Timing of early mobilization to optimize outcomes in mechanically ventilated ICU patients

Excerpt

Weakness acquired in the intensive care unit (ICU) is a common problem in survivors of critical illness, particularly as strategies to enhance survival have increased substantially over the past two decades. This has been known from the early space flight human experience, more than 50 years ago. Here, astronauts returning to earth were noted to have extreme muscle wasting after having been in a zero gravity environment. Indeed, with modern space travel, the national aeronautics and space administration (NASA) utilizes a very sophisticated approach to exercise to ensure that astronauts no longer suffer this sort of complication. ICU patients who are motionless in bed for extended time periods suffer a similar problem. Numerous animal studies of limb immobilization and full ventilatory support have demonstrated similar findings in extremity [1] and diaphragm muscles, respectively. In 2008, Levine, et al. described marked human diaphragm atrophy in as little as 18 h of full ventilatory support in brain dead organ donors [2]. The rapidity with which neuromuscular dysfunction occurs is sobering, and combating such a formidable problem is not easy. Yet we routinely care for sedated, ventilated patients in our ICUs who suffer identical complications. Most would agree that neuromuscular and neurocognitive deconditioning is one of the most common and devastating complications seen in modern ICUs. …