Patients who are critically ill and participate in mild exercise programs led by physical therapists achieve higher functional mobility and spend fewer days in intensive care units (ICU) and hospitals than those who receive less exercise, according to a report published in the April issue of the Archives of Physical Medicine and Rehabilitation.
In a quality improvement project implemented in a medical intensive care unit at Johns Hopkins Hospital, a multidisciplinary health care team focused on reducing the use of prescription sedatives to reduce patient drowsiness and increase patients' ability to exercise more frequently. The project included 57 patients who were on a mechanical ventilator for 4 or more days. The health care team found that this quality improvement process resulted in lower median daily doses of sedatives, improved patient alertness, and reduced delirium. These factors contributed to a greater number of rehabilitation treatments per patient with a higher level of functional mobility in the ICU, and a decrease in ICU and hospital length of stay by 2.1 and 3.1 days, respectively.
"Historically, patients in ICUs have been heavily sedated and immobile, which contributes to neuromuscular weakness that can, in turn, lead to physical impairments and decreased quality of life," said Jennifer Zanni, PT, MSPT, a co-author of the report. "The results of our quality improvement project show that rehabilitation of patients who are critically ill is safe and effective in improving mobility and returning patients to their homes sooner."
The rehabilitation-based exercise sessions typically lasted 30-45 minutes and consisted of arm and leg movements while lying in bed, sitting, or standing, or walking slowly in the ICU hallways.
"This report underscores the integral role that physical therapists, who are experts in restoring and improving motion, play in speeding recovery time for patients in ICUs," said R. Scott Ward, PT, PhD, president of the American Physical Therapy Association. "We hope these results encourage other critical care experts to consider early mobilization in this patient population."
- Dale M. Needham, Radha Korupolu, Jennifer M. Zanni, Pranoti Pradhan, Elizabeth Colantuoni, Jeffrey B. Palmer, Roy G. Brower, Eddy Fan. Early Physical Medicine and Rehabilitation for Patients With Acute Respiratory Failure: A Quality Improvement Project. Archives of Physical Medicine and Rehabilitation, 2010; 91 (4): 536 DOI: 10.1016/j.apmr.2010.01.002
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