In a new study, Johns Hopkins experts have shown that use of prescription sedatives goes down by half so that mild exercise programs can be introduced to the care of critically ill patients in the intensive care unit (ICU).
Curtailing use of the drowsiness-inducing medications not only allows patients to exercise, which is known to reduce muscle weakness linked to long periods of bed rest, but also reduces bouts of delirium and hallucinations and speeds up ICU recovery times by as much as two to three days, the paper concludes.
Mild exercise, the experts say, with sessions varying from 30 minutes to 45 minutes, should be performed by patients under the careful guidance of specially trained physical and occupational therapists and can include any combination of either leg or arm movements while laying flat in bed, sitting up or standing, or even walking slowly in the corridors of the ICU. ndeed, the Johns Hopkins team has since evaluated a number of additional physical rehabilitation therapies, such as cycling in bed using a specially designed peddling device, or stimulating contractions of the leg muscles with overlying electrical pads. Patients can often exercise while still attached to life support equipment, such as a mechanical ventilator that helps them breathe, the group shows.
In its latest exercise report, to be published in the journal Archives of Physical Medicine and Rehabilitation online April 9, the Johns Hopkins team closely monitored the progress of 57 patients admitted to The Johns Hopkins Hospital's medical intensive care unit (or MICU) in 2007.
Their treatment encompassed 794 days spent in the unit. Members of the MICU team checked the patients' records daily for several months before and after the physical rehabilitation project began. Each patient was mechanically ventilated for at least four days, with half receiving no more than one exercising session before the enhanced exercise plan started, while half received at least seven physical therapy sessions after the plan's implementation.
"Our work challenges physicians to rethink how they treat critically ill patients and shows the downstream benefits of early mobilization exercises," says critical care specialist Dale Needham, M.D., Ph.D., who spearheaded the project.
"Our patients keep telling us that they do not want to be confined to their beds, they want to be awake, alert and moving, and engaged participants in their recovery," says Needham, an ssociate professor at the Johns Hopkins University School of Medicine. "Patients are not afraid of exercising while they are in the ICU, and they are embracing this new approach to their are in the ICU. It actually motivates them to get well and reminds them that they have a life outside the four walls surrounding their hospital beds."