A pilot survey of ventilated cancer patients' perspectives and recollections of early mobility in the intensive care unit.

PURPOSE: To determine the level of recall, satisfaction, and perceived benefits of early mobility (EM) among ventilated cancer patients after extubation in the intensive care unit (ICU). METHODS: A survey of patients' perceptions and recollections of EM was administered within 72 h of extubation. Data on recall of EM participation, activities achieved, adequacy of staffing and rest periods, strength to participate, activity level of difficulty, satisfaction with staff instructions, breathing management, and overall rating of the experience were analyzed. The Confusion Assessment Method for ICU (CAM-ICU) was used for delirium screening. RESULTS: Fifty-four patients comprised the study group. Nearly 90% reported satisfaction with instructions, staffing, rest periods, and breathing management during EM. Participants indicated that EM maintained their strength (67%) and gave them control over their recovery (61%); a minority felt optimistic (37%) and safe (22%). Patients who achieved more sessions and "out-of-bed" exercises had better recall of actual activities compared with those who exercised in bed. Overall, patients with CAM-ICU-positive results (33%) performed less physical and occupational therapy exercises. CONCLUSIONS: Ventilated cancer patients reported an overall positive EM experience, but factual memory impairment of EM activities was common. These findings highlight the needs and the importance of shaping strategies to deliver a more patient focused EM experience.

Asterixis related to gabapentin as a cause of falls.

Negative myoclonus, commonly known as asterixis, is often observed in patients with toxic-metabolic encephalopathies or focal brain lesions. It is a movement disorder characterized by postural lapses resulting from brief cessation of tonic muscular contraction. Negative myoclonus has a characteristic appearance on needle electromyography. Lapses in continuous postural muscle activity can lead to falls. This increased risk of falls makes it particularly important to recognize and treat negative myoclonus, especially in patients with multiple medical problems, deconditioning, and gait disturbances. To our knowledge, there have been no published reports implicating negative myoclonus as a cause of falls in adults. We present a case of asterixis as a cause of falls and near falls in a patient with metastatic breast cancer and normal mental status who was receiving gabapentin.