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Posted October 15, 2016

FROM ICU TO HOME

When callers begin the conversation “..my father has been in ICU for 3 weeks,..”; hundreds of images of patients flash before me. Having worked in an ICU, the dramatic changes in the elder’s physical health stemming from the critical care environment is far too familiar.

To the general public an ICU is a smart environment, everything is buzzing all around, the most expensive medical equipment for life saving, blood transfusion as well as a number of available doctors, and junior doctors. It looks like a little city within a hospital. It is often a closed unit, with restricted access only to immediate family at the specified visiting times. As the most vulnerable patients fight for their lives, the threat of infection is high and the road to recovery remains at the hand of their families.

I visit my patient “Baba”, grandfather 18 times. His blood pressure has been stabilized and within reasonable limits after battling a chest infection. Large framed man, with extreme muscle weakness. He has not moved in 3 weeks confined to the hospital bed. His muscles have depleted, leaving sagging fat and lose skin. We call this muscle atrophy. The rate of muscle atrophy is higher in the elderly than in the younger adult. Every day of bed-rest causes depletion of muscles with higher loss to the leg muscles, responsible for stabilization during walking. The road to recovery begins with retraining and rebuilding those muscles. Rebuilding muscle in the elderly is FOUR times lengthier than in normal adult. Baba needs time to be able to stand and walk alone.

Muscles all over the body have depleted, including those responsible for breathing and swallowing. The rib cage space has constrained in size due to lack of positioning and immobility of the shoulders and arms. The lungs trapped within the rib cage cannot expand to its full capacity, sticky and unopened with small trapped particles inside at the bases, which further increases risk for infection. It’s time to sit up and cough. Deep breath and cough. Cough Baba Cough. Gaha Baba Gaha !

Hospitalization causes many complications in the elderly, and the road to recovery must begin from day one. While an ICU is welcomed during lifesaving, the risks of prolonged unnecessary stay need to be minimized. Minimizing muscle atrophy as a result of bed confinement should be a priority for families who wish to see their loved one restore as much functional status as possible. Having extra help at the hospital during the working hours can maximize the retraining and recovery time available. Skilled nurses will serve the best help for families to aid in the recovery time. Focus on breathing and airway management, muscle recovery and conditioning, coagulation prevention, nutritional support.

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