"Exercise" in the ICU promotes recovery, get moving!

Author: Le Meini Tongren Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Hu Yanli Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine

Kan Haiyan Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine

Zhiwei Zhao Tongren Hospital, Shanghai Jiaotong University School of Medicine

Illustration: Fu Enze Tongren Hospital Affiliated to Shanghai Jiaotong University School of Medicine

Reviewer: Nie Cheng, Chief Physician, First Affiliated Hospital of Nanchang University

The intensive care unit (ICU) often gives patients and their families a tense and closed feeling. Both sides hope to be transferred out of the ICU and return to the general ward as soon as possible. So, how can ICU patients accelerate the recovery process during intensive care treatment and thus reduce the ICU hospitalization time?

With the rapid development of critical care medicine and rehabilitation medicine, early activities have been proven to be beneficial for improving disease prognosis, promoting limb function recovery and improving quality of life. The concept of early, comprehensive and active rehabilitation is gradually becoming the core of the development of rehabilitation medicine. So, for patients living in the intensive care unit, how to implement early rehabilitation activities? What benefits will these activities bring to patients? Today, let's talk about "exercise" in the ICU.

1. What is early mobilization of critically ill patients?

Early mobilization of critically ill patients mainly refers to targeted active or passive exercise for patients, which aims to prevent or alleviate functional disorders and delirium in patients through early mobilization, thereby improving patients' prognosis and enhancing their long-term quality of life.

At present, there is no consensus on the initiation time of early mobilization. In domestic studies, some patients started early mobilization within 24 hours of mechanical ventilation[1], within 48 hours of mechanical ventilation[2], within 24 hours of ICU admission[3-4], within 24 to 48 hours of ICU admission[5,6], and within 24 hours of hemodynamic stabilization[7-8]. In foreign studies, early mobilization was mostly carried out within 48 hours of ICU admission[9-10], within 24 to 48 hours of mechanical ventilation[11], and within 72 hours of mechanical ventilation[12]. A meta-analysis showed that early mobilization within 48 to 72 hours of mechanical ventilation may be the best time to shorten the duration of mechanical ventilation and improve ICU-acquired weakness[13].

2. What are the benefits of early mobilization for critically ill patients?

1. Shorten the duration of mechanical ventilation for patients. Studies have shown that exercise therapy can effectively improve the patient's respiratory status, reduce the incidence of ventilator-associated pneumonia, and prompt patients to be weaned off the mechanical ventilation early, thereby reducing ICU hospitalization time.

Figure 1 Copyright image, no permission to reprint

2. Improve delirium symptoms. The expert consensus on delirium management in critically ill patients clearly states that early activity can promote blood circulation in the limbs and improve blood supply to the brain, thereby effectively reducing the possibility and duration of delirium.

Figure 2 Copyright image, no permission to reprint

3. Promoting the recovery of neuromuscular function. Early activities can effectively prevent complications such as decreased muscle strength, muscle atrophy, and difficulty in weaning from the ventilator.

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4. Reduce the incidence of pressure injuries. The occurrence of pressure injuries undoubtedly increases the time and risk of treatment for patients. Whether active or passive, early mobilization can help reduce the duration of continuous pressure on local tissues, protect the integrity of the patient's skin, and thus reduce the risk of pressure injuries.

Figure 4 Copyright image, no permission to reprint

5. Preventing the occurrence of deep vein thrombosis By squeezing the muscles during activity, such as using an air pump, the blood flow in the lower limbs can be improved, thereby preventing the formation of deep vein thrombosis.

Figure 5 Copyright image, no permission to reprint

6. Improve cardiopulmonary function. Early activities and breathing training can help increase lung volume, improve sputum drainage, strengthen respiratory muscles and cough strength, help clear the airways and further control the risk of related infections.

Figure 6 Copyrighted images are not authorized for reproduction

7. Increase psychological support. Early activities can help relieve patients' negative psychological reactions such as tension, fear, irritability, and anxiety. More doctor-patient interactions can help alleviate patients' loneliness and encourage them, stimulate a positive treatment mentality and the patient's subjective initiative, thereby promoting the outcome of the disease.

Figure 7 Copyright image is not authorized for reproduction

3. Is it safe for critically ill patients to engage in early activities?

Doctors will develop personalized activity plans for patients and carry them out in different levels. Usually, a multidisciplinary team including critical care medical team, rehabilitation therapists and respiratory therapists will conduct a comprehensive assessment of the patient, closely monitor the patient's various indicators, equip the patient with safe, practical and multi-mode rehabilitation equipment, and clearly define the start-up and provisional indicators at all levels to ensure the safety and effectiveness of the activities.

Figure 8 Copyright image, no permission to reprint

In summary, early activities play a positive role in accelerating the recovery of critically ill patients. We also encourage patients and their families to participate in the implementation of activity plans. Let us work together to promote the early recovery of critically ill patients!

References:

Wang Caihong, Qin Junmei, Ben Yanli. Effect of early rehabilitation training on ICU-acquired myasthenia in patients with mechanical ventilation[J]. Chinese Journal of Nursing Management, 2019, 19(3): 457-461.

Zhang Hao, Lu Bin, Yang Fuhong, et al. Observation on the efficacy of early rehabilitation intervention in patients with acute respiratory failure undergoing mechanical ventilation[J]. Chinese Journal of Physical Medicine and Rehabilitation, 2020, 42(12): 1063-1066.

Chen Shaolin, Jiang Yulan, Yu Bin, et al. Preventive effect of transcutaneous neuromuscular electrical stimulation on ICU-AW in patients with COPD undergoing mechanical ventilation[J]. Chinese Journal of Critical Care Medicine, 2019, (6): 709-713.

Huang Haiyan, Wang Xiaofang, Luo Jian, et al. Effect of early level 4 rehabilitation training on patients with mechanical ventilation in ICU[J]. Journal of Nursing, 2016, 31(15): 1-5.

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Han Runing, Li Xiuchuan, Peng Yaqin. Study on the effect of family members participating in early exercise for critically ill patients[J]. Journal of Mudanjiang Medical College, 2021, 42(2): 83-87+119.

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SCHALLER SJ, ANSTEY M, BLOBNER M, et al. Early, goal-directed mobilization in the surgical intensive care unit: a randomized controlled trial [J]. The Lancet, 2016, 388(10052): 1377-1388.

WALDAUF P, HRUSKOVA N, BLAHUTOVA B, et al. Functional electrical stimulation-assisted cycle ergometry-based progressive mobility program for mechanically ventilated patients: randomized controlled trial with 6 months follow-up[J]. Thorax, 2021,76(7):664-671.

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