Bed Rest Is Not Necessarily Beneficial

photo: intensive care unit

ICU-acquired muscle weakness
could be prevented;© Wikipedia/
Norbert Kaiser

"Patients who develop muscle weakness while they are critically ill do much worse," says Robert D. Stevens, M.D., associate professor of anesthesiology and critical care medicine, neurology, neurosurgery and radiology at the Johns Hopkins University School of Medicine. "They have higher mortality and their stay in the ICU is prolonged. They incur serious costs. Some of these patients in the long run remain weak and are unable to resume physical activities as before."

Some form of muscle weakness affects nearly half of patients with serious illness treated in intensive care units, or ICUs, the researchers say. But prevention or treatment of ICU-acquired weakness has been slowed, doctors say, by a lack of agreement on the definitions of what constitutes these disorders and an inadequate framework for properly classifying them.

Standard practice in ICUs, where patients are often hooked up to ventilators, dialysis machines and infusion pumps, has been to keep patients in bed until they recover from their critical illness. Stevens calls it the "classic paradox" in the treatment of many illnesses: Stay in bed and rest until you are better. It is now recognized, however, that muscle weakness is significantly worsened by being immobilized in ICU, Stevens says, and "that whole idea of bed rest as being something beneficial is being turned on its head."

Recognizing the muscle wasting and weakness associated with extended ICU stays, Stevens says new research is promoting reduced levels of sedation and early mobilization and exercise among those patients. Some recent efforts – including work being done at Johns Hopkins – have been to get patients cycling in bed, standing, sitting in a chair and even walking while they are still on respirators.; Source: John Hopkins University School of Medicine