Featured Research

from universities, journals, and other organizations

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

Date:
April 2, 2014
Source:
Johns Hopkins Medicine
Summary:
Patients have substantial physical impairments even two years after being discharged from the hospital after a stay in an intensive care unit (ICU), new research suggests. The scientists found that for every day of bed rest in the ICU, muscle strength was between 3 and 11 percent lower over the following months and years.

Dale M. Needham, M.D., Ph.D.
Credit: Keith Weller

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.

Related Articles


The scientists found that for every day of bed rest 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 patients' 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 muscle strength 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 muscle weakness were age and the duration of bed rest in the ICU, a unit where patients are traditionally confined to their beds because of deep sedation, 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 intensive care."


Story Source:

The above story is based on materials provided by Johns Hopkins Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. Thiti Sricharoenchai, Ann M. Parker, Jennifer M. Zanni, Archana Nelliot, Victor D. Dinglas, Dale M. Needham. Safety of physical therapy interventions in critically ill patients: A single-center prospective evaluation of 1110 intensive care unit admissions. Journal of Critical Care, 2013; DOI: 10.1016/j.jcrc.2013.12.012

Cite This Page:

Johns Hopkins Medicine. "Longer stay in hospital ICU has lasting impact on quality of life." ScienceDaily. ScienceDaily, 2 April 2014. <www.sciencedaily.com/releases/2014/04/140402121439.htm>.
Johns Hopkins Medicine. (2014, April 2). Longer stay in hospital ICU has lasting impact on quality of life. ScienceDaily. Retrieved November 28, 2014 from www.sciencedaily.com/releases/2014/04/140402121439.htm
Johns Hopkins Medicine. "Longer stay in hospital ICU has lasting impact on quality of life." ScienceDaily. www.sciencedaily.com/releases/2014/04/140402121439.htm (accessed November 28, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Friday, November 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Rural India's Low-Cost Sanitary Pad Revolution

Rural India's Low-Cost Sanitary Pad Revolution

AFP (Nov. 28, 2014) — One man hopes his invention -– a machine that produces cheap sanitary pads –- will help empower Indian women. Duration: 01:51 Video provided by AFP
Powered by NewsLook.com
Research on Bats Could Help Develop Drugs Against Ebola

Research on Bats Could Help Develop Drugs Against Ebola

AFP (Nov. 28, 2014) — In Africa's only biosafety level 4 laboratory, scientists have been carrying out experiments on bats to understand how virus like Ebola are being transmitted, and how some of them resist to it. Duration: 01:18 Video provided by AFP
Powered by NewsLook.com
WHO Says Male Ebola Survivors Should Abstain From Sex

WHO Says Male Ebola Survivors Should Abstain From Sex

Newsy (Nov. 28, 2014) — WHO cites four studies that say Ebola can still be detected in semen up to 82 days after the onset of symptoms. Video provided by Newsy
Powered by NewsLook.com
Ebola Leaves Orphans Alone in Sierra Leone

Ebola Leaves Orphans Alone in Sierra Leone

AFP (Nov. 27, 2014) — The Ebola epidemic sweeping Sierra Leone is having a profound effect on the country's children, many of whom have been left without any family members to support them. Duration: 01:02 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:

Strange & Offbeat Stories

 

Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins