Choosing Your ICU Wisely

Early patient mobility and muscle retention. Early patient mobility is a key factor which advances healing during any hospitalization. In fact, the lack of mobility creates many problems that have for far too long been ignored by medical facilities. It is important to choose your ICU wisely and to ask if they have implemented, or are moving to implement, early mobility protocols as a standard practice. Have the conversation, your health and the health of your loved ones depend upon it.

Patient Ambulation is the Key to Healing and Muscle Retention

Key Facts:

Trauma patients who are immobilized in bed for more than 72 hours are very likely to develop musculoskeletal complications. (Saunders 2015)

Healthy people who stay in bed for more than 24 hours lose 1%-1.5% of their quadriceps muscle strength every day. (Drummond 2013)

Inflammation exaggerates the effects of immobility and causes even greater muscle loss in patients whose immune systems are under stress. (Saunders 2015)

In older patients, immobility may also increase inflammation caused by traumatic injury. (Drummond 2013)

Muscles that help hold the body upright (skeletal muscles) are the first to be damaged by bed rest; this is worrying because skeletal muscle strength helps prevent falls. (Drummond 2013, Mirzoev 2018)

Muscle atrophy can also impact metabolism, decreasing the body’s ability to process proteins which are necessary to maintain healthy muscle and make new muscle tissue. (Drummond 2012)

Human bones constantly regenerate, but without regular stress (movement and exercise) bones tend to degrade, especially in older patients. (Ferrando 2006)

ICU Physical Therapy

Benefits of Physical Therapy in the ICU

Benefits of physical therapy in the ICU. You might ask yourself what a physical therapist does in the ICU. That is a great question. The role of a P.T. in the ICU will vary from facility to facility. Some facilities have a dedicated P.T. who spends the day mobilizing patients, doing progressive resistance exercises and acting as the expert for positioning and prevention of contractions. Other facilities order a P.T. consult only when a patient is extubated and active.

There are some important things that a P.T. needs to be knowledgeable about when working in the ICU. I would recommend brushing up on the following; cardiopulmonary physiology, ventilator and respiratory equipment, medications commonly used in the ICU, exclusion criteria for mobility, clinical implications of lab values, and monitoring systems. It is also beneficial to take 2-4 hours to shadow an ICU nurse and a respiratory therapist if your facility allows for this.

There are many P.T. activities that can be done while the patient is sitting edge of bed such as; PREs for lower extremities, therapeutic exercises, deep breathing, ADLs, trunk control and seated balance activities.

The ultimate goal of ICU P.T. is to get patients mobile which will inevitably help them wean off of a ventilator, become more independent and eventually transfer out of the ICU.

As a P.T. who has worked in the ICU I can tell you that it is rewarding, exciting and important. The evidence for early mobility is strong and it is “Best Practice” for ICU patients. I encourage you to get trained, get involved and get your patients moving.

Beneficial Reading

Implementation of an Early Mobility Program

See the mobigo here

See the mobilite here

See the mobikidz here

Tag: muscle atrophy

Early Patient Mobility and Muscle Retention

Choosing Your ICU Wisely

Patient Ambulation is the Key to Healing and Muscle Retention

Key Facts: