Returning home from hospital after an ITU stay

Returning home from hospital is a major positive step in your recovery following your illness, however it can be daunting to have less support and advice than you had access to in hospital.

It is normal to find some daily activities more difficult following an admission to ITU.

The resources below are designed to help you understand and manage your symptoms, as well as provide advice regarding how and when to seek additional support.

Click on the tabs below to find more information about the cause of the symptoms and how to manage them:

Why do I feel more tired? 

It is normal after an ITU admission to find everyday activities much more tiring, both physically and mentally. During your admission you may have been sedated and will probably have spent most of the time in bed. When you begin having to do things for yourself again it is a big adjustment and can be very tiring.

The importance of pacing yourself 

Pacing yourself is very important in learning to manage your fatigue, it is all about doing things in small, manageable sections and allowing yourself sufficient rest in between. Over time you can gradually increase how much you do in a day and build up your stamina. 

It is natural to have some days where you feel more tired  and need more rest than usual. You will likely experience some bumps along the road during your recovery, but it is important to find the balance of pushing yourself and taking the rest you need. If you don’t pace yourself you may risk falling into the “boom bust cycle”. This occurs when you have a good day and try to do as much as possible, leaving you more tired, needing to take more rest and being able to do less for the following days, this can lead to a gradual decline in your stamina. 

This is why even on a good day it is still important to pace yourself, so as not to make yourself too tired for the following days. By pacing yourself on good days and allowing yourself the rest you need on bad days, you can continue to make improvements to your fatigue over time. 

When pacing yourself it is important to prioritise the activities that are most important to you. Try not to tire yourself out with activities that are less important or less enjoyable. 

How to build up to doing more? 

It can be useful to monitor how much you’re doing and when you feel more or less fatigued, for example it may be useful to keep an exercise diary. You can then set yourself small, manageable goals and gradually build up. 

Here is an example of an activity diary

The advice below is designed for managing long term breathlessness. If you have rapidly worsening breathlessness and/or chest pain, please seek urgent medical assistance. 

Why do I feel breathless? 

Often when people are in intensive care they need the help of a ventilator, this is the machine that helps you to breathe. After being ventilated it is normal to experience breathlessness, as your body adjusts to having to breath on its own again. This can sometimes be made more difficult if it was a problem with your chest that bought you into intensive care, or you developed a chest infection during your admission. 

You may also find you get more breathlessness than before your admission due to general weakness and fatigue that can happen after being in intensive care. Please see our pages on these topics for more information. 

The feeling of being out of breath can be very scary, this can cause anxiety which often makes breathing more difficult. When this occurs, you can find yourself in a cycle that is difficult to break. Below are some techniques that can help you to break this cycle. Everybody finds different techniques and strategies helpful, it is important to explore different options and find what works best for you. 

Breathing exercises and positions of ease 

Managing weakness

Why do I feel weak?

It is very common for people to experience generalised muscle weakness following an ITU admission. This can affect lots of different aspects of every day life, for example your mobility, ability to climb stairs, ability to wash and dress yourself, prepare your meals and the dexterity in your hands.

There are a number of factors that can contribute to muscle weakness following a critical illness. During the time you were very unwell it is likely that you spent the majority of the time in bed, especially initially. When you don’t use your muscles, they can waste away very quickly and cause you to become weak. This is made worse when you are very unwell as your body prioritises fighting the illness, rather than maintaining your muscles.

Some people may also experience a form of nerve damage following an ITU admission, this can make it very difficult to activate and use your muscles.

Muscle weakness and decreased mobility

When you are discharged from hospital you may go home with a walking aid, such as a stick or zimmer frame.

While these aids can be very useful in helping to keep you safe they can be cumbersome and restrictive. By increasing your physical strength and improving your balance you may be able to decrease your reliance on your walking aid. The exercises below are designed to support you with this.

When you initially begin the exercises, it is important to pace yourself, doing too much too soon can make you tired and leave you feeling weaker. Begin by doing a small number of each exercises, such as 5-8 repetitions, once a day. You can increase the difficulty over time by increasing the number of repetitions, doing the exercises more than once a day, or adding hand/ankle weights.

You’ll know you’re doing the exercises correctly if you feel a slight ache in your muscles, but not a serious pain. You’ll know if doing the right number of exercises when the last few repetitions of each exercises are effortful, but not too difficult.

Strengthening exercises

Seated exercises 

Arm exercises

Standing exercises 

Balance exercises

When doing the balance exercises always make sure to prioritise your safety. Make sure you stand near something sturdy that you can hold onto if you need to.

Balance exercises 

Advanced balance exercises 

There can be other factors contributing to decreased mobility aside from strength and balance, for example fatigue and breathlessness. Please see the sections on these topics for additional information and advice.

If you have tried to decreased your reliance on your walking aid but haven’t been successful or feel unsafe trying to do this alone it may help to have a physiotherapist see you at home. You may have been referred for this at the time of your discharge from hospital, if not please contact your GP for a referral to Physiotherapy.

If you have a walking aid at home that you are no longer using and wish to return you can drop it into any Cardiff and Vale hospital. Please see our Walking aids  service page for more information. 

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