Why and how not to stay at the bottom of the bed in the intensive care unit? (the intensivist's perspective)

Abstract

Thirty to fifty percent of critically ill patients develop a polyneuromyopathy while in the Intensive Care Unit (ICU), also called “ICU acquired weakness”. This condition is associated with prolonged duration of mechanical ventilation, prolonged ICU and hospital lengths of stay, as well as excess hospital and long-term mortalities. In addition to pathophysiological risk factors associated with the primary disease (shock, multiple organ dysfunction syndrome, sepsis, oxidative stress, hyperglycemia…), immobilization determined by the use of a deep or prolonged sedation is actually the main iatrogenic risk factor. Strategies to early interrupt sedation in critically ill patients (passive awakening) associated with early active mobilization strategies (active awakening) have proved to be effective to reduce patients’ functional disability at hospital discharge. This communication reports on the practical feasibility of such a strategy in the intensivist's perspective, resuscitation-rehabilitation being more and more intricate. Interconnection between ICU, rehabilitation and physical therapy teams is discussed. This is an important facilitator for a successful implementation of early active mobilization in the ICU setting.