Longer stay in hospital ICU has lasting impact on quality of life

April 2, 2014, Johns Hopkins University School of Medicine

Patients have substantial physical impairments even two years after being discharged from the hospital after a stay in an intensive care unit (ICU), new Johns Hopkins research suggests.

The scientists found that for every day of in the ICU, muscle strength was between 3 and 11 percent lower over the following months and years.

"Even a single day of bed rest in the ICU has a lasting impact on weakness, which impacts ' physical functioning and quality of life," says Dale M. Needham, M.D., Ph.D., an associate professor of medicine and of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine and senior author of the study described in the April issue of Critical Care Medicine. "We previously thought that bed rest and sedation in an ICU were helpful for patients, but we're finding this approach to care is actually harmful to the long-term recovery of many."

For the study, the Johns Hopkins team followed up on 222 patients discharged from one of 13 ICUs at four Baltimore hospitals between October 2004 and October 2007. All patients spent time on a mechanical ventilator as part of their successful treatment for acute lung injury, a syndrome marked by inflammation and excessive fluid in the lungs and frequent multiorgan failure. The disorder is considered an archetype disease in studying patients with critical illness.

The patients underwent evaluation of at hospital discharge and also three, six, 12 and 24 months later. More than one-third of survivors had muscle weakness at discharge, and while many saw improvement over time, the weakness was associated with substantial impairments in physical function and quality of life at subsequent follow-up visits.

The two variables most associated with a patient's were age and the duration of bed rest in the ICU, a unit where patients are traditionally confined to their beds because of , breathing tubes and life-sustaining machinery. "Age is not a modifiable risk factor, but bed rest is," Needham says. "We need to focus on changing bed rest to improve patients' recovery."

Previous research has shown that during the first three days a severely ill patient spends in the ICU, he or she can expect a 9 percent decrease in muscle size. The patients in this new study spent an average of two weeks in the ICU.

The key to improving long-term physical outcomes for survivors of critical illnesses may be in rethinking how patients are treated in the ICU, the researchers say.

"The standard of care for really sick patients has been keeping them sedated and in bed," says Eddy Fan, M.D., Ph.D., a former Johns Hopkins physician who now works at the University of Toronto and the study's first author. "Many doctors and nurses believe that when there's a breathing tube in place, patients need deep sedation, not rehab. But that is a myth. We need our patients awake and moving." Needham stresses the importance of keeping ICU patients as active as possible, even for severely ill patients who may only be able to sit up at the edge of the bed or have their arms and legs exercised by a physical or occupational therapist.

ICU-based rehabilitation therapy is underutilized, he adds, despite growing evidence of its safety and benefits. In a study being published in the June issue of the Journal of Critical Care, Needham and his colleagues found that among 1,110 patients consecutively admitted to The Johns Hopkins Hospital's Medical Intensive Care Unit and undergoing more than 5,500 physical therapy sessions, only 34 sessions (0.6 percent) had significant changes in vital signs or potential safety concerns. Many of the 34 issues documented were a change in heart rate or blood pressure that remedied itself once the patient stopped the activity.

"Nothing is free of risk in the ICU, but the harms of bed rest far exceed the potential harms of giving these patients rehabilitation delivered by a skilled clinical team—even when patients are very sick and on life support," Needham says.

"We must stop making excuses about why a patient can't do rehabilitation today—he has a CT scan or she's getting dialysis," he adds. "We need to highly prioritize rehabilitation, which we now see as just as—if not more—important than many other tests and treatments we offer our patients in ."

Explore further: Physical therapy in the intensive care unit benefits hospital's bottom line

Related Stories

Physical therapy in the intensive care unit benefits hospital's bottom line

January 11, 2013
In a study evaluating the financial impact of providing early physical therapy for intensive care patients, researchers at Johns Hopkins found that the up-front costs are outweighed by the financial savings generated by earlier ...

Practical play: Interactive video games appear valuable for patients

October 4, 2011
Interactive video games, already known to improve motor function in recovering stroke patients, appear to safely enhance physical therapy for patients in intensive care units (ICU), new research from Johns Hopkins suggests.

Burden of futile care in ICU studied: Patients waiting for care affected negatively, study presented

October 28, 2013
Researchers at UCLA studied the opportunity costs of providing futile care to patients in the ICU, finding that care was delayed or compromised for waiting patients when futile care was being provided in a full ICU. Futile ...

Simple measures to promote sleep can reduce delirium in intensive care patients

February 20, 2013
A hospital is not the best place to get a good night's sleep, especially in a noisy intensive care unit. It's a cause for concern because studies have shown that a lack of sleep can cause patients to experience delirium—an ...

Recommended for you

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...

Can muesli help against arthritis?

January 15, 2018
It is well known that healthy eating increases a general sense of wellbeing. Researchers at Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) have now discovered that a fibre-rich diet can have a positive influence ...

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.