Healthbeat Report: Better than bed rest?

February 19, 2009 9:18:40 PM PST
You might not expect a gravely ill patient to be told to get moving but that's what's happening in some hospitals. And some doctors say it could save patients from a life of impairment.Care in a hospital's intensive care unit is often life saving. But it can also leave patients with long term negative effects.

So some doctors are giving seriously ill patients a break from medication and prescribing a little exercise. Patients may even go for a walk.

The Intensive Care Unit - or the ICU - is where patients with life threatening illness are treated.

Some patients are heavily sedated hooked up to ventilators to help them breath. It would seem to make sense to keep these critically ill patients resting and still.

But in a challenge to conventional care some researchers are asking these patients to wake up and literally go for a walk, even though they may not remember.

"I'm sure I wasn't walking because I couldn't walk even when I was awake," said Richard Gardella, former ICU patient.

Gardella can't believe that early on in ICU he was up and moving around. Doctors think even though he was dangerously ill with pneumonia the little bit of exercise he did get helped him heal faster.

"He was up, he was walking with the breathing tube in," said Dr. John Kress, pulmonologist, University of Chicago Medical Center.

The big question is why would moving a desperately ill person be helpful?

It turns out state of the art care that initially saves your life could cause trouble later. What happens to the human body and brain when it's on life support for days on end isn't really clear.

Patients leave the ICU seemingly healed. But years later some patients are still living with horrible side effects, including debilitating weakness, neuropathy, terrible nightmares, even altered mood.

Dr. John Kress at the University of Chicago has been studying the problem for years.

"They can't walk, they can't dress themselves, they cant feed themselves and they can't take care of personal hygiene," said Dr. Kress.

How much of the impairment is due to the initial trauma or the ICU stay isn't easy to separate. But Dr. Kress suspects non-stop sedatives are part of the problem. So in a small study, he had ICU patients awakened for a short time everyday by briefly lowering their tranquilizers.

Dr. Kress says patients did better, got off ventilators faster, and cut their ICU stay by one third. They also showed a trend toward better outcomes.

The next question for some patients who are awake is how much better would they do if they actually sat up, even walked a bit.

"What we found is the group that got the intervention therapy early, 60 percent of them left the hospital functional and the control group who got the usual care was 33 percent," said Dr. Kress.

Richard Gardella has some neuropathy which affects his left foot. Doctors believe it might be as a result of being bedridden so long.

But Dr. Kress suspects getting in some exercise early in the ICU may have saved Galella from more devastating long term effects.

"I've heard some say I was lucky to come out of it," said Gardella.

Other researchers are also reporting early success with ICU patients who get moving. But not everyone approves of the tactic. There are concerns about the safety of walking around tethered to life support machines and the manpower it takes to make this happen.

Clinical trials are now in the works in hopes of proving it's really safe and worth the effort.

Dr. John Kress
Pulmonologist
Critical Care Medicine
University of Chicago Medical Center
Email:jkress@medicine.bsd.uchicago.edu
Office Phone:(773) 702-6790
Office Fax:(773) 702-4754

Office Postal Address:
John P. Kress, MD
University of Chicago Medical Center
5841 S. Maryland Avenue, MC 6026
Chicago, IL 60637


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