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John P. Kress, MD, FCCP; William D. Schweickert, MD
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From the Section of Pulmonary and Critical Care (Dr Kress), Department of Medicine, University of Chicago; and the Department of Medicine (Dr Schweickert), University of Pennsylvania Medical Center.

Correspondence to: John P. Kress, MD, FCCP, University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, 5841 S Maryland, MC 6026, Chicago, IL 60637; e-mail: jkress@medicine.bsd.uchicago.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


© 2012 American College of Chest Physicians


Chest. 2012;141(6):1642-1643. doi:10.1378/chest.12-0827
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To the Editor:

We thank Dr Bernhardt and the AVERT (A Very Early Rehabilitation Trial) Trialist Collaboration for their response to our recent review1 and applaud their scientific efforts to test very early mobilization in stroke. Clinicians’ concern for end-organ dysfunction resulting from therapy-related increases in oxygen consumption continues to be a major impediment to activity in the earliest days of critical illness. Efforts are underway to standardize criteria for defining stability to drive ICU physiotherapy consultation.

As the burden of ICU survivorship is further clarified,2,3 the opportunity for mobilization and rehabilitation programs to provide enduring improvements in both physical and neurocognitive function must be tested. Preliminary data suggest that ICU-based interventions may confer protection against hospital readmission or death.4 As Dr Bernhardt and colleagues highlight, the possibility that early activity enhances neuroplasticity and might reduce chronic brain dysfunction after critical illness is appealing.5 We look forward to the outcomes of AVERT phase 3 and other upcoming trials of early mobilization after an acute illness.

Schweickert WD, Kress JP. Implementing early mobilization interventions in mechanically ventilated patients in the ICU. Chest. 2011;1406:1612-1617. [CrossRef] [PubMed]
 
Bienvenu OJ, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Shanholtz C, Husain N, et al. Depressive symptoms and impaired physical function after acute lung injury: a 2-year longitudinal study. Am J Respir Crit Care Med. 2012;1855:517-524. [CrossRef] [PubMed]
 
Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med. 2011;392:371-379. [CrossRef] [PubMed]
 
Morris PE, Griffin L, Berry M, Thompson C, Hite RD, Winkelman C, et al. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci. 2011;3415:373-377. [CrossRef] [PubMed]
 
Jackson JC, Mitchell N, Hopkins RO. Cognitive functioning, mental health, and quality of life in ICU survivors: an overview. Anesthesiol Clin. 2011;294:751-764. [CrossRef] [PubMed]
 

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References

Schweickert WD, Kress JP. Implementing early mobilization interventions in mechanically ventilated patients in the ICU. Chest. 2011;1406:1612-1617. [CrossRef] [PubMed]
 
Bienvenu OJ, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Shanholtz C, Husain N, et al. Depressive symptoms and impaired physical function after acute lung injury: a 2-year longitudinal study. Am J Respir Crit Care Med. 2012;1855:517-524. [CrossRef] [PubMed]
 
Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med. 2011;392:371-379. [CrossRef] [PubMed]
 
Morris PE, Griffin L, Berry M, Thompson C, Hite RD, Winkelman C, et al. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci. 2011;3415:373-377. [CrossRef] [PubMed]
 
Jackson JC, Mitchell N, Hopkins RO. Cognitive functioning, mental health, and quality of life in ICU survivors: an overview. Anesthesiol Clin. 2011;294:751-764. [CrossRef] [PubMed]
 
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