Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients 2023 (J-ReCIP 2023)
JSICM (J-ReCIP 2023) · 2023 · Japan
Source and licence
- Authors
- Takeshi Unoki, Kei Hayashida, Yusuke Kawai et al.
- Title
- Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients 2023 (J-ReCIP 2023)
- Journal
- Journal of Intensive Care, 2023
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC10629099
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
CQ1: Should a standardized rehabilitation protocol be introduced for critically ill patients?
- Answer: We suggest the introduction of a rehabilitation protocol for critically ill patientsGrade 2D: Certainty of evidence = “Very low”
CQ2: Should multiple rehabilitation sessions be conducted per day for critically ill patients?
- Answer: We suggest conducting multiple daily rehabilitation sessions for critically ill patientsGRADE 2D: Certainty of Evidence = “Very Low”
CQ3: Should neuromuscular electrical stimulation and/or in-bed cycle ergometer be used for critically ill patients?
- Answer: We suggest performing neuromuscular electrical stimulation for critically ill patientsGRADE 2B: Certainty of evidence = “Moderate”
- We suggest performing in-bed cycle ergometerGRADE 2D: Certainty of evidence = “Very low”
- We suggest performing both neuromuscular electrical stimulation and in-bed cycle ergometerGRADE 2B: Certainty of evidence = “Moderate”
CQ5: Should critically ill patients be managed based on video endoscopic examination of swallowing?
- Answer: We suggest against managing critically ill ICU patients based on VEGRADE 2D: Certainty of evidence = “Very low”
CQ6: Should critically ill patients be provided rehabilitation therapy related to swallowing function?
- Answer: We suggested that rehabilitation therapy related to swallowing function should be provided for critically ill patientsGRADE 2C: Certainty of evidence = “Low”
CQ9: Should critically ill patients be given 20 kcal/kg/day or more or 70% or more of the energy expenditure as energy on Treatment Days 4–10?
- Answer: We suggest administering 20 kcal/kg/day or 70% or more of the energy expenditure as energy on treatment days 4–10 in critically ill patientsGRADE 2D: Certainty of evidence = “Very low”
CQ10: Should 1 g/kg/day or more of protein be given to critically ill patients on days 4–10 of treatment?
- Answer: We suggest administering protein of 1 g/kg/day or more to critically ill patients on days 4–10 of treatmentGRADE 2D: Certainty of evidence “Very low”
CQ11: Should an early physical rehabilitation protocol be introduced for critically ill children?
- Answer: We suggest an early physical rehabilitation protocol be introduced for critically ill childrenGRADE 2D: Certainty of evidence = “Very low”
CQ12: Should respiratory physiotherapy be provided to mechanically ventilated children from the acute phase?
- Answer: We suggest performing respiratory physiotherapy to mechanically ventilated children from the acute phase.GRADE 2D: Certainty of evidence = “Very low”
CQ13: Should enhanced rehabilitation after ICU discharge be provided to critically ill patients?
- Answer: We suggest providing enhanced rehabilitation to critically ill patients after ICU discharge.GRADE 2D: Certainty of evidence = “Very low”
Abstract
Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the “Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit” to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This endeavor resulted in the formulation of Clinical Practice Guidelines (CPGs), designed to elucidate best practices in early ICU rehabilitation. The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making, ultimately contributing to the enhancement of patient outcomes in critical care settings. No previous CPGs in the world has focused specifically on rehabilitation of critically ill patients, using the GRADE approach. Multidisciplinary collaboration is extremely important in rehabilitation. Thus, the CPGs were developed by 73 members of a Guideline Development Group consisting of a working group, a systematic review group, and an academic guideline promotion group, with the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the JSICM at its core. Many members contributed to the development of the guideline, including physicians and healthcare professionals with multiple and diverse specialties, as well as a person who had been patients in ICU. Based on discussions among the group members, eight important clinical areas of focus for this CPG were identified. Fourteen important clinical questions (CQs) were then developed for each area. The public was invited to comment twice, and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four background questions. In addition, information for each CQ has been created as a visual clinical flow to ensure that the positioning of each CQ can be easily understood. We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions.
Supplementary Information: The online version contains supplementary material available at 10.1186/s40560-023-00697-w.
Contents of the original publication
The section headings of the original.
- Introduction
- Name
- Purpose
- Target population
- Perspectives covered by the clinical practice guidelines
- Target users
- Relationship with existing guidelines
- Organization
- Important clinical areas
- Scope not covered by the clinical practice guidelines
- Ways to reflect the values of the target population (patients, families, and care providers)
- Ensuring quality and transparency
- Drafting funds
- Strategies to disseminate the clinical practice guidelines
- Outline of clinical practice guidelines drafting method
- Plans for revision
- External assessment
- CQ1: Should a standardized rehabilitation protocol be introduced for critically ill patients?
- CQ2: Should multiple rehabilitation sessions be conducted per day for critically ill patients?
- CQ3: Should neuromuscular electrical stimulation and/or in-bed cycle ergometer be used for critically ill patients?
- CQ 4: What is the frequency of dysphagia in critically ill patients in the ICU and how can it be screened?
- CQ5: Should critically ill patients be managed based on video endoscopic examination of swallowing?
- CQ6: Should critically ill patients be provided rehabilitation therapy related to swallowing function?
- CQ7: What are the criteria for initiation of mobilization and exercise therapy in critically ill patients?
- CQ8: What are the criteria for termination of mobilization and exercise therapy in critically ill patients?
- CQ9: Should critically ill patients be given 20 kcal/kg/day or more or 70% or more of the energy expenditure as energy on Treatment Days 4–10?
- Rationale
- CQ10: Should 1 g/kg/day or more of protein be given to critically ill patients on days 4–10 of treatment?
- Rationale
- CQ11: Should an early physical rehabilitation protocol be introduced for critically ill children?
- Rationale
- CQ12: Should respiratory physiotherapy be provided to mechanically ventilated children from the acute phase?
- Rationale
- CQ13: Should enhanced rehabilitation after ICU discharge be provided to critically ill patients?
- Rationale
- CQ14: What is the significance of family participation in the rehabilitation of critically ill patients?
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