Exercise in the ICU Flashcards
What is the ICU?
- Special department of hospital that provides intensive care medicine
What kind of patients are in the ICU?
- Seriously/Critically Ill
- Risk of or recovering from life-threatening conditions
What are some common conditions treated in the ICU?
- Acute respiratory distress syndrome
- Septic Shock
- Other life-threatening conditions
What is common with patients in the ICU?
- Muscle Dysfunction
-peripheral
-respiratory
Why is muscle dysfunction common in patients in the intensive care unit?
- Inactivity
- Inflammation
- Pharmacologic Agents
- Neuromuscular syndromes with critical illness
What might respiratory muscle weakness be at its onset?
- Important factor, leading to prolonged ICU stay
Why might respiratory muscle weakness onset be a factor leading to prolonged ICU stay?
- Weaning failure from mechanical ventilation
How prevalent is peripheral muscle weakness in patients with mechanical ventilation for 4-7 days?
25-33%
How prevalent is peripheral muscle weakness in patients with acute respiratory distress syndrome?
60%
How prevalent is peripheral muscle weakness in patients with septic shock?
35-76%
What is peripheral muscle weakness linked within the ICU?
- Increased Mortality
What does a prolonged ICU stay contribute to?
- Impaired functional status
- Impaired quality of life
How long can a prolonged ICU stay contribute to impaired functional status and quality of life?
- Possibly 1 year after discharge
What is associated with impaired functional status? What is not associated with it?
Is
- Muscle Weakness
Is NOT
- Pulmonary Function
When is muscle wasting the highest during an ICU stay?
- During first 2-3 weeks
What is important for patients with expected prolonged bed rest regarding muscle wasting?
- Important to prevent or attenuate muscle deconditioning as early as possible
What does the European Respiratory Society and Society of Intensive Care Medicine advice regarding critically ill patients?
- Start early with active and passive exercise
What was the rational for the study on early exercise in critically ill patients?
- Prolonged stay in ICU associated with muscle dysfunction
- Muscle dysfunction contributes to impaired functional status up to 1 year after discharge.
What was the objective of the study on early exercise in critically ill patients?
- Investigate whether daily exercise is safe and effective for preventing decrease in functional exercise capacity, functional status, and quadriceps force associated with prolonged ICU stay
What was the design of the study on early exercise in critically ill patients?
- Randomized Controlled Trial
What was the setting of the study on early exercise in critically ill patients?
- Medical/surgical ICU at University Hospital Gasthuisberg
Who were the patients in the study on early exercise in critically ill patients?
- 90 critically ill patients
- Starting day 5 of recovery
- expected prolonged ICU stay
What was the intervention of the study on early exercise in critically ill patients?
Both Groups
- Respiratory physiotherapy
- Standardized passive/active motion session of upper and lower limbs
Treatment Group
- Passive or active exercise training session 20min/day using bedside ergometer bike
Describe the exercise intervention used in the treatment group of the study on early exercise in critically ill patients?
- 5 days a week, 20min/day
- Bedside cycle ergometer
- Divided into two bouts of 10min
- Individually adjusted intensity level
Why did they use a cycle ergometer for the study on early exercise in critically ill patients?
- Offers passive or active cycling at 6 levels increasing resistance
What were the results of the study on early exercise in critically ill patients?
- Daily cycle exercise is feasible and safe during early ICU stay
- Intervention improved functional exercise capacity, muscle force, and perceived functional status at discharge
- increased quad strength and 6 minute walking distance
What was the aim of the study on early bedside cycle exercise on GI function in ICU patients on MV?
- Investigate effects of daily exercise on GI function in patients with severe pneumonia who received MV
What are patients in the ICU often treated for regarding GI?
- Dysfunction or disease
- Vomiting
- Gastric residual volumes
- Diarrhea
- Bowel Dilation
What occurs in approximately 50% of critically ill patients?
- Feeding Intolerance due to delayed gastric emptying
What is a common and well-known complication that influences adverse outcomes in critically ill patients?
- Gastrointestinal failure
What was the experimental design of the study on early exercise to counter GI distress in ICU patients?
- Randomized Controlled Trial
- Tertiary Hospital
What were the two patient groups in the study on early exercise for ICU patients who were on MV?
- Control
- Treatment: Passive/Active ergometer 20min/day
When was gastrointestinal function and nutritional status evaluated during the study on early exercise for ICU patients with MV?
- first, fourth, and seventh day
What were the results of the study on early exercise for ICU patients who were on MV?
- Treatment group had significantly lower rates of diarrhea than control
- Treatment group had higher albumin/lymphocyte levels
- Treatment group had less invasive ventilation days
What is the conclusion of the study on early exercise in ICU patients who had MV?
- Early exercise in critical ICU survivors who received MV enhanced the recovery of GI function and improved patient’s nutrition status at discharge
