Patients have substantial physical impairments even two years after being discharged following a stay in the ICU, according to a study.
Researchers found that for every day of bed rest in the ICU, muscle strength was between 3% and 11% 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, Dale M. Needham, MD, PhD, senior author of the study and an associate professor of medicine and of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine in Baltimore, said in a news release.
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, published in the April issue of the journal Critical Care Medicine, 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, which 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 a 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. Age is not a modifiable risk factor, but bed rest is, Needham said. 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% 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 said.
The standard of care for really sick patients has been keeping them sedated and in bed, Eddy Fan, MD, PhD, the study’s first author and a former Johns Hopkins physician who now works at the University of Toronto, said in the news release. 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 stressed the importance of keeping ICU patients as active as possible, even in the cases of 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, Needham added, despite growing evidence of its safety and benefits.
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 said.
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 added. We need to highly prioritize rehabilitation.