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Bed rest after lung injury linked to muscle weakness, functional impairments

Publish date: April 21, 2014
By
Amy Karon
MDedge News

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Intensivist/patient appreciates all sides of the issue

Dr. Steven Q. Simpson is not only an intensivist, but a former ICU patient. He said both perspectives lead him to support early occupational and physical therapy for survivors of severe acute illness.


Dr. Steven Q. Simpson

"I can assure you that recovery from such an episode is prolonged," said Dr. Simpson. "Thanks to [my] experience, I have been especially tuned in to the recent movement among intensivists toward concern for the long-term welfare of our ICU patients."

At the University of Kansas Medical Center, he said, intensivists "are aggressive users of a progressive upright mobility protocol, including ambulating patients who are on the mechanical ventilator. We include physical therapy and occupational therapy orders on our admission to the ICU order set, and we use a daily checklist to ensure that the patients have been seen and are receiving active PT and OT to the full extent that they can participate."

He added that ventilated patients have daily sedation interruptions, in part so they can participate in PT and OT.

"Finally, we have a sleep management protocol in our ICU to help alleviate the exhaustion that accompanies ICU care by allowing eligible patients to sleep for at least 5 uninterrupted hours per night," he said. "Believe me, I never got that as an ICU patient!"

Dr. Simpson is an intensivist and director of the pulmonary disease and critical care medicine fellowship at the University of Kansas Medical Center, Kansas City.


 

FROM CRITICAL CARE MEDICINE

Duration of bed rest during acute lung injury was the most consistent predictor of muscle weakness among survivors 2 years later, according to a report in the April issue of Critical Care Medicine.

For every additional day of bed rest, survivors’ muscle strength was 3%-11% lower at 24-month follow-up, said Dr. Eddy Fan of the division of critical care medicine, University of Toronto.

The results underscore the importance of evidence-based methods to reduce bed rest during critical illness, including early physical and occupational therapy, wrote Dr. Fan and his colleagues (Crit. Care Med. 2014;42:849-59).

The prospective, multisite, longitudinal study comprised 520 patients with acute lung injury, of whom 222 underwent muscle strength evaluations. During follow-up visits at 3, 6, 12, and 24 months, investigators measured extremity, hand grip, and respiratory muscle strength; anthropometric variables; and the distance patients could walk in 6 minutes. Patients completed a short-form survey on health-related quality of life.

The researchers found that patients generally recovered muscle strength within 12 months after acute lung injury, but that muscle weakness was associated with significant limitations in physical function and quality of life that persisted for at least another 12 months. Only 36% of patients received any physical therapy while in the ICU, and while the average ICU stay was 13 days, patients who did receive PT went an average of 10 days before it began.

The researchers noted that they did not use nerve conduction studies, electromyography, or muscle and nerve biopsies, and did not control for factors such as outpatient rehabilitation or subsequent hospitalizations.

The National Institutes of Health partially funded the research. The authors did not disclose any conflicts of interest.

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