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Mastering the design for rehabilitation strategies in ICU survivors
  1. Peter E Morris,
  2. Ashley Montgomery-Yates
  1. Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky School of Medicine, Lexington, Kentucky, USA
  1. Correspondence to Dr Peter E Morris, Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky School of Medicine, 740 South Limestone, Lexington, KY 40536, USA; peter.morris{at}uky.edu

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Although the data from several recent trials have informed our understanding of early intensive care unit (ICU) exercise treatment. There remains a distinct lack of clarity in terms of the dose, duration, and frequency of exercise therapy that should be provided to the ICU survivor.1–4 Indeed, the coordination and integration of care for the critically ill patient, from early ICU exercise therapy and mobilisation to post-ICU rehabilitation, will be key going forward. In Thorax, McDowell et al5 report on the REVIVE trial, which provides insight into the management of the post-ICU survivor and, in particular, the effectiveness of exercise on physical function (PF) in patients discharged from hospital following critical illness. The target population had received invasive ventilation for at least 4 days in the ICU with the exercise intervention delivered in the outpatient setting after hospital discharge. As with all outpatient-based UK exercise training programmes, the majority of sessions were supervised by a rehabilitation physiotherapist. It was delivered as a bespoke and personalised intervention that was modified based on the response of the individual patient to exercise. The intervention consisted of two directly supervised exercise sessions and one independent unsupervised session per week over 6 weeks. Importantly, there was a standard operation procedure for delivery of the multimodal exercise therapies to ensure uniform delivery of the intervention. More specifically, the training schedule for the rehabilitation physiotherapists included targeted exercise treatments based on the physical capability of the patient with an instruction to deliver goal-directed therapy and progress the patient through the exercises over multiple sessions. The detail of the dose, duration and frequency of the exercise therapy were recorded to permit the investigators to interpret the relationship between these factors and outcome in terms of PF. This is the strict controlled approach …

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