William D Schweickert, Mark C Pohlman, Anne S Pohlman, Celerina Nigos, Amy J Pawlik, Cheryl L Esbrook, Linda Spears, Megan Miller, Mietka Franczyk, Deanna Deprizio, Prof Gregory A Schmidt, Amy Bowman, Rhonda Barr, Kathryn E McCallister, Prof Jesse B Hall, Dr John P Kress
We assessed the efficacy of combining daily interruption of sedation with physical and occupational therapy on functional outcomes in patients receiving mechanical ventilation in intensive care. 104 sedated adults (?18 years of age) in the ICU who had been on mechanical ventilation for less than 72 h, were expected to continue for at least 24 h, and who met criteria for baseline functional independence were randomly assigned to early exercise and mobilisation (physical and occupational therapy) during periods of daily interruption of sedation or to daily interruption of sedation with therapy as ordered by the primary care team. The primary endpoint—the number of patients returning to independent functional status at hospital discharge—was defined as the ability to perform six activities of daily living and the ability to walk independently. Return to independent functional status at hospital discharge occurred in 59% patients in the intervention group compared with 35% patients in the control group.
A strategy for whole-body rehabilitation—consisting of interruption of sedation and physical and occupational therapy in the earliest days of critical illness—was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care.
The Lancet, 14 May 2009, online article ahead of print