Physical problems after critical care

General weakness & activities of daily living

Patients lose muscle mass rapidly on ICU and it takes a long time to restore this. Joints are stiff, balance is affected, fine movements less co-ordinated and the smallest exertion can at first be exhausting. But with gradual increases in activity levels (physiotherapists often provide an exercise regime to slowly rebuild strength) and improving nutrition this gets better, although it can take months. Sometimes the patient can be frustrated by the slow progress but setting realistic goals, advice and encouragement will all help. Occupational therapist can help with household aids and adjustments that help mobility and function.

Appearance

Patients often look thin and their hair and skin are drier than before. This improves with time but can be distressing and cosmetics, hair and skin care may help the patient’s morale. The tubes and lines may leave scars in the neck and throat which fade with time but may require intervention at a later stage if they remain unsightly and troublesome for the patient.

Specific new disabilities

Some patients are left with lasting problems such as a brain damage, a stoma or an amputation that further impair their recovery. Increased levels of rehabilitation are often required, and specialist or district nursing input required.

Eating & appetite and voice

As a result of all the tubes going through the mouth and voice-box patient often complain of changes in their sense of taste and smell, and their voice. This usually get better in time but occasionally requires referral to the ear, nose and throat team for further assessment. Weakness, loss of taste and smell and low mood all contribute to reduced appetite, at a time when good nutrition is essential. Eating a little and often, build up drinks and advice from dieticians can help with rebuilding strength.