by By Lauran Neergaard
In this photo provided by the Wake Forest Baptist Medical Center, taken March 11, 2015 in the intensive care unit at Wake Forest Baptist Medical Center, physical therapist Katie Kellner helps patient Terry Culler do some exercises and briefly stand despite being hooked to a ventilator. There's increasing evidence that mild exercise may have its place even for the sickest ICU patients, and new animal research suggests it may target both muscles and lungs. (AP Photo/Warren Cameron Dennis III, Wake Forest Baptist Medical Center)
The intensive care unit is a last frontier for physical therapy: It's hard to exercise patients hooked to ventilators so they can breathe.
Some hospitals do manage to help critically ill patients stand or walk despite being tethered to life support. Now research that put sick mice on tiny treadmills shows why even a little activity may help speed recovery. It's work that supports more mobility in the ICU.
"I think we can do a better job of implementing early mobility therapies," said Dr. D. Clark Files of Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, who led the research and whose hospital is trying to get more critically ill patients up, ventilator and all.
Hospitals have long nudged less critical patients out of bed, to prevent their muscles from wasting away. But over the past several years, studies in ICUs have shown that some of the sickest of the sick also could benefit—getting out of intensive care sooner, with fewer complications—once it's medically feasible for them to try.
This isn't just passively changing a patient's position. It could involve helping them sit on the side of the bed, do some arm exercises with an elastic band or in-bed cycling, or even walk a bit with nurses holding all the tubes and wires out of the way. It takes extra staff, and especially for patients breathing through tubes down their throats, it isn't clear how often it's attempted outside specialized centers.
At Wake Forest Baptist, a physical therapist helped Terry Culler, 54, do arm and leg exercises without dislodging his ventilator tubing, working up to the day he stood from the bedside for the first time since developing respiratory failure about three weeks earlier. "I cheered, I was clapping," his wife, Ruanne Culler said after two therapists and a nurse finally helped him to his feet.
Biologically, why could such mild activity help? Files focused on one especially deadly reason for people to wind up on a ventilator: acute respiratory distress syndrome, or ARDS, the problem Terry Culler battled. It strikes about 200,000 Americans a year, usually after someone suffers serious injuries or another illness such as pneumonia, and it can rapidly trigger respiratory failure. Survivors suffer profound muscle weakness.
Files' team injured the lungs of laboratory mice in a way that triggered ARDS. The animals were sick but still breathing on their own, and walked or ran on a treadmill for a few minutes at a time over two days.
The surprise: That short amount of exercise did more than counter wasting of the animals' limbs. It also slowed weakening of the diaphragm, used to breathe. And it tamped down a dangerous inflammatory process in the lungs that Files suspects fuels muscle damage on top of the wasting of enforced bed-rest.
When certain white blood cells stick inside ARDS-affected lungs too long, they slow healing. The lungs of the exercised mice contained fewer of those cells—and their blood contained less of the protein that activates them, Files reported in the journal Science Translational Medicine this month.
Then Files examined blood frozen from ARDS patients who had participated in an earlier Wake Forest Baptist study comparing early mobility to standard ICU care. Sure enough, patients who had gotten a little exercise harbored less of that protein.
The new research adds to the biologic rationale, but there's already enough evidence supporting early mobility that families should ask whether their loved one is a candidate, said ICU specialist Dr. Catherine Hough of the University of Washington, who wasn't involved with Files' study.
She's surveying a sample of U.S. hospitals and finding variability in how often ICUs try, from those that help a majority of critically ill patients stand to others where no ventilated patients do. Obviously key is whether the patient can tolerate movement. But so is whether hospitals keep ventilated patients sedated despite research showing many don't need to be, Hough said.
"Ask about it every day," University of Washington's Hough advises families. "One of the key messages to ICU families is that critical illness changes frequently. On Monday, the patient might have a good reason not to be moving forward with mobilization, but there's a very good chance it's different on Tuesday."
Explore further: Therapeutic exercise lessens lung injury and muscle wasting in critically ill patients
© 2015 The Associated Press. All rights reserved.
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by By Lauran Neergaard
In this photo provided by the Wake Forest Baptist Medical Center, taken March 11, 2015 in the intensive care unit at Wake Forest Baptist Medical Center, physical therapist Katie Kellner helps patient Terry Culler do some exercises and briefly stand despite being hooked to a ventilator. There's increasing evidence that mild exercise may have its place even for the sickest ICU patients, and new animal research suggests it may target both muscles and lungs. (AP Photo/Warren Cameron Dennis III, Wake Forest Baptist Medical Center)
The intensive care unit is a last frontier for physical therapy: It's hard to exercise patients hooked to ventilators so they can breathe.
Some hospitals do manage to help critically ill patients stand or walk despite being tethered to life support. Now research that put sick mice on tiny treadmills shows why even a little activity may help speed recovery. It's work that supports more mobility in the ICU.
"I think we can do a better job of implementing early mobility therapies," said Dr. D. Clark Files of Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, who led the research and whose hospital is trying to get more critically ill patients up, ventilator and all.
Hospitals have long nudged less critical patients out of bed, to prevent their muscles from wasting away. But over the past several years, studies in ICUs have shown that some of the sickest of the sick also could benefit—getting out of intensive care sooner, with fewer complications—once it's medically feasible for them to try.
