Bringing Exercise to the ICU Could Improve Outcomes for Pediatric Rare Disease Patients

Sedation Versus Sleep

Sleep and sedation are not synonymous terms, despite the fact that they are often used interchangeably in the hospital setting. The biggest difference? Sleep is always beneficial and restorative. Sedation, especially when used long-term in intensive care units, can be detrimental. It can negatively effect patients’ recovery and harm their long-term health. So why is it utilized? Why aren’t the cons discussed openly?

ICU care, like all healthcare, has improved over the years. But there has recently been a movement aimed at finding ways to ensure patients are being provided the best possible care to improve their long-term well being. It’s not just about caring for the patient in the moment, it’s about making sure they have the best life possible when they’re discharged.

The History

Sedation essentially puts the brain in a semi-conscious or completely unconscious state through pharmaceuticals. Sometimes paralytics are also given to patients to keep them from moving. The goal is to keep the patient safe and comfortable, making the pain tolerable and stopping them from pulling out any necessary tubes or lines.

Standards for sedation within ICUs were first introduced in the 1980s. Essentially, standards from the operating room were just shifted to the ICU. Then, in 2000, an article was published which showed there were benefits from interrupting sedation for periods of time each day. Later, it was uncovered that sedation itself had side effects. These include memory deficits and other cognitive issues as well as muscle deconditioning and impaired physical function. These effects can be long-lasting.

ICU Liberation

The recent ICU liberation movement’s goal is to improve the care ICU patients receive and minimize their side effects, both physical and mental. Part of this initiative is to limit sedation and encourage exercise as soon as possible.

We’ve known for a long time that exercise has benefits. One of which is enhancing sleep. Physical exercise for adult ICU patients has been studied for years, but it was never really investigated for youth due to safety concerns. It was Sapna Kudchadkar who first took the leap to investigate whether or not pediatric ICU patients could benefit from physical activity earlier on in their hospital stay.

She and her team’s catchphrase is “illness doesn’t mean stillness.” The idea is now spreading across the country.

Kudchadkar began the initiative despite doubtful colleagues. It wasn’t about forcing exercise if patients weren’t ready. It was about providing the opportunity of exercise for those patients who could significantly benefit from it. Studies of exercise in Parkinson’s disease, multiple sclerosis (MS), ADHD, and concussion recovery backed up Kudchadkar’s work.

In general, the earlier a patient can begin moving again the better. But there are important safety concerns to keep in mind. That is what Kudchadkar’s first study aimed to uncover. Specifically focused on safety, this study lasted one year and included pediatric patients in the ICU. With positive results, a multi center trial began. This trial is evaluating the effect of exposure to sedatives, mechanical ventilation duration, and the length of time that patients stay in the ICU.

Bicycling

Another study is ongoing at McMaster University. This study is investigating how “in-bed cycling” may aid patients. Used under the guidance of a physical therapist, bike pedals mounted up on a platform can even allow patients who are on life support to move their body. The sessions are usually 30 minutes long, and patients have spoken to the sense of control it brings them and the hope and optimism it supports. Its been implemented at 17 different hospitals across the United States, Australia, and Canada in trial form so far.

The hope is that in the near future bicycles and other initiatives like this will begin to come to fruition, putting patients longterm care as a top priority.

You can read more about this new initiative here.