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Original Research: Critical Care |

Impact of Early Mobilization on Glycemic Control and ICU-Acquired Weakness in Critically Ill Patients Who Are Mechanically VentilatedInsulin, Early Mobility, ICU-Acquired Weakness

Bhakti K. Patel, MD; Anne S. Pohlman, MSN; Jesse B. Hall, MD, FCCP; John P. Kress, MD, FCCP
Author and Funding Information

From the Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, IL.

CORRESPONDENCE TO: John P. Kress, MD, FCCP, Department of Medicine, Section of Pulmonary and Critical Care, 5841 S Maryland Ave, MC6026, Chicago, IL 60637; e-mail: jkress@medicine.bsd.uchicago.edu


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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


Chest. 2014;146(3):583-589. doi:10.1378/chest.13-2046
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BACKGROUND:  ICU-acquired weakness (ICU-AW) has immediate and long-term consequences for critically ill patients. Strategies for the prevention of weakness include modification of known risk factors, such as hyperglycemia and immobility. Intensive insulin therapy (IIT) has been proposed to prevent critical illness polyneuropathy. However, the effect of insulin and early mobilization on clinically apparent weakness is not well known.

METHODS:  This is a secondary analysis of all patients with mechanical ventilation (N = 104) previously enrolled in a randomized controlled trial of early occupational and physical therapy vs conventional therapy, which evaluated the end point of functional independence. Every patient had IIT and blinded muscle strength testing on hospital discharge to determine the incidence of clinically apparent weakness. The effects of insulin dose and early mobilization on the incidence of ICU-AW were assessed.

RESULTS:  On logistic regression analyses, early mobilization and increasing insulin dose prevented the incidence of ICU-AW (OR, 0.18, P = .001; OR, 0.001, P = .011; respectively) independent of known risk factors for weakness. Early mobilization also significantly reduced insulin requirements to achieve similar glycemic goals as compared with control patients (0.07 units/kg/d vs 0.2 units/kg/d, P < .001).

CONCLUSIONS:  The duel effect of early mobilization in reducing clinically relevant ICU-AW and promoting euglycemia suggests its potential usefulness as an alternative to IIT.

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