An Italian study (Clini et al., 2011) followed 77 tracheostomy patients who were determined to be difficult to wean from mechanical ventilation. A physical training program began 48 hours after admission to their regional weaning center. The program consisted of active movement of the limbs, interventions focusing on trunk control, body posture, upper and lower limb activities, and transfers from bed to chair and standing up.
Overall success with weaning was 74%, and the hospital survival rate was 87%.
While the outcomes from this rehabilitation setting are impressive, a study by Morris and others (2008) showed that the benefits of exercise begin even earlier, in the ICU setting. With a dedicated mobility team, they decreased time spent on bedrest from 11 to 5 days, length of stay in the ICU decreased from 6.9 to 5.5 days, overall hospital length of stay decreased from 14.5 to 11.2 days.
Clinicians’ concern with exercise in the ICU often has been related to their fear of dislodgement of invasive devices; however, this study found that there were no incidents of cardiopulmonary compromise nor inadvertent removal of invasive devices. They recommended that further research is needed to determine the optimal type of therapy, frequency of therapy and other outcomes that can be influenced by early mobility.
Clini, EM, Crisafulli, E, Degli Antoni, F, Beneventi, C, Trianni, L, Costi, S, Fabbri, LM, Nava, S (2011). Functional recovery following physical training in tracheotomized and chronically ventilated patients. Resp Care 56(3), 306-313.
Morris, PE, Goad, A, Thompson, C, Taylor, K, Harry, B, Passmore, L, Ross, A, Anderson, L, Baker, S, Sanchez, M, Penley, L, Howard, A, Dixon, L, Leach, S, Small, R, Hite, RD, Haponik, E. (2008). Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med, 36(8), 2238-2243.