0
Correspondence |

Physiotherapy in Patients in the ICU Treated With IV Tissue Plasminogen Activator for StrokePhysiotherapy in ICU Patients FREE TO VIEW

Olivia Davis, OTD; Scott Arnold, PT; William D. Freeman, MD
Author and Funding Information

From Physical Medicine & Rehabilitation (Dr Davis and Mr Arnold) and Departments of Neurology, Critical Care, and Neurosurgery (Dr Freeman), Mayo Clinic.

Correspondence to: William D. Freeman, MD, Departments of Neurology, Critical Care, and Neurosurgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224; e-mail: freeman.william1@mayo.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.


Chest. 2014;145(2):431-432. doi:10.1378/chest.13-2285
Text Size: A A A
Published online
To the Editor:

We read with interest the recent article in CHEST (September 2013) by Stiller,1 who provided a systematic review of the literature on physiotherapy in the ICU. The author concluded that early patient mobilization should be a priority in adult ICUs. We agree with this practice and suggest that it is beneficial for most critically ill patients, even in patients not receiving mechanical ventilation. Although not a primary focus of this review, we found little mention of patients in the neuro-ICU, with the exception of intracranial pressure monitoring in neurosurgery patients as seen in Table 3 of the article.1 Between June 2011 and July 2012, we performed mobilization in 30 patients in the ICU within 13 to 24 h of receiving IV recombinant tissue plasminogen activator for acute ischemic stroke at the Mayo Clinic in Florida.2 We tracked the safety of early physiotherapy and found that 67% of the patients had no complications related to mobilization. Moreover, 87% of mobilization activities (ie, sitting, standing, walking, transferring to chair) were tolerated, with no adverse response. Safety was measured by neurologic and hemodynamic monitoring. No patient experienced sustained neurologic deficit or bleeding from any invasive line (eg, venous line, arterial line, or Foley catheter).

The potential for earlier initiation of rehabilitative therapies in the neuro-ICU to reduce length of stay may facilitate a more rapid turnover of the patient population and, thus, may enable critical care clinicians to serve a larger number of patients. We believe this is an important consideration given the aging of the population, the mounting shortage of critical care providers, and the growing burden of neurologic diseases that ICU clinicians will face by 2025.3,4 Early mobilization of patients may have significant financial implications in light of imminent cost-cutting initiatives in US health care.5

References

Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013;144(3):825-847. [CrossRef] [PubMed]
 
Davis O, Mooney L, Dinkins M, Freeman WD, Arnold S. Early mobilization of ischemic stroke patients post intravenous tissue plasminogen activator [abstract]. Stroke. 2013;44:A121. [CrossRef]
 
Dall TM, Storm MV, Chakrabarti R, et al. Supply and demand analysis of the current and future US neurology workforce. Neurology. 2013;81(5):470-478. [CrossRef] [PubMed]
 
Krell K. Critical care workforce. Crit Care Med. 2008;36(4):1350-1353. [CrossRef] [PubMed]
 
Freeman WD, Vatz KA, Griggs RC, Pedley T. The Workforce Task Force report: clinical implications for neurology. Neurology. 2013;81(5):479-486. [CrossRef] [PubMed]
 

Figures

Tables

References

Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013;144(3):825-847. [CrossRef] [PubMed]
 
Davis O, Mooney L, Dinkins M, Freeman WD, Arnold S. Early mobilization of ischemic stroke patients post intravenous tissue plasminogen activator [abstract]. Stroke. 2013;44:A121. [CrossRef]
 
Dall TM, Storm MV, Chakrabarti R, et al. Supply and demand analysis of the current and future US neurology workforce. Neurology. 2013;81(5):470-478. [CrossRef] [PubMed]
 
Krell K. Critical care workforce. Crit Care Med. 2008;36(4):1350-1353. [CrossRef] [PubMed]
 
Freeman WD, Vatz KA, Griggs RC, Pedley T. The Workforce Task Force report: clinical implications for neurology. Neurology. 2013;81(5):479-486. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543