This isn't just passively changing a patient's position. It could involve helping them sit on the side of the bed, do some arm exercises with an elastic band or in-bed cycling, or even walk a bit with nurses holding all the tubes and wires out of the way. It takes extra staff, and especially for patients breathing through tubes down their throats, it isn't clear how often it's attempted outside specialized centers.
At Wake Forest Baptist, a physical therapist helped Terry Culler, 54, do arm and leg exercises without dislodging his ventilator tubing, working up to the day he stood from the bedside for the first time since developing respiratory failure about three weeks earlier. "I cheered, I was clapping," his wife, Ruanne Culler said after two therapists and a nurse finally helped him to his feet.
Biologically, why could such mild activity help? Files focused on one especially deadly reason for people to wind up on a ventilator: acute respiratory distress syndrome, or ARDS, the problem Terry Culler battled. It strikes about 200,000 Americans a year, usually after someone suffers serious injuries or another illness such as pneumonia, and it can rapidly trigger respiratory failure. Survivors suffer profound muscle weakness.
Files' team injured the lungs of laboratory mice in a way that triggered ARDS. The animals were sick but still breathing on their own, and walked or ran on a treadmill for a few minutes at a time over two days.
The surprise: That short amount of exercise did more than counter wasting of the animals' limbs. It also slowed weakening of the diaphragm, used to breathe. And it tamped down a dangerous inflammatory process in the lungs that Files suspects fuels muscle damage on top of the wasting of enforced bed-rest.
When certain white blood cells stick inside ARDS-affected lungs too long, they slow healing. The lungs of the exercised mice contained fewer of those cells—and their blood contained less of the protein that activates them, Files reported in the journal Science Translational Medicine this month.
Then Files examined blood frozen from ARDS patients who had participated in an earlier Wake Forest Baptist study comparing early mobility to standard ICU care. Sure enough, patients who had gotten a little exercise harbored less of that protein.
The new research adds to the biologic rationale, but there's already enough evidence supporting early mobility that families should ask whether their loved one is a candidate, said ICU specialist Dr. Catherine Hough of the University of Washington, who wasn't involved with Files' study.
She's surveying a sample of U.S. hospitals and finding variability in how often ICUs try, from those that help a majority of critically ill patients stand to others where no ventilated patients do. Obviously key is whether the patient can tolerate movement. But so is whether hospitals keep ventilated patients sedated despite research showing many don't need to be, Hough said.
"Ask about it every day," University of Washington's Hough advises families. "One of the key messages to ICU families is that critical illness changes frequently. On Monday, the patient might have a good reason not to be moving forward with mobilization, but there's a very good chance it's different on Tuesday."
Explore further: Therapeutic exercise lessens lung injury and muscle wasting in critically ill patients
© 2015 The Associated Press. All rights reserved.
Medical Xpress on facebook
Related Stories
Therapeutic exercise lessens lung injury and muscle wasting in critically ill patients
Acute respiratory distress syndrome (ARDS) is a life-threatening lung condition that affects approximately 200,000 people a year in the United States and has a higher mortality rate than breast and prostate ...
Longer stay in hospital ICU has lasting impact on quality of life
Patients have substantial physical impairments even two years after being discharged from the hospital after a stay in an intensive care unit (ICU), new Johns Hopkins research suggests.
Study: Wake Up and Breathe program benefits ICU patients
Researchers from the Regenstrief Institute and the Indiana University Center for Aging Research report that waking intensive care unit patients and having them breathe on their own decreased both sedation levels and coma ...
Mild exercise while in the ICU reduces bad effects of prolonged bed rest
Critical care experts at Johns Hopkins are reporting initial success in boosting recovery and combating muscle wasting among critically ill, mostly bed-bound patients using any one of a trio of mild physical therapy exercises ...
Physical therapist-led exercise in patients in ICU improves function and decreases hospital stay
Patients who are critically ill and participate in mild exercise programs led by physical therapists achieve higher functional mobility and spend fewer days in intensive care units (ICU) and hospitals than those who receive ...
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Future GPs could benefit from longer training
Newly-qualified GPs could be better prepared for practice by increasing the variety and duration of their training programme, according to research being published in the April 2015 issue of the British Jo ...
Researchers observe major hand hygiene problems in operating rooms
An observational study by Sahlgrenska Academy researchers at a large Swedish hospital found 2,393 opportunities for hand disinfection and/or aseptic techniques. Doctors and nurses missed 90% of the opportunities.
Patient awareness of health care report cards gradually increases
A recently published study indicates chronically ill patients are becoming more aware of comparative doctor and hospital performance reports though growth is slower than expected.
Ozone air pollution could harm women's fertility
Many urban and suburban areas have high levels of ground-level ozone, an air pollutant that can adversely affect lung and heart health. New research in mice suggests breathing high levels of ozone could also affect women's ...
Consuming eggs with raw vegetables increases nutritive value
There is burgeoning research showing that co-consuming cooked whole eggs with your veggies can increase carotenoids absorption. With the recent scientific report from the 2015 Dietary Guidelines Advisory Committee ...
Exercise can outweigh harmful effects of air pollution
New research from the University of Copenhagen has found that the beneficial effects of exercise are more important for our health than the negative effects of air pollution, in relation to the risk of premature ...
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