ICCU – ACQUIRED WEAKNESS IN ELDERLY PATIENT ADMITTED FOR ACUTE CARDIAC CRITICAL ILLNESS

Over the last thirty years there has been a profound change in the demographic and epidemiological (1) profile of patients admitted to Intensive Cardiac Care Units (ICCU). Patients with multi–comorbidity and multi–organ failure have significantly increased; this resulted in an exponential extension of the ICCU stay. As related to what was said above, there has been an increase in weakness with consequent growth in medical–care complexity. In addition to these aspects, the increase in manifestations such as disorientation syndrome and delirium in these patients during hospitalization is of great importance. The pathophysiological characteristics of weakness acquired in ICCU are well known, while it is difficult in clinical practice to use neuro–pathophysiological diagnostics to describe its etiology (reduced peripheral nerve conduction velocity, reduced CMAP–compound muscle action potential, reduced muscle excitability, etc.). Given the complexity described, in our opinion it is essential to include the figure of a dedicated physiotherapist in medical nursing care in the ICCU. It would thus finally be possible to structure a multidisciplinary approach useful for the early rehabilitation of elderly and multi–morbid patients in order to reduce hospital stay (2), clinical complications and possible improvement in terms of clinical outcomes. Our group therefore has attempted to define a multidisciplinary intervention protocol through the use of rehabilitation assessment tools validated in patients admitted to ICCU aged 65 years and over. The protocol will provide for a randomization of patients consecutively admitted to our ICCU for an early structured multidisciplinary treatment vs usual care. A series of clinical–laboratory parameters will also be evaluated to define the incidence of the following complications: hyper–catabolic state, development of Acute Renal Failure with increase in creatinine >40% compared to baseline, infectious complications, clinically evident Congestive Heart Failure or episodes of left ventricular failure and NTproBNP trend during hospitalization. With the definition of this protocol, we would like to elaborate the numerous evidence in the literature on early rehabilitation intervention models (3), as there is no certain data in patients admitted to ICCU.