Low Levels of Physical Activity During Critical Illness and Weaning: The Evidence-Reality Gap.

BACKGROUND: Physical rehabilitation can benefit critically ill patients during intensive care unit (ICU) admission, but routine clinical practice remains inconsistent nor examined in prolonged mechanical ventilation patients transferred to a specialist ventilator weaning unit (VWU). Behavioral mapping is a sampling approach that allows detailed reporting of physical activity profiles. The objective of this study was to characterize the physical activity profile of critically ill patients in a UK ICU and VWU. METHODS: Single-center, prospective observational study in a university teaching hospital. Patient observations, conducted Monday through Sunday from 08:30 am to 08:00 pm and for 1 minute every 10 minutes, included data points of patient location, people in attendance, and highest level of activity. Descriptive statistics were utilized to analyze and report data. RESULTS: Forty-two ICU and 11 VWU patients were recruited, with 2646 and 693 observations, respectively, recorded. In the ICU, patients spent a median (interquartile range) of 100% (96%-100%) of the day (10.5 [10.0-10.5] hours) located in bed, with minimal/no activity for 99% (96%-100%) of the day (10.4 [9.7-10.5] hours). Nursing staff were most frequently observed in attendance with patients irrespective of ventilation or sedation status, although patients still spent approximately two-thirds of the day alone. Bed-to-chair transfer was the highest activity level observed. In the VWU, patients spent 94% (73%-100%) of the day (9.9 [7.7-10.5] hours) in bed and 56% (43%-60%) of time alone. Physical activity levels were higher and included ambulation. All physical activities occurred during physical rehabilitation sessions. CONCLUSIONS: These profiles of low physical activity behavior across both patients in the ICU and VWU highlight the need for targeted strategies to improve levels beyond therapeutic rehabilitation and support for a culture shift toward providing patients with, and engaging them in, a multidisciplinary, multiprofessional environment that optimizes overall physical activity.

Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference.

BACKGROUND: Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. OBJECTIVES: To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families. PARTICIPANTS: Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge. DESIGN: Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems. MEASUREMENTS AND MAIN RESULTS: Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member. CONCLUSIONS: Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.

Prospective observation of physical activity in critically ill patients who were intubated for more than 48 hours.

PURPOSE: Critical illness can result in impaired physical function. Increased physical activity, additional to rehabilitation, has demonstrated improved functional independence at hospital discharge. The purpose of this study was to measure patterns of physical activity in a group of critically ill patients. METHODS: This was a single-center, open, observational behavioral mapping study performed in a quaternary intensive care unit (ICU) in Melbourne, Australia. Observations were collected every 10 minutes for 8 hours between 8:00 am and 5:00 pm with the highest level of physical activity, patient location, and persons present at the bedside recorded. RESULTS: Two thousand fifty observations were collected across 8 days. Patients spent more than 7 hours in bed (median [interquartile range] of 100% [69%-100%]) participating in little or no activity for approximately 7 hours of the day (median [interquartile range] 96% [76%-96%]). Outside rehabilitation, no activities associated with ambulation were undertaken. Patients who were ventilated at the time of observation compared with those who were not were less likely to be out of bed (98% reduction in odds). Patients spent up to 30% of their time alone. CONCLUSION: Outside rehabilitation, patients in ICU are inactive and spend approximately one-third of the 8-hour day alone. Strategies to increase physical activity levels in ICU are required.

Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study.

OBJECTIVES: To develop a comprehensive set of items describing physiotherapy mobilisation practices for critically ill patients, and to document current practices in intensive care units in Australia and New Zealand, focusing on patients having > 48 hours of mechanical ventilation. DESIGN: Prospective, observational, multicentre, single-day, point prevalence study. PARTICIPANTS AND SETTING: All patients in 38 Australian and New Zealand ICUs at 10 am on one of three designated days in 2009 and 2010. MAIN OUTCOME MEASURES: Demographic data, admission diagnosis and mobilisation practices that had occurred in the previous 24 hours. RESULTS: 514 patients were enrolled, with 498 complete datasets. Mean age was 59.2 years (SD, 16.7 years) and 45% were mechanically ventilated. Mobilisation activities were classified into five categories that were not mutually exclusive: 140 patients (28%) completed an in-bed exercise regimen, 93 (19%) sat over the side of the bed, 182 (37%) sat out of bed, 124 (25%) stood and 89 (18%) walked. Predefined adverse events occurred on 24 occasions (5%). No patient requiring mechanical ventilation sat out of bed or walked. On the study day, 391 patients had been in ICU for > 48 hours. There were 384 complete datasets available for analysis and, of these, 332 patients (86%) were not walked. Of those not walked, 76 (23%) were in the ICU for ≥ 7 days. CONCLUSION: Patient mobilisation was shown to be low in a single-day point prevalence study. Future observational studies are required to confirm the results.