In his report, Dale Needham of the Johns Hopkins University School of Medicine says that routinely keeping ICU patients deeply sedated and on bed rest can lead to muscle weakness and that it is probably best to get patients up and moving shortly after admission to an ICU.
Needham and colleagues found that across 24 studies, focused on ICU patients with sepsis, prolonged mechanical ventilation and multiple organ failure, 46 percent of 1,421 patients had neuromuscular dysfunction that was associated with extended use of mechanical ventilation and longer stays in the ICU. Other studies Needham reviewed showed that early physical medicine and rehabilitation therapy, while patients are on life support in the ICU, can safely allow patients to get out of bed and walk more quickly, resulting in shorter time on a ventilator and a shorter stay in the ICU for these critically ill patients.
According to Needham, early mobilisation of hospitalised patients was introduced in World War II as a means of getting injured soldiers quickly back to the battlefield. Even during the early years after creation of ICUs, patients were frequently awake and out of bed. Over time, however, technology and other factors led to the more routine use of deep sedation and bed rest in ICUs. Needham, in his review, cited numerous studies highlighting the physical harm of lengthy bed rest, such as loss of muscle strength and changes in heart function.
The cause of muscle weakness after an ICU stay are complicated, he says, but experimental studies do show that even healthy people experience a four to five percent loss of muscle strength for each week of bed rest, and require a prolonged recovery period. “Although there are many causes of muscle weakness, getting ICU patients up and moving does help modify the negative effects of bed rest,” he says.
Needham cautions that despite this evidence for early mobilisation, additional research is needed to more fully understand the best methods for doing it, and the short-term and long-term benefits.
MEDICA.de; Source: Johns Hopkins Medicine