Feasibility and Safety of Physical Therapy during Continuous Renal Replacement Therapy in the Intensive Care Unit.

Abstract

Early rehabilitation in an intensive care unit is associated with improved physical functioning and patient outcomes. However, relatively few data have been reported on physical therapy interventions during continuous renal replacement therapy (CRRT) for patients in intensive care units. To evaluate the feasibility and safety of physical therapy interventions, delivered as part of routine clinical care, for patients undergoing CRRT in an intensive care unit. Consecutive patients in the adult medical intensive care unit of one large tertiary care hospital who received physical therapy sessions while on CRRT were prospectively evaluated over 13 months. Physical therapy sessions were individualized on the basis of patients' physical impairments and activity tolerance, with patients' highest level of mobility recorded. Data on 15 different physiological abnormalities and potential safety events, including bleeding, dislodgement, or dysfunction of the CRRT catheter or circuit, were prospectively collected. Eleven physical therapists delivered 268 rehabilitation sessions to 57 patients while they were receiving CRRT, with the following highest levels of mobility achieved during individual sessions: 78 (29%) bed exercises, 72 (27%) supine cycle ergometry, 80 (30%) sitting at edge of bed, 13 (5%) transfer to chair, and 25 (9%) standing or marching in place. No CRRT-specific safety events occurred (0%; 95% upper confidence interval, 6.3%). There were six non-CRRT-related potential safety events (2.2% of all physical therapy sessions; 95% confidence interval, 0.6-8.2%), all of which were transient changes in blood pressure. In this prospective observational study at one adult medical intensive care unit, we found that provision of bedside physical therapy while patients underwent CRRT is feasible, and appears safe.