A Johns Hopkins Hospital critical care specialist has reviewed recent studies of intensive care unit patients and has concluded that deep sedation and bed rest in ICU patients may be causing unnecessary and long-term physical impairment and also poor quality of life after hospital discharge.

"The benefits of getting hospitalized patients out of bed and moving were understood during World War II with battlefield injuries," says Dale Needham, M.D., Ph.D., assistant professor in the Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine. "My review shows it may be time to go back to the future. It's becoming clear that the safety and benefits of early mobilization are real and that it's better to get moving sooner rather than later."

In a report in the latest Journal of the American Medical Association (JAMA), Needham says that the deep sedation and bed rest can lead to muscle weakness, and that a better approach is to have patients up and moving shortly after admission to an ICU. Needham's review of recent studies and experience at The Johns Hopkins Hospital medical intensive care unit focused on ICU patients with sepsis, prolonged mechanical ventilation and multiple organ failure, and found 46 percent of 1,421 patients had neuromuscular dysfunction that was associated with extended use of mechanical ventilation and longer stays in the ICU. By comparison, other studies Needham reviewed showed that early physical medicine and rehabilitation therapy, while patients are on life support in the ICU, can safely allow patients to get out of bed and walk more quickly, resulting in shorter time on a ventilator and a shorter stay in the ICU for these critically ill patients.

Needham also based his comments on experience with patients at The Johns Hopkins Hospital medical intensive care unit, where a new physical medicine and rehabilitation program has been developed for ICU patients. The cause of muscle weakness after an ICU stay are complicated, Needham says, but experimental studies do show that even healthy people experience a four percent to five percent loss of muscle strength for each week of bed rest, and require a prolonged recovery period. "Although there are many causes of muscle weakness, getting ICU patients up and moving does help modify the negative effects of bed rest," Needham concluded.

Needham cautions that despite this evidence for early mobilization, additional research is needed to more fully understand the best methods for doing it, and the short-term and long-term benefits.

Adapted from a press release from the Johns Hopkins University School of Medicine's Division of Physical Medicine and Rehabilitation.