Physical therapy beneficial for critically ill patients in ICU
Interrupting the sedation of critically ill patients to offer brief physical and occupational therapy may improve their ability to function independently when discharged from hospital, researchers have found.
In Thursday's online edition of the Lancet, researchers in the U.S. reported the results of their randomized, controlled trial of 104 patients who were on mechanical ventilators in the intensive care unit.
Weakness and neuropsychiatric diseases such as delirium are often complications of immobilization caused by sedation in the ICU, Dr. John Kress of the University of Chicago and his colleagues said.
The study looked at patients who were on mechanical ventilators for less than 72 hours but were expected to remain on ventilation for at least another 24 hours.
Among the 49 patients who were assigned to early exercise and mobilization — bathing, dressing, eating, grooming, transferring from bed to chair, and using the toilet — 59 per cent were able to walk unaided and carry out these tasks of daily living after discharge.
In comparison, 35 per cent of the 55 patients in the control group who received standard care were able to achieve the same "independent functional status" over four weeks of followup.
People who received the early physical therapy intervention also suffered half as many days of delirium in the ICU (2.0 days) as those in the control group (4.0 days).
Intervention patients also needed a ventilator for fewer days while in ICU (23.5 days versus 21.1 days for control), the researchers found.
"A strategy for whole-body rehabilitation — consisting of interruption of sedation and physical and occupational therapy in the earliest days of critical illness — was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care," the study's authors concluded.
Key role for exercise
Co-ordinating the efforts of doctors, physical and occupational therapists and nurses can achieve better outcomes in terms of the survival and mental and physical recovery of critically ill patients receiving mechanical ventilation, they added.
The findings show "exercise should have a central role in the treatment of critically ill patients," Dr. Stephan Jakob and Dr. Jukka Takala, of University Hospital, Switzerland, said in journal commentary accompanying the study.
But the frequency and type of physiotherapy greatly varies between types of hospitals and clinics, they noted.
"We've always recommended trying to get people moving as quickly as possible," said Cathy Anderson, co-chair of the cardiorespiratory division of the Canadian Physiotherapy Association.
Unlike the hospitals in this study, many hospitals in Canada often have physiotherapists involved in caring for a wide range of intensive care patients early on.
"Certainly in an ICU setting, often people in the public think the patients are so ill that they can't do anything," Anderson said. "But we know that every bit helps. The sooner we can get to them and get working with them, it does make an improvement on their outcome."