Assisted Exercise Beneficial for Critically Ill Patients

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Mild exercise with a physical therapist can help patients who are critically ill reduces the length of time spent in the ICU and lower sedative medication use, according to new research by Johns Hopkins University, published last week in the online journal Archives of Physical Medicine and Rehabilitation.

Lead study author Dale Needham, MD PhD and colleagues demonstrated that just 30 to 45 minute daily sessions could reduce the need of benzodiazepine use by almost 50% of what was previously observed while in the Medical Intensive Care Unit (MICU).

Benzodiazepines are commonly prescribed for relaxation and relief from anxiety and tension and include such medications as Xanax, Librium, Valium, and Ativan. In the ICU, they are used in combination with other sedating drugs to keep patients calm while they heal from their illness or injury.

In low to moderate doses, benzodiazepines can lead to side effects such as impaired motor coordination, drowsiness and fatigue, impaired thinking, respiratory depression, and GI effects such as nausea and constipation. High doses can cause slowed reflexes, mood swings, and hostile or erratic behavior.

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Using less benzodiazepine medication is beneficial because some medications are eliminated from the body slowly and ingestion of multiple doses over long periods of time can lead to significant accumulation in the body’s fatty tissues, leading to chronic impaired thinking, memory and judgment, disorientation, confusion, slurred speech, and muscle weakness and lack of coordination.

The 57 patients in the study were able to decrease the use of benzodiazepines to 26% of days spend in the ICU compared to those who were not on an exercise program who used the medications up to 50% of the days spent in critical care. Dosages of the medications were also decreased. After the exercise sessions, patients were able to reduce their daily use of midazolam by 32 milligrams and morphine by 46 milligrams.

The exercises included arm and leg movements while lying in bed, sitting up or standing. Some exercise was even accomplished before patients were weaned off of mechanical ventilation and other life-support equipment. Mobile patients walked slowly in the ICU hallways. The exercises also helped the patients speed their recovery and be able to move to a lower level of care two to three days earlier.

"Our work challenges physicians to rethink how they treat critically ill patients and shows the downstream benefits of early mobilization exercises," said Dr. Needham, critical care specialist at Johns Hopkins. “Patients are not afraid of exercising while they are in the ICU,” he continued. “They are embracing this new approach to their care. It actually motivates them to get well and reminds them that they have a life outside the four walls surrounding their hospital beds.”

Source reference:
Needham DM, et al "Early physical medicine and rehabilitation for patients with acute respiratory failure: A quality improvement project" Arch Phys Med Rehabil 2010.

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