Imagine waking up with a tube down your throat that is breathing for you, lines and tubes coming out of parts of your body, people rolling you to clean your diaper, washing you, putting lotion on your bottom to prevent skin breakdown, tube feed running down a tube for your nourishment.  Being completely bedridden and stuck in positions that aren't comfortable. You think just a few days ago, you were living, going out to dinner with friends, driving to the grocery store.and now you are completely debilitated. What if you were able to get up and move, take a deep breath, off your back and on your feet? 

Therapy can have a positive effect on mood and the outlook on what can seem to be a grim situation. Initially, it can be scary for patients to learn that they aren't as steady as what they were prior to admission, but we as professionals need to rehabilitate these patients back on their feet. 

Secondary Weakness
A common complication of an ICU patient is acquired weakness secondary to being immobilized for a prolonged period of time. Immobilization is usually due to sedative use which also has the side effect of delirium, hallucinations, or the feeling of being unaware of your surroundings.  It is often mistaken that the sedated patient is resting or when awake confused, when in fact, sedation can cause a deprivation in deep sleep. 

After being intubated, one patient told me, "The nurses treated me as if I was dumb, drugged me up to sleep because I had the tube down my throat.all I wanted to do was get out of bed.it was the best thing for me."

Many studies have shown that reducing sedation and being more awake could speed up a patient's recovery. Therapeutic intervention by a trained therapist is safe and has been shown to increase functional outcomes. Just changing a patient's body position optimizes the ventilation-perfusion ratios, thus improving respiratory function. Utilizing your muscles can lessen the amount that is wasted, getting off the ventilator quicker, getting out of the ICU and to the ultimate goal of home and living life.  

Therapy services in the ICU at Baltimore Washington Medical Center have shown a decrease in ventilator use, decrease length of stay in the ICU, and ultimate quicker discharge from the hospital.

An intensive care unit bed is an additional $1250.00 a day more than a general medical bed.  Utilization of a vent ranges from $180 to more than $350, depending on greater or lesser than 12 hours. On average, early physical therapy intervention has been shown to decrease the amount of days the patient requires a vent by 6 days, the average length of stay in the ICU has also decreased by 6.5 days. That makes the nurses happy, gives the therapist feeling a sense of accomplishment, the hospital saves on cost, and ultimately, the patient can now see the light at the end of the tunnel. 

What is Appropriate
Typically, a patient in the ICU can be from ages 18 to 90, with diagnosis to include but not limited to respiratory distress, cardiac issues, post surgical complications, sepsis, strokes, and so on. Generally, we have rounds daily and the nurses, respiratory therapist and rehab talk about each individual case and decide appropriateness of patient in all their aspects of care. This is also where we decide when it is appropriate for rehab intervention. Rehab intervention can include bed mobility, sitting edge of bed, balance, activities, out of bed activities to include transfers to chair and ambulation, as well as exercises. There are tasks we do with all patients; however, it is critical to be constantly monitoring that patient's vital signs on the monitor, or by observation of the patient. Know your vents and what certain bells sound like, what is a true concern versus what may be artifact, know how to react to the ventilator, when to call for the nurse, what is a true a-line waveform, and how to adjust treatment when your vented patient begins to cough. 

Having a good baseline of the patient prior to treatment and knowing what to adjust during your treatment is key-all while keeping your composure because these patients are watching your every move. If you look frazzled, they will become anxious and nervous. Patients are followed throughout their hospital course and as they transfer to different floors.

With the increase need for therapy, these patients are not able to get the recommended frequency, which is a barrier to their timely discharge. Lengths of stay are based on a case-by-case situation, depending on age, motivation of patient, tolerance to medical intervention, etc.

Comfort Zones
We have shown that therapeutic intervention has decreased their length of stay on the ventilators, in the ICU, and in the hospital. So how do you get there? I wouldn't suggest physical therapists work in the ICU unless they are trained with all the lines, tubes, bells and whistles. It is crucial that a therapist go into each patient's room with the knowledge and know-how to get them up and moving safely. 

I would suggest going to courses to assist in training a therapist to manage a patient with their lines, tubes and ventilators. A trained rehab therapist can make mobility in the ICU both safe and rewarding for you and your patient. For the patients' recovery, it is also imperative to involve a team approach, to include nurses, respiratory therapists, doctors, physical and occupation therapy, dietary personnel, nursing techs, families and patients.

Step out of your comfort zone and make a difference. Next time you walk into an ICU, imagine you or your family member lying in that hospital bed and what it might feel like to be completely debilitated. You can make a difference in not only a patient's life, but in a family's. The long-term affects on early mobility are ultimately priceless. 

Kristin Lucido Hillegass is a critical care PT specialist at Baltimore Washington Medical Center in Glen Burnie, MD. She graduated from University of Maryland, Baltimore County with a bachelor's degree in psychology, pursued her doctorate degree in physical therapy at the University of Maryland, Baltimore, School of Medicine, Department of Physical Therapy and Rehabilitation Sciences.