Bed Rest Detrimental to ICU Patients

The routine use of deep sedation and bed rest in intensive care unit (ICU) patients may be causing unnecessary and long-term physical impairment and poor quality of life, claims a new review.

A researcher at the Johns Hopkins University School of Medicine (Baltimore, MD, USA) conducted a systematic review of 24 studies focused on ICU patients with sepsis, prolonged mechanical ventilation, and multiple organ failure. Among the findings were that 46% of 1,421 patients in one study had neuromuscular dysfunction that was associated with extended use of mechanical ventilation and longer stays in the ICU; the review also cited numerous studies highlighting the physical harm of lengthy bed rest, such as loss of muscle strength and changes in heart function. Other studies showed that the opposite actions, such as early physical medicine and rehabilitation therapy while patients are still on life support in the ICU, can safely allow them to get out of bed and walk more quickly, resulting in shorter time on a ventilator and a shorter stay in the ICU for these critically ill patients. The researcher also based his comments and observations on his experience with patients at The Johns Hopkins Hospital medical ICU, where a new physical medicine and rehabilitation program has been developed for ICU patients. The review was published in the October 8, 2008, issue of Journal of the American Medical Association (JAMA).

"The benefits of getting hospitalized patients out of bed and moving were understood during World War II with battlefield injuries,” said review author Dale Needham, M.D., Ph.D., an assistant professor in the division of pulmonary and critical care medicine. "My review shows it may be time to go back to the future. It's becoming clear that the safety and benefits of early mobilization are real and that it's better to get moving sooner rather than later.”

Among the effects of prolonged bed rest are deep vein thrombosis (DVT), bed sores, osteoporosis, pneumonia, depression, poor balance, weakness, nausea, blood glucose changes, dizziness, and changes in hearing and eyesight Even one day in bed can cause some of these changes. Additionally, a growing body of literature demonstrates that significant and prolonged residual neuromuscular complications impair physical function and quality of life long after hospital discharge.

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Johns Hopkins University School of Medicine