YOĞUN BAKIMDA PALYATİF BAKIMIN GEREKLİLİĞİ

Yaşlanan popülasyon ve yaşam süresinin artmasını sağlayan teknolojiler nedeniyle ciddi veya yaşamı tehdit edici hastalıklara sahip bireylerin sayısı giderek artmaktadır. Bu hastalıklar sırasında yaşam kalitesini arttırmak için artan bir şekilde palyatif bakım programları geliştirilmektedir. Palyatif bakımda hizmet, deneyimli ve eğitimli sağlık personeli ve gönüllülerden oluşan bir ekip tarafından sunulmakta ve her ülkenin kendi koşulları içerisinde; hastane ortamında, birinci basamak sağlık alanlarında, ev ortamında ve son dönem evleri veya hospislerde verilmektedir. Yoğun bakım üniteleri, kritik hastaların hızlı ve hayat kurtarıcı müdahaleler aldığı özgün bakım ortamlarıdır. Fizik tedavi ve rehabilitasyon programları gelişmiş ülkelerde pek çok hastanede yoğun bakım ünitelerine entegre olmuş bir bölüm olarak yer almaktadır. Yoğun bakım ünitelerinde hastaların ihtiyaçları ve komplikasyonları göz önünde bulundurulduğunda, bu hastaların yaşam kalitelerinin iyileştirilmesinin önemi akılda tutulması geren bir durum olmalıdır. Fizik tedavi ve rehabilitasyon programları ile hastalardaki optimum respiratuar ve sirkulatuar fonksiyonun sürdürülmesi, kas atrofisi ve kas kısalmasının, eklem kontraktürlerinin önlenmesi, ağrının kontrol edilmesi ve giderilmesi, fonksiyonun ve bağımsızlığın optimize hale getirilmesi, hastaların eğitimi ve bakıcının katılımı hedeflenmektedir. Fizik tedavi ve rehabilitasyon uzmanları, fizyoterapistler ve iş-uğraşı terapistleri multidisipliner palyatif bakım ekibi içerisinde hastaların mobilitesinin, bağımsızlığının ve yaşam kalitesinin arttırılmasına yardımcı olmak için birlikte çalışmaktadırlar. Maalesef palyatif bakım kaynaklarının dağıtımı sırasında fizyoterapi ve rehabilitasyon olasılıklarının yüksek oranda göz ardı edilmekte olduğu ve gerekli kaynak aktarımının yeterince yapılmadığı gözlenmektedir. Biz bu yazımızda palyatif bakımın önemli bir bileşeni olan rehabilitasyonun, yoğun bakım ünitesindeki rolünü, gerekliliğini ve sağladığı faydanın vurgulanması amaçlamaktayız.

NECESSITY OF PALLIATIVE CARE IN THE INTENSIVE CARE

The number of individuals with serious or life-threatening diseases is gradually increasing because of the aging population and technologies that enable longer life expectancy. Palliative care programs are developed in order to improve quality of life during the course of these diseases. In palliative care, service is provided by experienced and educated healthcare personnel and a team of volunteers, and in hospital, first line treatment environment, house or hospices, depending on the conditions of each country. Intensive care units (ICUs) are unique environments where patients with critical condition receive rapid and aggressive life-saving interventions.Indevelopedcountriesphysicaltherapyand rehabilitation programs are integrated parts of intensive care units in many hospitals. Considering patient needs and complications in intensive care units, the importance of improving patients’ quality of life emerges as an issue to be kept in mind. Physical therapy and rehabilitation programs aim to maintain optimum respiratory and circulatory function in these patients, prevent muscular atrophy, muscular problems and joint contractures, control pain, optimize functioning and independency, educate patients and enable the participation of the caregiver. Physical therapy and rehabilitation specialists, physiotherapists and occupational therapies work together in a multidisciplinary palliative care team in order to increase patients’ mobility, independency and quality of life. Unfortunately it is observed that physical therapy and rehabilitation programs are largely ignored during the distribution of palliative care resources and that necessary transfer of funds is not provided. In this study we aim to highlight the role, necessity and benefit of rehabilitation, one of the important components of palliative care, in intensive care units.

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