Physical therapy
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Historically, the management of patients in the intensive care unit (ICU) has involved immobilization and sedation, with care focused on physiological impairments and survival. Because more ICU patients are now surviving their hospital stay, it is imperative that their ICU care be managed with the goal of long-term health, wellness, and functioning. The evidence confirms that mobilization and exercise are feasible in the ICU and demonstrates that the benefits of early mobilization include reduced length of stay in the ICU and hospital. ⋯ This model appears to be successful in some institutions, but there is variation among institutions. The SCCM Task Force developed major areas of focus that require multidisciplinary action to improve long-term outcomes after discharge from an ICU. This article describes physical therapist practice in the management of ICU survivors, the importance of long-term follow-up after ICU discharge, and how APTA is taking steps to address the major areas of focus identified by the SCCM Task Force to improve long-term outcomes after ICU discharge.
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Neuromuscular weakness and impaired physical function are common and long-lasting complications experienced by intensive care unit (ICU) survivors. There is growing evidence that implementing rehabilitation therapy shortly after ICU admission improves physical function and reduces health care utilization. Recently, there is increasing interest and utilization of extracorporeal membrane oxygenation (ECMO) to support patients with severe respiratory failure. Patients receiving ECMO are at great risk for significant physical impairments and pose unique challenges for delivering rehabilitation therapy. Consequently, there is a need for innovative examples of safely and feasibly delivering active rehabilitation to these patients. ⋯ Although greater experience is needed to more fully evaluate the safety of rehabilitation on ECMO, these initial cases are encouraging. We recommend systematically and prospectively tracking safety events and patient outcomes during rehabilitation on ECMO to provide greater evidence in this area.
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Bed rest and immobility in patients on mechanical ventilation or in an intensive care unit (ICU) have detrimental effects. Studies in medical ICUs show that early mobilization is safe, does not increase costs, and can be associated with decreased ICU and hospital lengths of stay (LOS). ⋯ Early mobilization of patients in a TBICU was safe and effective. Medical, nursing, and physical therapy staff, as well as hospital administrators, have embraced the new culture of early mobilization in the ICU.
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Prolonged bed rest in hospitalized patients leads to deconditioning, impaired mobility, and the potential for longer hospital stays. ⋯ The initial experience with a nurse-driven mobility protocol suggests that the rate of patient ambulation in an adult ICU and IMCU during the first 72 hours of a hospital stay can be increased.
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Case Reports
Innovative mobility strategies for the patient with intensive care unit-acquired weakness: a case report.
Although the benefits of early mobilization in the intensive care unit (ICU) have been well documented in recent years, the decision-making process and customization of treatment strategies for patients with ICU-acquired weakness have not been well defined in the literature. This case report will describe a patient with ICU-acquired weakness in the long-term acute care hospital (LTACH) setting and mobilization strategies that include novel devices for therapeutic exercise and gait training. ⋯ This case report describes novel mobility strategies for managing a patient with ICU-acquired weakness. The application of a graded mobilization program using a mobile leg press and a hydraulic-assist platform walker was safe and feasible, and appeared to expedite the patient's recovery process while decreasing the amount of manual lifting for the therapists.