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Cited by 3,339Intensive Care Unit Cognitive DisordersRespiratory Support and MechanismsNosocomial Infections in ICU

Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial

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Schweickert, William D, Pohlman, Mark C, Pohlman, Anne S, Nigos, Celerina, Pawlik, Amy J, Esbrook, Cheryl L, Spears, Linda, Miller, Megan +8 more·2009·The Lancet
DOI 10.1016/s0140-6736(09)60658-9PMC PMC9906655
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Abstract

Background Long-term complications of critical illness include intensive care unit (ICU)-acquired weakness and neuropsychiatric disease. Immobilisation secondary to sedation might potentiate these problems. We assessed the efficacy of combining daily interruption of sedation with physical and occupational therapy on functional outcomes in patients receiving mechanical ventilation in intensive care. Methods Sedated adults (>/=18 years of age) in the ICU who had been on mechanical ventilation for less than 72 h, were expected to continue for at least 24 h, and who met criteria for baseline functional independence were eligible for enrolment in this randomised controlled trial at two university hospitals. We randomly assigned 104 patients by computer-generated, permuted block randomisation to early exercise and mobilisation (physical and occupational therapy) during periods of daily interruption of sedation (intervention; n=49) or to daily interruption of sedation with therapy as ordered by the primary care team (control; n=55). The primary endpoint-the number of patients returning to independent functional status at hospital discharge-was defined as the ability to perform six activities of daily living and the ability to walk independently. Therapists who undertook patient assessments were blinded to treatment assignment. Secondary endpoints included duration of delirium and ventilator-free days during the first 28 days of hospital stay. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00322010. Findings All 104 patients were included in the analysis. Return to independent functional status at hospital discharge occurred in 29 (59%) patients in the intervention group compared with 19 (35%) patients in the control group (p=0.02; odds ratio 2.7 [95% CI 1.2-6.1]). Patients in the intervention group had shorter duration of delirium (median 2.0 days, IQR 0.0-6.0 vs 4.0 days, 2.0-8.0; p=0.02), and more ventilator-free days (23.5 days, 7.4-25.6 vs 21.1 days, 0.0-23.8; p=0.05) during the 28-day follow-up period than did controls. There was one serious adverse event in 498 therapy sessions (desaturation less than 80%). Discontinuation of therapy as a result of patient instability occurred in 19 (4%) of all sessions, most commonly for perceived patient-ventilator asynchrony. Interpretation A strategy for whole-body rehabilitation-consisting of interruption of sedation and physical and occupational therapy in the earliest days of critical illness-was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care. Funding None.

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  • Evidence supports the combination of exercise and protein/amino acid supplementation for prevention and treatment of muscle loss in certain debilitating clinical conditions, including bed rest for acute critical illness or injury and chronic diseases such as COPD and congestive heart failure.

    “Evidence supports the combination of exercise and protein/amino acid supplementation for prevention and treatment of muscle loss in certain debilitating clinical conditions, including bed rest for acute critical illness or injury 153e160 and also for chronic diseases, such as COPD 161e165 and congestive heart failure (CHF).99,163,166”

    From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [159]

    The Methods and Results describe early physical and occupational therapy for mechanically ventilated, critically ill patients and report improved functional independence at discharge. The paper does not test exercise combined with protein or amino acid supplementation, or establish that the combination prevents or treats muscle loss. The citations for COPD and heart failure are attached to different parts of the citing sentence, not to this source. (LLM, conf=0.88)

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Authors
Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., Spears, L., Miller, M., Franczyk, M., Deprizio, D., Schmidt, G. A., Bowman, A., Barr, R., McCallister, K. E., Hall, J. B., & Kress, J. P.
Affiliations
  • University of Pennsylvania (US)
  • University of Chicago (US)
  • University of Iowa (US)
Corresponding author
Kress, John P
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2009-05
Volume
373
Issue
9678
Pages
1874-1882
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(09)60658-9
PMC
PMC9906655
OpenAlex
W2109005423
Cited by
3,339
References
2
Citations by year
2026: 160 · 2025: 167 · 2024: 166 · 2023: 196 · 2022: 214 · 2021: 211 · 2020: 248 · 2019: 228 · 2018: 211 · 2017: 235 · 2016: 228 · 2015: 216 · 2014: 201 · 2013: 203 · 2012: 189
FWCI
111.04
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
Keywords
early mobilization, physiotherapy, occupational therapy, mechanical ventilation, critically ill patients, sedation interruption, ICU-acquired weakness, delirium, ventilator-free days, functional recovery, activities of daily living, weaning from mechanical ventilation, weaning
MeSH terms
Activities of Daily Living, Adult, Aged, Bed Rest, Chicago, Critical Care, Delirium, Early Ambulation, Exercise Therapy, Female, Humans, Iowa, Male, Middle Aged, Occupational Therapy, Respiration, Artificial, Time Factors, Logistic Models, Proportional Hazards Models, Single-Blind Method, Conscious Sedation, Procedural Sedation, Critical Illness, Treatment Outcome, Statistics, Nonparametric, Mobility Limitation, Kaplan-Meier Estimate

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