Bedside coaching and exercising for ICU patients on ventilators

Few people have thought about providing an exercise workout in the intensive care unit, especially for patients on ventilators - even those who are comatose - but a researcher from Frances Payne Bolton School of Nursing at Case Western Reserve University will be doing some bedside coaching and exercising to get patients stretching and flexing their muscles.

Chris Winkelman, assistant professor of nursing, will study the benefits of a range of exercises for people bed-bound, awake or comatose, and hooked to ventilators for breathing, to see if the workouts improve their physical and mental health.

"No one likes to be sick and stay in bed," says Winkelman. "It feels good when you are healthy to exercise, and we think ICU patients can also benefit from exercising."

She will lead a two-year, $431,000 National Institutes of Health's National Institute of Nursing Research study, "Dose of Early Therapeutic Mobility: Does Type and Frequency Matter?"

Non-ventilated ICU patients are encouraged to get up and start moving around, but it takes longer for patients on ventilators. These are patients that Winkelman and three research nurses will assist. Bed-bound patients who are in the ICU and on assisted breathing for more than five days can experience profound weakness from muscle loss and contraction of unused tendons.

Intensive care patients won't be doing push-ups or jumping jacks, but they will be getting a workout for at least 20 minutes a day during what they call sedation vacations-the times when patients are brought out of sedation to assess how well they are doing.

Half of the 99 ICU patients at University Hospitals of Cleveland that Winkelman will study will exercise during one of wake period and the other half will have two exercise times: when awake a second time or during a sedated time, depending upon how well the patient is recovering.

The research team will also take blood samples and test for biomarkers like IL-6, IL-10 or C-reactive protein (CRP) that measure for levels of inflammation. Winkelman plans to see if exercise lowers inflammation systematically, and if so, it will provide evidence of the positive impact of exercising while recovering.

So whether patients are comatose, semi-comatose, alert or ready to get out of bed, they will receive a level of exercise to provide some movement to their muscles and tendons to prevent the tightening of the limbs.

The idea is a holistic approach in helping a person recover and not to face some grave physical challenges after overcoming the medical ones.

Funds for the study came through the American Recovery and Reinvestment Act and will enable Winkelman to hire three research nurses to conduct exercise sessions with the ICU patients.

Source: Case Western Reserve University