Revolving door respiratory patients: A rehabilitative perspective

Monaldi Arch Chest Dis. 2017 Sep 22;87(3):857. doi: 10.4081/monaldi.2017.857.

Abstract

Rehabilitation is an integral component of care for patients affected by either acute or chronic pulmonary diseases. The key elements of rehabilitation treatment for critical respiratory patients are as follows: weaning from mechanical ventilation, respiratory therapy, physical reconditioning, and occupational therapy. It should be noted that patients affected by pulmonary diseases are prone to hospital re-admission due to frequent exacerbations, especially in cases with more severe stages of chronic obstructive pulmonary disease. A periodical worsening of clinical conditions is common in asthma, acute respiratory distress syndrome survivors, obstructive sleep apnea syndrome, and pulmonary fibrosis, as well as in patients with severe neuromuscular diseases. These patients are often identified as "revolving door patients". Pulmonary patients are typically forced to maintain bed rest, or at least spend most of their waking hours dealing with mobility limitations, due to various pathological conditions including dyspnea, fatigue, and poor tolerance of movements. Alterations in mood are common in pulmonary patients who experience a decreased quality of life and limited social interactions. These negative emotional and cognitive aspects can be a major limitation to the provision of care, because to enhance and facilitate a degree of autonomy, the patient must be cooperative and pro-active.

Keywords: Pulmonary rehabilitation; acute respiratory distress syndrome; chronic obstructive pulmonary disease; intensive care units; noninvasive ventilation.

MeSH terms

  • Bed Rest / statistics & numerical data
  • Disease Progression
  • Humans
  • Neuromuscular Diseases / complications
  • Neuromuscular Diseases / epidemiology
  • Patient Readmission / statistics & numerical data*
  • Patient Readmission / trends
  • Pulmonary Disease, Chronic Obstructive / epidemiology*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Pulmonary Disease, Chronic Obstructive / psychology
  • Pulmonary Disease, Chronic Obstructive / rehabilitation*
  • Pulmonary Fibrosis / complications
  • Pulmonary Fibrosis / epidemiology
  • Respiration, Artificial / methods
  • Respiratory Distress Syndrome / complications
  • Respiratory Distress Syndrome / epidemiology
  • Sleep Apnea, Obstructive / complications
  • Sleep Apnea, Obstructive / epidemiology
  • Ventilator Weaning / methods*
  • Ventilator Weaning / trends