Early Mobility Best for ICU Patients

Getting out of bed sooner helped quality of life after discharge, study finds

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TUESDAY, Oct. 7, 2008 (HealthDay News) -- The best medicine for intensive care unit (ICU) patients may be getting them out of bed and moving as soon as they're able, a new report says.

Based on a review of ICU patient data, Johns Hopkins University School of Medicine researchers concluded that the routine use of deep sedation and bed rest may cause unnecessary and long-term physical impairment and poor quality of life after hospital discharge.

"The benefits of getting hospitalized patients out of bed and moving were understood during World War II with battlefield injuries," Dr. Dale Needham, assistant professor in the Division of Pulmonary and Critical Care Medicine and the Department of Physical Medicine and Rehabilitation, said in a school news release. "My review shows it may be time to go back to the future. It's becoming clear that the safety and benefits of early mobilization are real, and that it's better to get moving sooner rather than later."

His report, published in the Oct. 8 issue of the Journal of the American Medical Association, said muscle weakness can be the result of the current sedation-and-bed-rest routine. Instead, he recommended getting patients up and moving shortly after admission to an intensive care unit.

Based on a review of 24 studies of ICU patients with sepsis, prolonged mechanical ventilation and multiple organ failure, nearly half of the 1,421 patients had neuromuscular dysfunction associated with extended use of mechanical ventilation and lengthy ICU stays.

In other studies Needham reviewed, the use of early physical medicine and rehabilitation therapy for ICU patients -- even those on life support -- safely helped patients to get up and about more quickly. This leads to less time on a ventilator and a shorter stay in the ICU, he said.

According to Needham, hospitalized soldiers in World War II were encouraged to move about as a means of getting them quickly back to the battlefield. Time, technology and other factors have changed that approach, even though, Needham said, his review found several studies highlighting the harm of lengthy bed rest, such as loss of muscle strength and changes in heart function.

"Although there are many causes of muscle weakness, getting ICU patients up and moving does help modify the negative effects of bed rest," he said.

Still, Needham cautioned that more research is needed to find the best methods for using his approach, as well as its short- and long-term benefits.

More information

The American College of Chest Physicians has more about mechanical ventilation.

SOURCE: Johns Hopkins University, news release, Oct. 7, 2008

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