A Cup A Day

After my long post yesterday, I’m sure you all are curious to hear a bit more about early rehabilitation in the ICU. Why is it so important ? Well, try these stats on for size:

• By 2026, the anticipated need for mechanical ventilation will increase 80% (1)
• Bed rest is associated with loss of strength 4-5% in HEALTHY subjects (2)
• Long-term physical disability measured by the 6 minute walk test persists for up to 5 years after discharge from the ICU (3)
• Results of the Johns Hopkins rehab project show that length of stay in the medical ICU by 30% and in the hospital by 18% (4)

However, there are many barriers to getting people up and moving while in the ICU.

Perhaps the most significant, is our perception and culture around illness. There is an overall discomfort with getting “sick” people moving, in our minds we EQUATE HEALING AND REST. While there certainly are times when absolute rest is necessary, we need to be comfortable as an interdisciplinary team to recognize that those cases are few and far between. (Case in point: my father had a visit from physical therapy less than 12 hours after his heart transplant surgery to get him moving…. )

So if you find yourself thinking:

Change Culture to promote Early Rehab….

Dispel those preconceived barriers that “patients are too sick” or “too sedated/delirious” or “there are too many lines and equipment”

Start reading up on some of this amazing literature and see that there is truly some great evidence out there to help you change your cultural perceptions about healing. This will also help you become a better advocate for your patients and to share with other clinicians, staff, & family that may still feel like snuggling up in bed with chicken soup will cure what ailes ya (well, perhaps for a cold winter day )

And don’t forget to check out these great resources:

• Check out the twitter feed from the event, for articles and other stimulating convo:#icurehab
• Visit these sites
  • www.hopkinsmedicine.org/OACI
  • www.mobilization-network.org

(1) Crit Care Med. 2005; 33(3): 574-597

(2) Ferrando AM J Physiol 1996; 270:E627-E633

(3) NEJM. 2001; 364(14):1293-304

(4) Arch Phys Med Rehabil 2010; 91:536-42