Friday, 12 June 2015

Could exercise be the key to better ICU patient outcomes and survival rates?

Senior Research Fellow, Dr Carol Hodgson from SPHPM’s Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) is leading an exciting project that could unlock the key to greater health outcomes and long-term survival for intensive care unit (ICU) patients.

The Trial of Early Activity and Mobilization (TEAM) is a multi-phase trial of ventilated ICU patients to evaluate how early mobilization (EM) influences long-term survival and recovery – you can read the full paper here. Phase One of the study was a prospective, multi-centre, cohort study conducted in 12 ICUs in Australia and New Zealand. The 192 participants had a mean age of 58.1 years and by day 90 the mortality rate was 26.6 per cent (51/192).

“Patients in ICU traditionally receive bed rest as part of the management of their critical illness. We know that muscle weakness can start after only a few days of mechanical ventilation, which can prolong the time spent in the ICU and in hospital, delaying functional recovery and resulting in slower return home and to work,” Dr Hodgson said.

“Improved strength at the time of ICU discharge is also associated with improved recovery times and a higher survival rate for ICU patients.”

Over 1351 study days, information was collected during 1288 planned early mobilization episodes in patients on mechanical ventilation for the first 14 days or until extubation (whichever occurred first). Despite the presence of dedicated physical therapy staff, no mobilization occurred in 84 per cent of these episodes. Where mobilization occurred, the maximum levels of mobilization were exercises in bed (7 per cent), standing at the bed side (0.9 per cent) or walking (2 per cent).

“We know that early mobilization in the ICU is not widely practised in Australia and New Zealand despite the high level and longstanding involvement of physical therapists in ICU multidisciplinary teams in the region. We also know that the two main barriers to mobilization are intubation and sedation.

“However with the use of extra staff and innovative equipment, such as a stationary bicycle that allows patients to exercise while lying down, we can combat the barriers of intubation and sedation.

“The aim of this study is to show the importance of early mobilization intervention for ICU patients not only while in ICU and the hospital but their long term recovery and survival rates once discharged,” Dr Hodgson said.

More than 50 per cent of participating patients discharged from the ICU had developed ICU-acquired muscle weakness, which was associated with death between ICU discharge and day 90.

“Muscle atrophy and weakness prolong the recovery. This study is allowing us to better understand how carefully supervised rehabilitation, as opposed to continuous sedation and bed rest, can improve recovery,” Dr Hodgson said.

The TEAM study is endorsed by the Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group and is funded by the Intensive Care Foundation. The TEAM investigators comprise of ICU specialists including doctors, nurses and physiotherapists.

Phase two was a pilot study to assess the feasibility of randomising patients to extra exercise in ICU. This multi-centre pilot study is completed and preliminary results show promise. Phase three of the clinical trial will be to determine the effectiveness of early mobilization on patient-centered outcomes.

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