無気肺による呼吸不全に対しICU入室早期からの作業療法介入が認知機能・身体機能・ADLの向上に有効であった1症例

Effectiveness of early occupational therapy intervention in the intensive care unit for a patient with respiratory failure due to atelectasis: A case report

要旨：今回，ICU入室早期から作業療法を開始して良好な経過をたどった急性呼吸不全症例を経験した．症例は他院での下顎歯肉癌術後に無気肺による呼吸状態悪化を認め，集中治療管理目的で当院へ転入となった．ICUで人工呼吸器管理を行い，入室3日目から作業療法介入を開始した．初期評価時，認知機能，身体機能，ADLに低下を認めた．多職種で協働して離床を進め，あわせて認知機能，身体機能，ADLに対するアプローチを実施した．約1ヵ月の入院中の介入にて，無気肺は解除，認知機能，身体機能，ADLは改善し，癌治療継続目的に紹介元病院へ転院となった．ICU入室中からの早期作業療法は，各種機能の改善やさらなる機能低下の予防に有用な可能性がある．

　Rehabilitation intervention has been proposed to improve medium to long term physical function for post intensive care syndrome in critically ill patients. We experienced a successful case with acute respiratory failure in which early occupational therapy commenced in the ICU. A 79-year-old female was admitted to the intensive care unit of our hospital due to the worsening of the respiratory condition caused by lung atelectasis after surgery for mandibular gingival cancer. She received mechanical ventilation in the ICU, and the occupational therapy intervention was performed from day 3. Although she could communicate consciously, cognitive function, physical function, and ADL declined markedly. We proceeded with leaving bed and walking training in the ICU in cooperation with a physiotherapist and also carried out cognitive function training, functional occupational therapy, and ADL training. After continuing the intervention after leaving the ICU, the patient fully recovered from the lung atelectasis and the cognitive and physical function improved. Adverse effects due to occupational therapy intervention were not observed. The patient was transferred to the referral hospital for continuing cancer treatment 1 month later. Early occupational therapy intervention for patients with respiration management can be useful not only for improving ADL but also for improving cognitive and physical functions.