Home' Trinidad and Tobago Guardian : March 31st 2015 Contents A28
body & soul
Guardian www.guardian.co.tt Tuesday, March 31, 2015
The intensive care unit is a last frontier for physical
therapy. It s hard to exercise patients hooked to ven-
tilators so they can breathe.
Some hospitals do manage to help critically ill patients
stand or walk despite being tethered to life support.
Now research that put sick mice on tiny treadmills
shows why even a little activity may help speed recovery.
It s work that supports more mobility in the ICU.
"I think we can do a better job of implementing
early mobility therapies," said Dr D Clark Files of Wake
Forest Baptist Medical Center in Winston-Salem, North
Carolina, who led the research and whose hospital is
trying to get more critically ill patients up, ventilator
Hospitals have long nudged less critical patients out
of bed, to prevent their muscles from wasting away.
But over the past several years, studies in ICUs have
shown that some of the sickest of the sick also could
benefit---getting out of intensive care sooner, with fewer
complications---once it s medically feasible for them
to try. This isn t just passively changing a patient s
It could involve helping them sit on the side of the
bed, do some arm exercises with an elastic band or
in-bed cycling, or even walk a bit with nurses holding
all the tubes and wires out of the way. It takes extra
staff, and especially for patients breathing through
tubes down their throats, it isn t clear how often it s
attempted outside specialised centres.
At Wake Forest Baptist, a physical therapist helped
Terry Culler, 54, do arm and leg exercises without dis-
lodging his ventilator tubing, working up to the day
he stood from the bedside for the first time since devel-
oping respiratory failure about three weeks earlier. "I
cheered, I was clapping," his wife, Ruanne Culler of
Lexington, North Carolina, said after two therapists
and a nurse finally helped him to his feet.
Biologically, why could such mild activity help? Files
focused on one especially deadly reason for people to
wind up on a ventilator, acute respiratory distress syn-
drome, or Ards, the problem Terry Culler battled. It
strikes about 200,000 Americans a year, usually after
someone suffers serious injuries or another illness such
as pneumonia, and it can rapidly trigger respiratory
failure. Survivors suffer profound muscle weakness.
Files team injured the lungs of laboratory mice in
a way that triggered Ards. The animals were sick but
still breathing on their own, and walked or ran on a
treadmill for a few minutes at a time over two days.
The surprise---that short amount of exercise did
more than counter wasting of the animals limbs. It
also slowed weakening of the diaphragm, used to
breathe. And it tamped down a dangerous inflammatory
process in the lungs that Files suspects fuels muscle
damage on top of the wasting of enforced bed-rest.
"It s not only putting a load on the legs," Files
explained. "It s something systemic."
When certain white blood cells stick inside Ards-
affected lungs too long, they slow healing. The lungs
of the exercised mice contained fewer of those cells
---and their blood contained less of the protein that
activates them, Files reported in the journal Science
Translational Medicine this month.
Then Files examined blood frozen from Ards patients
who had participated in an earlier Wake Forest Baptist
study comparing early mobility to standard ICU care.
Sure enough, patients who had gotten a little exercise
harbored less of that protein.
The new research adds to the biologic rationale, but
there s already enough evidence supporting early mobility
that families should ask whether their loved one is a
candidate, said ICU specialist Dr Catherine Hough of
the University of Washington, who wasn t involved
with Files study.
She s surveying a sample of US hospitals and finding
variability in how often ICUs try, from those that help
a majority of critically ill patients stand to others where
no ventilated patients do. Obviously key is whether
the patient can tolerate movement. But so is whether
hospitals keep ventilated patients sedated despite
research showing many don t need to be, Hough
Back at Wake Forest Baptist, Ruanne Culler remem-
bered her father being kept sedated while on a ven-
tilator at another hospital, so she was surprised that
physical therapy was an option for her husband.
It began once Terry Culler was medically stable,
and he scribbled notes saying he wanted the exercise.
Getting patients on their feet
may speed recovery in ICU
In the intensive care unit at Wake Forest Baptist Medical Center, physical therapist
Katie Kellner helps patient Terry Culler do some exercises and briefly stand despite
being hooked to a ventilator. AP PHOTO
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