Early Rehabilitation in adult and paediatric critically ill patients with respiratory failure, sepsis, and pneumonia: Case series

Abstract

Background: Critically ill patients with acute respiratory failure,sepsis, pneumonia,and complex comorbidities frequently develop prolonged ventilator dependence,impaired airway clearance, intensive care unit-acquired weakness (ICU-AW), anda high risk oof post-intensive care syndrome (PICS). Early, structured rehabilitationthat integrates respiratory support, neuromuscular preservation, and mobilizationmay improve recovery.

Case: This case series describes three patients treated in the adult ICU andpediatric ICU of Persahabatan General Hospital's who received individualizedintensive rehabilitation. A young adult with obesity, type 2 diabetes and sepsis; amiddle-aged adult with severe community-acquired pneumonia and prolongedmechanical ventilation; and a preschool child with status epilepticus, sepsis, andbronchopneumonia. Functional status was evaluated using ICU Mobility Scale(IMS), Chelsea Critical Care Physical Assessment Tool (CPAx), Medical ResearchCouncil Sum Score (MRC-SS), Functional Status Scale (FSS), and grip strength.After 2 weeks, case 1 showed IMS improving from 0 to 6, CPAx from 2 to 27, andMRC-SS from 40 to 60, alongside successful ventilator weaning. After 3 weeks,case 2 showed CPAx improving from 5 to 20, IMS from 1 to 4, MRC-SS from 24to 32, grip strength from 5.2 to 11.3 kg in both arms, and cough flow from 45 to 79L/min. Case 3 showed FSS improving from 23/36 to 16/36 and IMS from 0 to 6after 3 weeks.

Discussion: These cases illustrate the feasibility of early multimodal rehabilitationin medically complex ICU/PICU patients. The combination of positioning,progressive mobilization, airway clearance techniques, Neuro-Muscular ElectricalStimulation (NMES), and caregiver engagement was associated with meaningfulgains in functional recovery.

Conclusion: A structured, multidisciplinary rehabilitation program may supportventilator liberation and functional improvement in critically ill patients across awide age range. Larger prospective studies are needed to define optimal protocolsand long-term outcomes.