A Multidisciplinary Pain, Agitation, and Delirium Management Team Can Promote Rehabilitation in the Intensive Care Unit: A Case Report.

BACKGROUND: Team-based approaches involving the cooperation of various professionals have the power to improve the quality of medical care by utilizing the specialized knowledge and skills of each professional. A multidisciplinary pain, agitation, and delirium (PAD) management team was established in Hiroshima University Hospital. Herein, we describe smooth patient mobilization achieved by enabling discussions among members of this multidisciplinary management team. CASE: The patient was a 72-year-old Japanese woman with acute exacerbation of interstitial pneumonia and respiratory failure. We identified a suspected alveolar hemorrhage by bronchofiberscopy on the patient's first day in the intensive care unit (ICU). This finding required the patient to be placed on bed rest. Therefore, her physiotherapy program was restricted to mobilization. In team rounds during the patient's 5th day in the ICU, we discussed her mobilization. Discussions among the multidisciplinary medical staff led to mobilization and a reduction in sedation medication administered because of the suspected alveolar hemorrhage. The patient underwent a second bronchofiberscopy by emergency medical doctors to assess the alveolar hemorrhage immediately after PAD rounds. The suspected alveolar hemorrhage was not confirmed. Therefore, the physiotherapy program was amended to include standing exercises and sitting in a wheelchair; the new program was initiated the same day. The patient did not experience worsening symptoms during her hospitalization and was discharged from the hospital 95 days after initial admission.
CONCLUSIONS: By discussing treatment options within a multidisciplinary medical team, we achieved smooth patient mobilization and administered reduced levels of sedation medication. ©2016 The Japanese Association of Rehabilitation Medicine.