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Original Research: Critical Care |

Interventions to Improve the Physical Function of ICU SurvivorsPhysical Function Interventions in ICU Survivors: A Systematic Review

Enrique Calvo-Ayala, MD; Babar A. Khan, MD; Mark O. Farber, MD, FCCP; E. Wesley Ely, MD, MPH, FCCP; Malaz A. Boustani, MD, MPH
Author and Funding Information

From the Division of Pulmonary, Allergy, Critical Care, Occupational, and Sleep Medicine (Drs Calvo-Ayala, Khan, and Farber), and the Division of General Internal Medicine and Geriatrics (Dr Boustani), Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; the Indiana University Center for Aging Research (Drs Khan and Boustani), Indianapolis, IN; the Regenstrief Institute (Drs Khan and Boustani), Indianapolis, IN; the Division of Allergy, Pulmonary, and Critical Care Medicine (Dr Ely), Department of Medicine, and the Center for Health Services Research (Dr Ely), Vanderbilt University School of Medicine, Nashville, TN; and the Veterans Affairs Tennessee Valley Geriatric Research, Education, and Clinical Center (Dr Ely), Nashville, TN.

Correspondence to: Babar A. Khan, MD, 410 W 10th St, Ste 2000, Indianapolis, IN 46202; e-mail: bakhan@iupui.edu


A portion of these data were presented at the 2012 American Thoracic Society International Meeting, on May 18-23, 2012, San Francisco, CA.

Funding/Support: This study was supported by grants from the National Institute on Aging [Grant K23-AG043476 to Dr Khan and Grant R01AG034205 to Dr Boustani].

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


Chest. 2013;144(5):1469-1480. doi:10.1378/chest.13-0779
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Background:  ICU admissions are ever increasing across the United States. Following critical illness, physical functioning (PF) may be impaired for up to 5 years. We performed a systematic review of randomized controlled trials evaluating the efficacy of interventions targeting PF among ICU survivors. The objective of this study was to identify effective interventions that improve long-term PF in ICU survivors.

Methods:  MEDLINE, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Physiotherapy Evidence-Based Database (PEDro) were searched between 1990 and 2012. Two reviewers independently evaluated studies for eligibility, critically appraised the included studies, and extracted data into standardized evidence tables.

Results:  Fourteen studies met the inclusion criteria. Interventions included exercise/physical therapy (PT), parenteral nutrition, nurse-led follow-up, spontaneous awakening trials, absence of sedation during mechanical ventilation, and early tracheotomy. Nine studies failed to demonstrate efficacy on PF of the ICU survivors. However, early physical exercise and PT-based interventions had a positive effect on long-term PF.

Conclusions:  The only effective intervention to improve long-term PF in critically ill patients is exercise/PT; its benefit may be greater if started earlier. Further research in this area comparing different interventions and timing is needed.

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