ABSTRACT
Patients who survive massive trauma and critical illness must not only overcome the initial injury but also the profound debilitation of many other organ systems during their recovery. For example, orthopedic spine injuries may cause paralysis (with its multiple ramifications); pulmonary contusions may lead to severe acute respiratory distress syndrome and prolonged ventilatory dependence; and hemorrhagic pancreatitis will often cause anemia, as well as metabolic and nutritional complications. Organ systems not directly injured by the trauma may also become impaired following critical illness. For example, renal failure may develop from radio-contrast dye, hypotension, aminoglycosides, or immunosuppressant therapy. ICU psychosis may result from sleep deprivation and drug withdrawal, or the administration of multiple psychoactive compounds. Even in excellent specialized trauma units, critically ill patients may develop derangements in the hematological, endocrine, metabolic, and immunological systems. Furthermore, all patients confined to bedrest for prolonged periods of time will suffer deconditioning of cardiovascular and musculoskeletal systems and become susceptible to decubitus ulcers, deep venous thrombosis (DVT), muscle weakness, and joint contractures. All of these systems must be rehabilitated for optimum outcomes to occur.
