Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Mild exercise while in the ICU reduces bad effects of prolonged bed rest

23.09.2009
Critical care experts at Johns Hopkins are reporting initial success in boosting recovery and combating muscle wasting among critically ill, mostly bed-bound patients using any one of a trio of mild physical therapy exercises during their stays in the intensive care unit (ICU).

"ICU-related muscle weakness is the number one factor in prolonging a patient's recovery and delaying their return to a normal life, including work and recreational activities," says critical care specialist Dale Needham, M.D., Ph.D., the senior researcher involved in producing the report, to be published in the journal Critical Care Medicine online Sept. 21.

"Our ICU patients are telling us that they want to be awake and moving. Gone are the days when we should only think of critically ill patients on complete bed rest," says Needham, whose 2008 publication in the Journal of the American Medical Association reported that a majority of ICU patients experienced prolonged fatigue and delayed recovery after bed rest.

In the new report, Needham and colleagues describe muscle-strengthening exercises that can be introduced early into the treatment plans of critically ill patients. Needham's team, including two physical therapists, have used these exercises in treating over 400 patients in The Johns Hopkins Hospital's medical ICU in the last year.

Although longer follow-up is needed, Needham and his team say their early approach to having patients exercise while in the ICU is showing signs of success, with patients leaving the hospital sooner, stronger and happier.

Some of the ICU patients are undergoing electrical stimulation to strengthen leg muscles, getting up to walk around the ICU, and even cycling while lying in bed using a specially designed device attached to the end of the bed.

Experts say there are plenty of data suggesting that long periods of bed rest, even episodes lasting a few days, can lead to significant muscle weakness. In some studies, patients have lost as much as 5 percent per week of leg muscle mass.

Developing physical therapy regimens for ICU patients requires good planning, says Needham, an assistant professor at the Johns Hopkins University School of Medicine, because most of the patients are on mechanical ventilators to help them breathe, and some are also sedated while undergoing treatment.

In neuromuscular electrical stimulation, a technique used to hasten recovery in injured athletes, electrodes are placed on the skin over three major muscle groups in each leg, with low-voltage electrical impulses inducing muscle contractions that may mimic mild exercise. Three patients at The Johns Hopkins Hospital have used the electrical pads for half-hour, twice daily exercise sessions as part of the devices' clinical testing. Needham says the team is still tracking recovery times, but he notes that studies in patients who were not critically ill have demonstrated that the technique keeps muscles from weakening.

For the walks, patients remain connected to their ventilators, heart monitors, and other equipment while using a standard walker. A nurse and physical and respiratory therapists accompany and monitor the patient, stopping for rest periods as needed. Walking sessions, including rest breaks, usually last half an hour.

The team has also developed, with help from Johns Hopkins biomedical engineering students, a special walker called the "MOVER Aid," with a built-in seat for patients who need to sit and rest. The MOVER includes a wheeled pole to hold a ventilator and ICU monitoring equipment.

The motorized stationary bicycle affixed to the ICU bed has also been used by over a dozen patients at Hopkins, some sedated and others wide awake. Patients peddle for as much as 20 minutes per day.

Researchers in Europe, where the cycle ergometry device is made, recently compared a group of over 30 ICU patients who used the cycle to a similar number who did not and found that at discharge from the hospital, trained patients had stronger leg muscles and more were able to walk on their own.

According to critical care expert Eddy Fan, M.D., an instructor at Hopkins who collaborates on research with Needham, the long-term complications from stays in the ICU have only come to light as survival rates in critically ill patients have improved over the last 20 years. He says many more people are now surviving after being admitted with acute respiratory distress syndrome, one of the most severe medical conditions in need of critical care support.

"Bed rest often only compounds the problem and makes it worse," says Fan, who has had one patient lose as much as 60 pounds during an ICU stay of several weeks. "Many patients are already weak when they arrive in the ICU, having been sick for a while, and having dropped weight as a result of poor appetite. So they are often starting from a personal low point when they get here, and the lack of physical activity only hastens their decline.

"Early physical therapy is helping us to fix this problem," he adds. "It really is changing the way we practice critical care medicine in the ICU."

Since the introduction of early mobility practices in the ICU, Fan points out, average stays in Hopkins Hospital's medical intensive care unit have dropped by as much as two days (more than 20 percent.)

Furthermore, Fan says, efforts to reduce sedative use and its associated delirium are also proving effective. Delirium and its associated hallucinations are known to occur in ICU patients who have been heavily sedated, prolonging their recovery.

Needham says his team's next steps are to continue with long-term clinical tests of each technique, already under way at several U.S. hospitals, in which some critically ill patients are exercising heavily and others less so or not at all. The ultimate goal, the researchers say, is to determine if and by how much early mobility exercises improve quality of life.

David March | EurekAlert!
Further information:
http://www.jhmi.edu

More articles from Health and Medicine:

nachricht A promising target for kidney fibrosis
21.04.2017 | Brigham and Women's Hospital

nachricht Stem cell transplants: activating signal paths may protect from graft-versus-host disease
20.04.2017 | Technische Universität München

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

DGIST develops 20 times faster biosensor

24.04.2017 | Physics and Astronomy

Nanoimprinted hyperlens array: Paving the way for practical super-resolution imaging

24.04.2017 | Materials Sciences

Atomic-level motion may drive bacteria's ability to evade immune system defenses

24.04.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>