Early Exercise Boosts Outcomes for ICU Patients
THURSDAY May 14, 2009 -- Interrupting the sedation of critically ill patients in the intensive care unit (ICU) to engage them in brief physical therapy may lead to better outcomes, a new study suggests.
As noted by researchers writing in the May 13 online edition of The Lancet, weakness and neuropsychiatric disease are often complications of the immobilization caused by long-term sedation in the ICU.
The new randomized, controlled trial involved 104 patients who were on mechanical ventilators for less than 72 hours but were expected to continue on ventilation for another 24 hours. A team led by Dr. John Cress of the University of Chicago assigned 49 of the patients to daily interruption of sedation and early exercise and mobilization, while the other 55 patients received standard care.
The team then tracked patients after discharge for signs of "independent functional status" -- the ability to walk unaided and carry out six tasks of daily living.
According to the Chicago researchers, 59 percent of those who got the early exercise achieved that functional milestone over four weeks of follow-up, compared to 35 percent in the standard care group. Early physical therapy also cut the rate of delirium episodes in half and reduced the number of days in which patients required a ventilator.
"A strategy for whole-body rehabilitation -- consisting of interruption of sedation and physical and occupational therapy in the earliest days of critical illness -- was safe and well-tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care," the researchers wrote.
Writing in an accompanying commentary, Dr. Stephan M. Jakob and Dr. Jukka Takala, of University Hospital, Switzerland, noted that "exercise should have a central role in the treatment of critically ill patients... Although physiotherapy is commonly administered to patients in intensive care during recovery from critical illness in the USA, the frequency and type of physiotherapy greatly varies between the type of hospital and clinical scenarios."
There's more on care in the ICU at the Society of Critical Care Medicine.
Posted: May 2009