Exercise intervention in the critical care unit – what is the evidence?

Abstract

Objectives: Physical morbidity is a well documented phenomenon of the patient confined to bed with critical illness and may persist for months following the critical care stay. Early rehabilitation activities initiated during the critical care stay may ameliorate these changes and reduce the long term burden of care associated with a critical care admission. The objective of this review is to explore the known evidence examining the issue of rehabilitation of the patient with critical illness.Methods: Database searches were performed to retrieve the search terms mobilisation, rehabilitation, exercise therapy, physiotherapy, ambulation, muscle strength, functional training, mechanical ventilation, intensive care, and critical care.Results: Physiotherapy practice varies widely throughout Europe, North America and Australasia and rehabilitation interventions for critically ill patients have received little research attention. Retrieved data was reviewed in the following categories: a) The incidence of rehabilitation practices within intensive care units, b) Safety issues associated with exercising the critically ill patient, c) The acute response to exercise in the critically ill, and d) The effects of physical training programmes in ventilator dependent subjects.Discussion: Evidence of the effectiveness of physical training within the intensive care environment remains limited to long term respiratory failure patients who may not be representative of a general critically ill population. Preliminary data from protocol initiated physiotherapy intervention initiated within 48 h of the onset of mechanical ventilation in medical patients reveal both decreased intensive care unit and hospital length of stay. It is clear that research funding should be allocated to strengthen physiotherapeutic practice in this area. In particular the relationship between muscle strength, functional scales and other measures of outcome including number of days to wean from mechanical ventilation and length of stay need to be explored.