Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation*

TLDR

Physical and occupational therapy can be initiated immediately after intubation in mechanically ventilated ICU patients. The study aimed to describe a protocol of daily sedative interruption followed by early physical and occupational therapy for mechanically ventilated patients, detailing ICU‑based therapy, neurocognitive state, barriers, and adverse events. Patients received daily sedative interruption followed by physical and occupational therapy every hospital day, starting with active range‑of‑motion and progressing to activities of daily living, sitting, standing, and walking as tolerated, with therapy occurring on 90 % of MICU days and including sitting at the bed edge (69 %), bed‑to‑chair transfers (33 %), standing (33 %), and ambulation (15 % of sessions, median 15 feet). Early physical and occupational therapy was feasible from the onset of mechanical ventilation, with 49 patients receiving therapy a median of 1.5 days after intubation, 89 % of encounters encountering at least one barrier, only 4 % of sessions interrupted prematurely, and adverse events were uncommon.

Abstract

Physical and occupational therapy are possible immediately after intubation in mechanically ventilated medical intensive care unit patients. The objective of this study was to describe a protocol of daily sedative interruption and early physical and occupational therapy and to specify details of intensive care unit-based therapy, including neurocognitive state, potential barriers, and adverse events related to this intervention.Detailed descriptive study of the intervention arm of a trial of mechanically ventilated patients receiving early physical and occupational therapy.Two tertiary care academic medical centers participating in a randomized controlled trial.Patients underwent daily sedative interruption followed by physical and occupational therapy every hospital day until achieving independent functional status. Therapy began with active range of motion and progressed to activities of daily living, sitting, standing, and walking as tolerated.Forty-nine mechanically ventilated patients received early physical and occupational therapy occurring a median of 1.5 days (range, 1.0-2.1 days) after intubation. Therapy was provided on 90% of MICU days during mechanical ventilation. While endotracheally intubated, subjects sat at the edge of the bed in 69% of all physical and occupational therapy sessions, transferred from bed to chair in 33%, stood in 33%, and ambulated during 15% (n = 26 of 168) of all physical and occupational therapy sessions (median distance of 15 feet; range, 15-20 feet). At least one potential barrier to mobilization during mechanical ventilation (acute lung injury, vasoactive medication administration, delirium, renal replacement therapy, or body mass index ≥ 30 kg/m) was present in 89% of patient encounters. Therapy was interrupted prematurely in 4% of all sessions, most commonly for patient-ventilator asynchrony and agitation.Early physical and occupational therapy is feasible from the onset of mechanical ventilation despite high illness acuity and presence of life support devices. Adverse events are uncommon, even in this high-risk group.