Journal article
Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation
Critical care medicine, Vol.38(11), pp.2089-2094
2010
DOI: 10.1097/CCM.0b013e3181f270c3
PMID: 20711065
Abstract
Objective:
Physical and occupational therapy are possible immediately after intubation in mechanically ventilated medical intensive care unit patients. The objective of this study was to describe a protocol of daily sedative interruption and early physical and occupational therapy and to specify details of intensive care unit-based therapy, including neurocognitive state, potential barriers, and adverse events related to this intervention.
Design and Patients:
Detailed descriptive study of the intervention arm of a trial of mechanically ventilated patients receiving early physical and occupational therapy.
Setting:
Two tertiary care academic medical centers participating in a randomized controlled trial.
Intervention:
Patients underwent daily sedative interruption followed by physical and occupational therapy every hospital day until achieving independent functional status. Therapy began with active range of motion and progressed to activities of daily living, sitting, standing, and walking as tolerated.
Measurements and Main Results:
Forty-nine mechanically ventilated patients received early physical and occupational therapy occurring a median of 1.5 days (range, 1.0–2.1 days) after intubation. Therapy was provided on 90% of MICU days during mechanical ventilation. While endotracheally intubated, subjects sat at the edge of the bed in 69% of all physical and occupational therapy sessions, transferred from bed to chair in 33%, stood in 33%, and ambulated during 15% (n = 26 of 168) of all physical and occupational therapy sessions (median distance of 15 feet; range, 15–20 feet). At least one potential barrier to mobilization during mechanical ventilation (acute lung injury, vasoactive medication administration, delirium, renal replacement therapy, or body mass index ≥30 kg/m2) was present in 89% of patient encounters. Therapy was interrupted prematurely in 4% of all sessions, most commonly for patient-ventilator asynchrony and agitation.
Conclusion:
Early physical and occupational therapy is feasible from the onset of mechanical ventilation despite high illness acuity and presence of life support devices. Adverse events are uncommon, even in this high-risk group.
Details
- Title: Subtitle
- Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation
- Creators
- Mark C POHLMAN - Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL, United StatesWilliam D SCHWEICKERT - Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, United StatesGregory A SCHMIDT - Department of Medicine, Division of Pulmonary and Critical Care, University of Iowa, Iowa City, IA, United StatesAmy BOWMAN - Department of Medicine, Division of Pulmonary and Critical Care, University of Iowa, Iowa City, IA, United StatesRhonda BARR - Therapy Services, University of Iowa, Iowa City, IA, United StatesKathryn MCCALLISTER - Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL, United StatesJesse B HALL - Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL, United StatesJohn P KRESS - Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL, United StatesAnne S POHLMAN - Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL, United StatesCelerina NIGOS - Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL, United StatesAmy J PAWLIK - Therapy Services, University of Chicago, Chicago, IL, United StatesCheryl L ESBROOK - Therapy Services, University of Chicago, Chicago, IL, United StatesLinda SPEARS - Therapy Services, University of Chicago, Chicago, IL, United StatesMegan MILLER - Therapy Services, University of Chicago, Chicago, IL, United StatesMietka FRANCZYK - Therapy Services, University of Chicago, Chicago, IL, United StatesDeanna DEPRIZIO - Therapy Services, University of Chicago, Chicago, IL, United States
- Resource Type
- Journal article
- Publication Details
- Critical care medicine, Vol.38(11), pp.2089-2094
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/CCM.0b013e3181f270c3
- PMID
- 20711065
- ISSN
- 0090-3493
- eISSN
- 1530-0293
- Language
- English
- Date published
- 2010
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984094704202771
Metrics
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