Getting ICU Patients Back on Their Feet

A device to enable critically ill intensive care unit (ICU) patients to leave their beds and walk while remaining tethered to essential life-support equipment would allow patients to achieve carefully supervised rehabilitation, as opposed to continuous sedation and bed rest.

Undergraduate students in biomedical engineering at Johns Hopkins University (Baltimore, MD, USA) formed a team with the purpose of devising a mobility aid for ICU patients. Over two semesters, the students, supervised by faculty members and graduate students, and advised by hospital staff, produced a device called the ICU Mover Aid. The device needed to meet three key criteria: first, it had to provide physical support for the patient during walking; second, it had to safely house all necessary monitoring and therapeutic equipment for critically ill patients; finally, it needed a safety backup system for patients who need to immediately sit down due to fatigue or a sudden change in their medical condition. The final prototype version features a walker type framework, similar to devices used by frail or elderly people. Immediately behind the patient, however, a fabric seat is attached to the frame so that a tired patient can sit down. The seat can also "catch” a patient who abruptly collapses because of a medical problem.

As a separate component, the prototype features a tower designed to accommodate two oxygen tanks and three medical devices: a cardiac monitor, intravenous infusion pumps to provide medications, and a ventilator to support breathing. Despite the equipment attached to it, the Mover Aid prototype was small enough to maneuver through the medical ICU's narrow hallways, although using it in the ICU patient rooms, which are smaller, proved to be more challenging. In terms of improved efficiency, the inventors said, the Mover Aid requires only two hospital staff members to accompany the walking patient, compared with four staff members needed under earlier systems.

"We ended up building three versions,” said Joshua Lerman, a senior biomedical engineering student who served as team leader. "First, we used PVC pipes to work on the basic design. Then, we made an aluminum version. We made the final prototype mostly of steel. All through the process we got feedback from the hospital's ICU staff, who told us what we needed to change to make it better suit patients' needs.”

"The finished product is truly outstanding,” said Dale Needham, M.D., an assistant professor in the division of pulmonary and critical care medicine at the Johns Hopkins School of Medicine (Baltimore, MD, USA). "The most recent version of the Mover is far beyond a rough prototype. The students exceeded everyone's expectations in designing a device that we could routinely use in the medical ICU.”

Some clinicians believe that allowing ICU patients to get out of bed and walk could avert some of the muscle weakness, bedsores, and depression that typically develop when these patients are kept heavily sedated and confined to bed. Because such patients usually must remain connected to an artificial breathing machine, heart monitors, and intravenous lines with essential medications, a simple walk down the hall can require four or more staff members to accompany the patient.


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