Early mobilization of patients in ICU improves outcomes

May 18, 2009

Aside from the obvious and immediate health problems that patients undergoing mechanical ventilation face, those who recover often do so with profound loss of strength and mobility that can impair their daily functioning and even lead to increased risk of morbidity and mortality down the line. Now research shows that functional status may be restored earlier to ICU patients by performing daily interruptions in sedation paired with mobilization and exercise, as led by physical and occupational therapists.

The study results will be announced on May 17 at the 105th International Conference of the American Thoracic Society in San Diego.

"Weakness and loss of functional independence—the inability to transfer from bed, walk and execute typical daily self-care activities, such as cleaning and dressing oneself—are commonly experienced among discharged from the ," said William Schweickert, M.D., assistant professor of medicine in the Pulmonary, Allergy, and Critical Care Division at the University of Pennsylvania Medical Center. "This can result in major disability and protracted rehabilitation and may be accelerated or exacerbated by prolonged periods of immobility, especially among patients who undergo mechanical ventilation and sedation."

"Because ICU-acquired weakness is associated with such poor outcomes and potentially exacerbated by deep sedation and immobility, we wanted to see whether mobilization begun in the earliest days of respiratory failure would improve patient function at hospital discharge and reduce delirium," he continued.

Dr. Schweickert and colleagues conducted a randomized trial of 100 patients who were undergoing sedation and mechanical ventilation in the ICU. They compared patients who underwent a protocol of daily mobilization in conjunction with sedative interruption with those who underwent sedative interruption alone and therapy services as ordered by their primary care team.

They found that patients who underwent the mobilization protocol were more frequently able to get out of bed, stand and occasionally walk with assistance during mechanical ventilation. The physical regimens prescribed by the primary care team, on the other hand, often began only after mechanical ventilation was no longer needed, potentially leading to a longer loss of functional status and a longer recovery time.

The degree of functional loss in the control arm was substantial—only one third of patients left the hospital able to function independently. In contrast, nearly 60 percent of the early mobilization patients had achieved independence.

"Overall, patients in the mobilization group were nearly twice as likely to regain their functional independence at hospital discharge and experienced less delirium than did their counterparts who did not receive the intervention," said Dr. Schweickert.

"The benefits of pairing mobilization and sedative interruption from the inception of critical illnesses are substantial, but the improvements in function are not easily recognizable until about two weeks," observed Dr, Schweickert, adding that "starting these therapies early can be difficult in the context of ongoing critical illness, yet the data highlights that it can be done safely. We still need to test how this intervention and its findings translate into longer-term survival and better quality of life."

Source: American Thoracic Society (news : web)

Related Stories

Recommended for you

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.