Korean Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients and Post-Intensive Care Syndrome
Abstract
Background: Survivors of critical illness commonly experience persistent physical, cognitive, and psychological impairments, collectively known as post–intensive care syndrome. Although intensive care unit (ICU) rehabilitation is now recognized as an important part of recovery after critical illness, rehabilitation practices remain inconsistent, and clinical practice guidelines adapted to the Korean healthcare context have not been available.Methods: These clinical practice guidelines were developed de novo by a multidisciplinary panel comprising critical care physicians, rehabilitation specialists, nurses, and allied health professionals. The panel prioritized 15 key clinical questions addressing adult, pediatric, and neonatal ICU (NICU) rehabilitation. Systematic literature searches were conducted in Medline via PubMed, Embase, the Cochrane Library, and KoreaMed, and the final searches for all 15 questions were completed by November 30, 2024. The certainty of evidence and strength of recommendations were assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Final recommendations were approved through a structured consensus process requiring at least 70% panel agreement.Results: The panel issued 15 recommendations across major rehabilitation domains, including early structured rehabilitation, criteria for withholding or discontinuing therapy, adjunctive modalities, rehabilitation frequency, inspiratory muscle training, swallowing rehabilitation, cognitive and occupational therapy, nutritional support, neonatal and pediatric ICU rehabilitation, and post-ICU follow-up care. Thirteen recommendations were conditional, whereas two were strong, mainly because they addressed patient safety.Conclusions: These guidelines provide evidence-informed recommendations for rehabilitation in critically ill patients across adult, pediatric, and NICUs in Korea. They are designed to standardize practice, improve patient safety, support patient-centered functional recovery beyond survival, and identify priorities for future research.
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Authors: Chi Ryang Chung, Hye Ju Yeo, Eunjeong Choi, Jong Geol, Yoonju Na, Jiyeon Kang, Jeong‐Yi Kwon, Hyun Jung Kim, Jin‐Young Park, Hak‐Jae Lee, Myung Hun Jang, Seung-tak Kang, Kyung Hyup Koo, Young Seok Kim, Won Kim, Tae Yoon Kim, Jiyoun Park, Jaewon Beom, Kyung Cheon Seo, Hyun-Woo Sun, Woochul Son, Myung‐Jun Shin, So Young Ahn, Song‐I Lee, Min-Hyung Rhee, Yu Hui Won, Myungeun Yoo, Yu Jin Im, Sun Ju Chang, Ye Rim Chang, Mi‐Kyeong Jeon, Jin Hee Jung, Yumi Ha, Sung Eun Hyun, Suk‐Kyung Hong, Gee Young Suh
Institutions: Ewha Womans University, Pusan National University Yangsan Hospital, Yonsei University, Ulsan College, Seoul National University Bundang Hospital, Samsung Medical Center, Eulji University, University of Ulsan, Asan Medical Center, Chungnam National University Hospital, Seoul National University Hospital, Ajou University Hospital, Soonchunhyang University Hospital Seoul, Chungnam National University, Sungkyunkwan University, Seoul National University, Kangbuk Samsung Hospital, Severance Hospital, Gangnam Severance Hospital, Pusan National University Hospital, Korea University, Dong-A University, Changwon National University, Ewha Womans University Seoul Hospital, Jeonbuk National University Hospital