Task Force 4: Inpatient Management of Patients with MCSD - The ...

appointments after discharge from MCS implant, it is imperative to address
psychological disorders during the index hospitalization.
Physical Therapy/Rehabilitation/Occupational Therapy. Evidence suggests that
early mobilization and progressive exercise training in MCS patients is safe and reduces
adverse events. 61 The patient should be assessed by physical therapy/occupational
therapy as soon as the patient is medically stabilized post operatively and transferred to
the non-ICU setting. A specific rehabilitation plan should be established with
documentation of goals. Prior to discharge from the hospital following MCS
implantation, patients should exhibit hemodynamic stability with exertion. In addition to
in-hospital exercise training provided by physical therapists, occupational therapists can
assess and assist patients with fine motor skills, which are important in “hands on”
device management, and return to activities of daily living, including use of MCS shower
kits. Patients who are unable to meet these goals in the hospital may need referral to an
inpatient rehabilitation facility which is able to support MCS patients.
Palliative care. Finally, an important member of the MCS multidisciplinary team a
provider of palliative care. Palliative care is focused on relief of symptoms and holistic
interdisciplinary support for the patient and their family 62 . During the informed consent
process, palliative care services (e.g., management of distressing symptoms, provision
of psychological and spiritual support, and provision of support to caregivers) can be
shared, regardless of whether patients choose MCS or medical therapy. 62,63 End of life
and device deactivation may also be useful to discuss at the time of informed consent,
especially for DT patients. 63,64 After MCSD implant, in-hospital palliative care services
may include symptom relief, especially management of pain, and psychosocial support.
If a catastrophic complication of MCS occurs prior to discharge, palliative care team
members may play a more prominent role in patient management, including providing
patient comfort measures and supportive care, and helping family members with coping,
anticipatory grief counseling, and elective device deactivation to allow for a natural
death. 65,66
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