Episode #9: The Big Picture of Immobility
For decades of critical care, we have assumed patients were “too sick” to get out of bed. Are they really, or did we make them too weak to get out of bed and now too weak to breathe on their own?
Are tracheostomies always a result of lung failure? How often are they due to our failure to preserve strength and function?
When we fail to move patients on ventilators for more than a week, they develop ICU-acquired weakness (ICUAW). This new weakness increases mortality (48% with ICUAW vs. 19% without ICUAW) and results in 20 additional days of mechanical ventilation.
Do we really appreciate what ICU-acquired weakness is like for patients? Do we realize how much better their PTSD and quality of life is when they continue to have control of their own bodies and independence?
If we truly understood the reality of it, would we be willing to change our ways to fight it?
References:
Bienvenu, J., Colantuoni, E., Mendez-Tellez, P., Shanholtz, C., Dennison-Himmelfarb, C., Pronovost, P., & Needham, D. (2015). Cooccurrence of and remission from general anxiety, depression, and posttraumatic stress disorder symptoms after acute lung injury: a 2-year longitudinal study. Journal of Critical Care Medicine, 43(3). https://www.ncbi.nlm.nih.gov/pubmed/?term=Cooccurrence+of+and+remission+from+general+anxiety%2C+depression%2C+and+post-traumatic+stress+disorder+symptoms+after+acute+lung+injury%3A+a+2-year+longitudinal+study
Garton, A., Gupta, V., Pucci, J., Couch, C., & Connolly, E. (2019). Incidence and predictors of post-traumatic stress symptoms in a cohort of patient with intracerebral hemorhage. Clinical Journal of Neurology Neurosurgery, 190. https://www.ncbi.nlm.nih.gov/pubmed/?term=Incidence+and+predictors+of+post-traumatic+stress+symptoms+in+a+cohort+of+patient+with+intracerebral+hemorrhage
Vasilevskis, E., Ely, W., Speroff, T., Pun, B., Boehn, L., & Dittus, R. (2010). ICU-acquired delirium and Weakness- crossing the quality chasm. American College of Chest Physicians,138(5). https://www.ncbi.nlm.nih.gov/pubmed/?term=ICU-acquired+delirium+and+Weakness-+crossing+the+quality+chasm
