Getting Up And Walking Could Be Future for I.C.U. Patients

Some revolutionary doctors are revising years of practice by getting their I.C.U. patients up and about as soon as medically possible. The hope is by starting physical activity it will shorten the time it takes to recover.

Researchers tracking former patients in I.C.U.s tend to take years to recover. Some of those have post-traumatic stress disorder and memories of nightmares they had under heavy sedation.

Researchers have started to believe that it’s not just the illnesses that landed a patient in an I.C.U. that leaves them weak for months or years. They are now convinced that being on life support for days, weeks or months have long-lasting effects.

That research has lead to new policies. Getting patients, even those who are gravely ill, out of their beds and walking as soon as possible.

Immediately after been taken off a ventilator patients had difficulty moving their arms to raise themselves into a sitting position. Many could not push back against a researcher’s hand. Those results came after just days within an I.C.U. bed according to Dr. Naeem Ali of Ohio State University.

The research is focusing on why an I.C.U. stay can be so devastating and what changes need to take place to lessen that risk. As more medical advancements come forth, more patients are surviving their I.C.U. stays making this a real concern.

The New York Times reports:

“We had thought these patients just heal up,” said Dr. Peter Morris of Wake Forest University Baptist Medical Center. “But now so many of these reports from different universities say they are not really O.K..”

Dr. Dale Needham of John Hopkins has been tracking patients for the past five years. He has discovered that many former I.C.U. patients have a hard time recovering their prior strength and some never regain it after time spent in the I.C.U.

“We are asking ourselves, what can we do on Day 1 to get you out of the hospital and back to work sooner, without problems with weakness, mood and thinking? What can we do for you?”

The difficult part of this research is weeding out which future disabilities come from the illness itself and which come from the time spent in an I.C.U. bed. The fear is that mechanical ventilation along with the sedatives needed for that machine that would stop even a healthy person’s lungs from working is why patients have permanent strength loss.

Some doctors are wondering if the medicines used to help keep patients comfortable during this period are responsible for a reduced recovery.

Dr. John Kress, director of the University of Chicago’s medical I.C.U. tried experimenting with patients. The experiment consisted of waking patients every day for a brief time and turning off their infusion of sedatives.

Some people did not approve of this study believing that patients would be in a state of fear, dread and anxiety. The research team found that was the opposite of the result.

“We found, to the contrary, that patients actually did better” and even had a significantly lower rate of post-traumatic stress disorder, which is manifested by such things as mood disorders, anxiety, difficulty concentrating, shortness of temper and frightening memories. It is not clear why there was less post-traumatic stress but, Dr. Kress said, “My opinion is that maintaining some awareness of reality is better for your psyche.”

Ramona O. Hopkins, a professor of psychology and neuroscience at Brigham Young University, had the same idea as Needham and Dr Morris. Dr. Morris found that the patients that were in his pilot program recovered faster and left the I.C.U. and hospital at a quicker pace than other patients.

“Our biased impression is that mobilization is helpful,” Dr. Needham said. “A typical patient may not even be able to walk when they leave the I.C.U. or even the hospital. When we see them walk in the I.C.U., we believe that has to be better.”

Dr. Morris concludes that clinical trials ongoing and in the future will be the proof that is needed to change the way I.C.U.s operate, “there’s lots of room for improvement.”


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