Survivors of critical illness experience decrease quality of life due to physical limitations. It is assumed patients are too fragile to tolerate vigorous activity in an early phase of their illness incurring unavoidable immobilization. We postulate early activity is achievable and can be performed safely.
We recorded all activity over 150 days from June through December 2003 in our Respiratory ICU. Activity was defined as dangle (sit without back support), chair (sit with back support) and ambulation (walk in the hallway). We defined 6 activity-related complications; fall to knees, tube removal, systolic BP>200, systolic BP<90, desaturation<80%, and extubation.
(Mean ± SD): The patient population was defined as critically ill (APACHE II 17 ± 5), elderly (age 62 ± 15 years), with a prolonged ICU stay (16 ± 12 days). Sixty-nine percent of patients had ARDS, COPD, pneumonia, or sepsis. During the study period, there were a total of 1,449 activity events in 119 patients. Activity type was broken down into the following: 17% Dangle, 31% Chair, and 52% Ambulation. During activity, 41% of patients had an endotrachial tube, 11% had a tracheostomy tube, and 48% were not intubated. Oxygen concentrations prior to activity were <40% oxygen in 27%, 40% oxygen in 51%, 50% oxygen in 14%, and > 60% oxygen in 8% of patients respectively. A total of 14 activity complications (<1%) were recorded. Complications included; 5 falls to knees (without injury), 1 feeding tube removal, 1 Systolic BP>200, 4 Systolic BP<90, 3 desaturation <80%, and no extubations.
Activity is safe in respiratory failure patients early in their critical illness, including intubated patients on mechanical ventilation. Activity complications were infrequent (<1%), and did not lead to injury or prolonged deterioration. Our study is limited by the lack of blinding and randomization.
Early activity is achievable and can be performed safely in mechanically ventilated patients. Therefore, the complications that occur from prolonged immobilization may be preventable.
V.J. Spuhler, None.