Evidence for your Practice: Early physical and occupational therapy in mechanically ventilated, critically ill patients

 

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Article: Schweickert, W. D., Pohlman, M. C., Pohlman, A. S., Nigos, C., Pawlik, A. J., Esbrook, C. L., ... & Schmidt, G. A. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet, 373(9678), 1874-1882.

Study Aim: This randomized control trial study aims to examine a rehabilitation approach consisting of interruption of sedation along with physical and occupational therapy in the earliest days of critical illness and the effect of both functional outcomes and neuro psychiatric outcomes for adult patients (≥18 years of age) receiving mechanical ventilation in critical intensive care.

Key Findings: This study resulted in an improved return to (premorbid) independent functional status at hospital discharge.  59% of patients returned to independent function status with intervention as opposed to the 39% of patients in the control group. Additionally, patients in the intervention group had a shorter duration of ICU-associated delirium by 2 days and spent 2.4 more days alive and breathing without assistance than did the controls. Early physical and occupational therapy, combined with daily interruption of sedation, was found to be safe and well tolerated. Thus, this trial shows that both functional and psychological outcomes of patients on mechanical ventilation can be improved by the implementation of physical and occupational therapy in the earliest phases of critical illness.

Key Findings:

• 59% of patients returned to independent functional status with intervention as opposed to the 39% in the control group.
• Shorted duration of ICU delirium and breathing assistance.
• Improved function and psychological outcomes at hospital discharge. 

Bottom Line for OT: Occupational therapists implementing daily interruption of sedation combined with physical and occupational therapy may see better outcomes for patients receiving mechanical ventilation in the ICU, including shorter duration of delirium and improved functional status.

Post by CAOT-BC fieldwork student Liz Hadhazy

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