The length of stay for a group of respiratory-failure patients who received mobility therapy within 48 hours of the insertion of a breathing tube was reduced by an average of three days compared to the stay for patients who did not receive the therapy. This reduced length of stay included a reduction of time in the ICU of more than a day.
Initial therapy – called passive range of motion – was provided by nursing assistants who flexed the joints of the patients’ upper and lower limbs three times a day, seven days a week. As patients progressed, they received more advanced physical therapy from a physical therapist. The therapy proved safe, and there was also no addition to hospital costs because the salaries of the employees who provided mobility therapy were offset by reduced lengths of stay in the hospital, according to Peter Morris, M.D., lead investigator and associate professor in the Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases.
Immobility and the resulting loss of physical conditioning are common problems for patients with respiratory failure, which means they cannot breathe without the assistance of a ventilator, said Morris. However, little data exist on whether early mobility therapy for ICU patients is associated with improved outcomes or cost benefits.
“Although there are data for efficacy of exercise for emphysema patients and for congestive heart failure patients in the outpatient setting, this was the first time for ICU administration of exercise as a therapeutic agent,” said Morris. “The project confirms that it is safe to administer early mobility to ICU patients and that it is of benefit.”
Phase I of a planned two-phase study was designed to address this lack of data by conducting a structured project, or protocol, over 24 consecutive months from 2004 to 2006 in which respiratory-failure patients admitted to the Medical Center’s ICUs were assigned to one of two groups: 165 to a protocol group, which received early therapy from a mobility team (a critical care nurse, a nursing assistant and a physical therapist), and 165 to a control group, which received usual care. Some of those patients who received usual care also received therapy, although not as early or as frequently as those in the protocol group. Once patients were transferred to a regular nursing unit, both groups received usual care.
In addition to shorter hospital stays, the protocol patients also progressed more quickly to active physical therapy, were out of bed earlier and experienced no adverse events during an ICU therapy session.
Morris said further studies are needed in order to clarify the optimum number and duration of exercise sessions. Phase II of the study at the Medical Center will look at a broader range of ICU patients, both more and less ill, and will continue through hospital discharge. In addition, a study funded by the Medical Center’s Claude D. Pepper Older Americans Independence Center will examine the effect of early mobility therapy for the elderly, who may be more at risk than younger patients for ICU-related arm and leg weakness.
Morris will make additional presentations on the study in February at the 37th Critical Care Congress of the Society of Critical Care Medicine, and in May at the 2008 International Conference of the American Thoracic Society.
Phase I of the early mobility therapy study was conducted by a team from both N.C. Baptist Hospital and Wake Forest University School of Medicine representing hospital administration, nursing leadership, the Division of Public Health Sciences, physical therapy, and the Section on Pulmonary Care. The study was funded primarily by Baptist Hospital.
The Medical Center’s ICUs are one of 10 sites for the adult respiratory distress syndrome (ARDS) network of the National Institutes of Health, which is the critical care research network for the United States.
Karen Richardson | EurekAlert!
The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft
Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung
Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.
The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...
Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...
Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!
When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...
For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.
Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...
MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems Holding GmbH about commercial use of a multi-well tissue plate for automated and reliable tissue engineering & drug testing.
MBM ScienceBridge GmbH successfully negotiated a license agreement between University Medical Center Göttingen (UMG) and the biotech company Tissue Systems...
19.09.2017 | Event News
12.09.2017 | Event News
06.09.2017 | Event News
21.09.2017 | Life Sciences
21.09.2017 | Health and Medicine
21.09.2017 | Earth Sciences