News/Commentary

By Cheree Cleghorn, Editor

My father, in the recovery area from emergency surgery, was stirring beneath the sheets.

I asked if he were in pain, if he needed anything.

“Nope. I’m just doing foot circles so I won’t lose my muscle tone.”

At the time, I thought, oh, please, spare us, Mr. Athlete. This had been an emergency and he was worrying about that?

As it turns out, he was more right than we knew.

Many patients come out of the hospital weak, requiring time to get their strength back—days, weeks or months.

Years after researchers discovered what has come to be known as “ICU psychosis,” a condition in which the patient became disoriented because they couldn’t tell day from night under constant monitoring, new problems have emerged.

Now a new study suggests than an ICU stay, even a successful one, may have long-term, negative effects.

The researchers are doing a bigger version of my father’s “foot circles” prevention program. They are getting ICU patients up and moving even though they are seriously ill.

This is not easily accomplished but it is being done. Once there is enough information to see if this reduces these newly identified risks, the recommendations for ICU care may change. More research must be done.

Don’t expect this at an ICU near you this week.

New York Times

“…researchers say they are alarmed by what they are finding as they track patients for months or years after an I.C.U. stay. Patients, even young ones, can be weak for years. Some have difficulty thinking and concentrating or have post-traumatic stress disorder and terrible memories of nightmares they had while heavily sedated.

“While patients may be suffering lingering effects from illnesses that landed them in the I.C.U., researchers are increasingly convinced that spending days, weeks or months on life support in the units can elicit unexpected, long-lasting effects.

“So now some I.C.U.’s are trying what seems like a radical solution: reducing sedation levels and getting patients up and walking even though they are gravely ill, complete with feeding tubes, intravenous lines and tethers to ventilators.

“Even a few days in an I.C.U. can be physically devastating immediately afterward, said Dr. Naeem Ali of Ohio State University. In a recent study, he and colleagues at three other universities reported that 25 percent of patients who had spent at least five days on ventilators could not use their arms to raise themselves to sitting positions. Many could not push back against a researcher’s hand.”

Source:  New York Times, January 12, 2009 (Print edition)