Purpose: The purpose of this case is to illustrate the best available evidence to provide early therapeutic intervention for a critically ill patient presenting with cardiovascular and pulmonary complications due to multi-system compromise. Case Description: A 19-year-old male was admitted to the hospital with the diagnosis of necrotizing fasciitis and necrotizing pneumonia. He experienced numerous additional medical complications ultimately leading to tracheostomy, delirium, critical illness myopathy, and quadrilateral amputation secondary to necrotizing fasciitis and critical limb ischemia following prolonged veno-venous extracorporeal membrane oxygenation (VV-ECMO). Outcomes: Patient was discharged to an outside rehabilitation hospital after 103 days in the acute setting (56 days in the ICU) and was able to tolerate 40 minutes sitting edge of bed with supervision, perform bed mobility with supervision, and propel a standard wheelchair up to 50 feet independently. At 10 months’ post-discharge from the acute setting, the patient was ambulating independently up to 150 feet without assistive device using bilateral lower extremity prosthetics, able to propel a lightweight wheelchair community distances, independent in all transfers, and returned to school and work. Discussion: These findings suggest that clinicians may want to consider examining and combining the best available evidence of multiple medical conditions to provide a well-rounded therapeutic approach including but not limited to, close monitoring of vitals and early mobilization, to managing complex patients in the intensive care setting.

Author Bio(s)

Mallory A. Kargela, PT, DPT, is an Assistant Professor in the College of Health Sciences at Midwestern University in Glendale, Arizona. She is a licensed physical therapist and practices primarily in the intensive care setting.

Annette J. Siebens, OTR/L, is a licensed occupational therapist at Mayo Clinic Hospital in Phoenix, Arizona. She practices primarily in the intensive care setting.


The authors of this case study would like to thank the patient and his family for the effort and intensity put into his recovery. Additionally, thank you for allowing permission to release photos for the purpose of growing our body of evidence and advancing knowledge of the physical therapy profession. Lastly, the authors would like to thank Mayo Clinic Hospital Arizona, the ICU nurses and medical staff, and Dr. Ayan Sen for the interprofessional collaboration and mentorship throughout the patient’s journey to recovery.




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