Early Mobilization in Overcoming Critical Illness Myopathy: A Case Report

Case Diagnosis: Critical Illness Myopathy

Case Description or Program Description: A 34-year-old female underwent liver and kidney transplantation with rejection and multiple complications, including bacteremia, pressure ulcers, respiratory failure, and kidney injury. She spent weeks in the intensive care unit (ICU) without mobilization, range of motion exercises, and physical and occupation therapy. When she arrived at acute rehabilitation, she was severely deconditioned. Although ICU rehabilitation was not introduced, it is suggested that early intervention could have prevented the critical illness myopathy that she developed. Muscle wasting occurs within the first week of critical illness. Studies of early mobilization have demonstrated a variety of benefits, including decreased ICU stay and earlier return to independent functional status. (P.E. Morris, A. Goad, C. Thompson, et al.)

Setting: Acute Inpatient Rehabilitation

Assessment/Results: This patient progressed in therapy from moderate assist to minimum assist in all activities of daily living. She also improved in strength and endurance.

Discussion (relevance): This case demonstrates a rather common example of patients who develop critical illness myopathy due to lack of rehabilitation in the ICU setting. Critical illness myopathy (CIM) is considered a significant complication of critical care as it has the potential to increase morbidity and mortality. Post-transplant, the patient encountered multiple complications, that led to diffuse muscle weakness and CIM. The patient made modest gains during their stay in acute rehabilitation, but early ICU mobilization and earlier physiatry management could have mitigated deconditioning and supported functional recovery amidst ongoing complications. Perhaps if she had more function on arrival to acute rehabilitation, she may have had a shorter length of stay and left the rehabilitation unit at a higher level of independence.

Conclusions: This case underscores the need for integrating rehabilitation into ICU care to prevent deconditioning and enhance recovery in medically complex patients, emphasizing a multidisciplinary approach for optimal patient outcomes.