Introduction The practice of early exercise in the intensive care unit (ICU) is now receiving increasing clinical and research recognition. In order to determine the true effect of enhanced exercise therapy interventions, facilitate comparison across multiple datasets, and gain a better understanding of international practices, accurately defining ‘usual care’ is of vital importance.1 The objective of this study was to benchmark current provision of exercise therapy within the ICU of a large, university teaching hospital, including ‘dose’ of exercise therapy provided, clinical factors influencing intervention delivery, and whether service provision met published national guidelines.
Method A single-centre, prospective longitudinal observational study was conducted. Eligible patients were adults (≥18 years) receiving mechanical ventilation for at least 48 h, with no additional exclusion criteria. Consecutive eligible patient admissions were included. Data collection occurred remotely and independently, over a three month period, and using two electronic hospital databases to collect clinical, therapy and administrative data.
Results One hundred and fourteen patients were included between February and April 2014 (median (IQR) age 61.5 (45.8–74.0)years, M:F 51:53, admission diagnosis 71% medical, mean (SD) APACHE II score 19.1 (4.8), ICU length of stay 16 (10–22)days). Complete data analysis is currently reported for 50 patients. Physiotherapy contact and milestone data are reported in Table 1. Nineteen patients did not receive exercise therapy during their admission. In those patients receiving exercise therapy, sitting over the edge of the bed was the highest level of physical activity achieved and the most frequently performed. Exercise therapy was most commonly delivered to those patients with either a tracheostomy or own airway, and once spontaneous modes of ventilation had been commenced.
Conclusion These data represent initial analysis from a detailed description of exercise therapy delivered in a large, university hospital ICU. Completion of data analysis for the whole cohort is required to fully conclude what constitutes typical practice in this ICU, characteristics of patients receiving exercise therapy, and the influence of airways status on delivery of exercise therapy activities.
Parker A, Tehranchi K, Needham D. Critical care rehabilitation trials: the importance of ‘usual care’. Critical Care 2013;17(5):183