTIVE: To determine whether AOD (occurring in the first 30 days) was independently associated with 90-day survival, functional status, and health-related quality of life (HRQL) after controlling for baseline health status in patients who were hospitalized with community-acquired pneumonia (CAP) and survived to day 30. DESIGN: Prospective observational study. SETTING: Four hospitals in Pennsylvania, Massachusetts, and Nova Scotia, Canada, between October 1991 and March 1994. PATIENTS: One thousand three hundred thirty-nine patients who were hospitalized with CAP. INTERVENTIONS: Baseline and 90-day quality-of-life and functional status questionnaires. MEASUREMENTS AND RESULTS: We determined the 90-day survival rate in all patients (n = 1,339) and the functional status and HRQL in subsets of 261 and 219 patients, respectively. AOD occurred in one or more organ system in 639 patients (47.7%) and in two or more organ systems in 255 patients (19.1%). In univariate analyses, greater AOD was associated with a higher mortality rate (p < 0.0001), a lower HRQL (p = 0.006), and lower functional status (p = 0.009) at 90 days. However, after adjusting for baseline HRQL, AOD was not associated with mortality (p = 0.47) or HRQL (p = 0.14) at 90 days and was only weakly associated with 90-day functional status (p = 0.02). CONCLUSIONS: Although patients who develop AOD are at risk for late adverse outcomes, their risk is due predominantly to poor baseline status prior to illness and not to the organ dysfunction per se. Therefore, AOD does not appear to have significant long-term ramifications for patient-centered outcomes.

Complications of varicella zoster.

Primary infection with varicella zoster is characterzed by a generalized vesicular rash usually without significant systemic illness. Encephalitis, pneumonitis, pancreatitis, nephritis, Reye and Guillan-Barre syndrome transvers myelitis, myocarditis have been reported before, but there is not any case having all these system to be involved during the same infection in a sequential manner ending up with multiorgan failure. We wanted to represent 21-month-old boy had a multiorgan failure due to varicella zoster infection.

[Long-term outcome after multiple organ failure following severe trauma]. / Langzeitverlauf nach Multiorganversagen bei Polytrauma.

OBJECTIVE: The aim of this follow-up study was to find out if severely injured patients with multiple organ failure (MOF) show any organotopic sequelae in the late course. Additionally the occupational rehabilitation result as well as the reasons for a poor occupational result were investigated. METHODS: A total of 50 MOF patients with an injury severity of 45.3 +/- 2.1 PTS points were followed up 4.9 +/- 0.3 years after trauma. In order to show any organotopic sequelae, patients were examined and laboratory tests for the function of the lungs (function test, Horovitz-quotient), liver (bilirubin, GOT, bleeding time), and kidnies (creatinine, urea) were performed. The functional (locomotion and neurological system) and occupational rehabilitation results as well as the reasons for a poor occupational result were analysed. RESULTS: The clinical examination as well the functional and laboratory tests showed mainly normal results but in in 25% of the patients a significantly decreased range of motion of the elbow, hip, knee and ankle joint was found. The "return to work rate" was 64%. Reasons for a poor occupational result were the severity of head injury, a decreased range of motion of the hip joint and general physical fitness. CONCLUSIONS: Severely injured patients who survive MOF during their intensive care treatment, show no sequelae of organ failure. The occupational rehabilitation results were excellent with a "return to work rate" of 64% which was dependent on the severity of head injury, a decreased range of motion of the hip joint and general physical fitness.