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Effects of Extended Bed Rest in ICU Immobilization and Inactivity
Corresponding Author(s) : Nihar Ranjan Mohanty
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 12 No. 4 (2024): 2024 Volume -12 - Issue 4
Abstract
Extended bed rest, often a necessity for critically ill patients in Intensive Care Units (ICUs), has traditionally been prescribed to prevent complications, conserve metabolic resources, and ensure patient comfort. Historically, bed rest was considered beneficial for various medical conditions, including acute rheumatoid arthritis flares, cavitary tuberculosis, acute myocardial infarction, and acute low back pain. However, modern research through randomized controlled trials has largely debunked these benefits, revealing that prolonged immobilization can lead to significant adverse effects, thereby complicating recovery processes. This study delves into the extensive impact of prolonged bed rest on multiple physiological systems, emphasizing the severe consequences on muscle integrity, cardiovascular and respiratory functions, endocrine balance, and overall rehabilitation outcomes.
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- Convertino, V. A. Cardiovascular consequences of bed rest: effect on maximal oxygen uptake. Medicine & Science in Sports & Exercise, 1997; 29(2), 191-196.
- Hoppeler, H., Vogt, M. Muscle tissue adaptations to hypoxia. Journal of Experimental Biology, 2001; 204(18), 3133-3139.
- LeBlanc, A. D., Schneider, V. S., Evans, H. J., Engelbretson, D. A., & Krebs, J. M. Bone mineral loss and recovery after 17 weeks of bed rest. Journal of Bone and Mineral Research, 1990; 5(8), 843-850.
- Paddon-Jones, D., Rasmussen, B.B. Dietary protein recommendations and the prevention of sarcopenia. Current Opinion in Clinical Nutrition & Metabolic Care, 2009; 12(1), 86-90.
- Gogia, P. P., Schneider, V. S., LeBlanc, A. D., Krebs, J. M., Kasson, C., & Pientok, C. Bed rest effect on extremity muscle torque in healthy men. Archives of Physical Medicine and Rehabilitation, 1988; 69(12), 1030-1032.
- Trudel, G., & Uhthoff, H. K. Contractures secondary to immobility: is the restriction articular or muscular? An experimental longitudinal study in the rat knee. Archives of Physical Medicine and Rehabilitation, 2005; 86(3), 368-373.
- Beckman, S. M., & Buchanan, T. S. Ankle inversion injury and hypermobility: effect on hip and ankle muscle electromyography onset latency. Archives of Physical Medicine and Rehabilitation, 1995; 76(12), 1138-1143.
- Nicholas, J. A., Hershman, E. B., & Colosimo, A. J. The role of exercise in the treatment of ankle sprains. The American Journal of Sports Medicine, 1976; 4(6), 308-313.
- Topp, R., Ditmyer, M., King, K., Doherty, K., Hornyak, J. The effect of bed rest and potential of prehabilitation on patients in the intensive care unit. AACN Advanced Critical Care, 2002; 13(2), 263-276.
- Hermans, G., & Van den Berghe, G. Clinical review: Intensive care unit acquired weakness. Critical Care, 2015; 19, 274. doi: 10.1186/s13054-015-0993-7.
- Bailey, P., Thomsen, G. E., Spuhler, V. J., etal., Early activity is feasible and safe in respiratory failure patients. Critical Care Medicine, 2007; 35(1), 139-145. doi: 10.1097/01.CCM.0000251130.69568.87.
- Schweickert, W. D., Pohlman, M. C., Pohlman, etal., Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet, 2009; 373(9678), 1874-1882. doi: 10.1016/S0140-6736(09)60658-9.
- Truong, A. D., Fan, E., Brower, R. G., & Needham, D. M. Bench-to-bedside review: Mobilizing patients in the intensive care unit--from pathophysiology to clinical trials. Critical Care, 2009;13(4), 216. doi: 10.1186/cc7885.
- Herridge, M. S., Tansey, C. M., Matté, A., Tomlinson, G., Diaz-Granados, N., Cooper, A., & Canadian Critical Care Trials Group. Functional disability 5 years after acute respiratory distress syndrome. New England Journal of Medicine, 2011; 364(14), 1293-1304. doi: 10.1056/NEJMoa1011802.
- Needham, D. M., Davidson, J., Cohen, H., Hopkins, R. O., Weinert, C., Wunsch, H., Harvey, M. A. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders' conference. Critical Care Medicine, 2012; 40(2), 502-509. doi: 10.1097/CCM.0b013e318232da75.
- Hodgson, C. L., Berney, S., Harrold, M., Saxena, M., Bellomo, R., & Davidson, B. Clinical review: Early patient mobilization in the ICU. Critical Care, 2013; 17, 207. doi: 10.1186/cc11820.
- Thomas, P., Baldwin, C., Bissett, B., Boden, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. Journal of Physiotherapy, 2020; 66(2), 73-82. doi: 10.1016/j.jphys.2020.03.011.
- Winkelman, C. Inactivity and inflammation in the critically ill patient. Critical Care Clinics, 2009; 25(3), 439-458. doi: 10.1016/j.ccc.2009.04.001.
References
Convertino, V. A. Cardiovascular consequences of bed rest: effect on maximal oxygen uptake. Medicine & Science in Sports & Exercise, 1997; 29(2), 191-196.
Hoppeler, H., Vogt, M. Muscle tissue adaptations to hypoxia. Journal of Experimental Biology, 2001; 204(18), 3133-3139.
LeBlanc, A. D., Schneider, V. S., Evans, H. J., Engelbretson, D. A., & Krebs, J. M. Bone mineral loss and recovery after 17 weeks of bed rest. Journal of Bone and Mineral Research, 1990; 5(8), 843-850.
Paddon-Jones, D., Rasmussen, B.B. Dietary protein recommendations and the prevention of sarcopenia. Current Opinion in Clinical Nutrition & Metabolic Care, 2009; 12(1), 86-90.
Gogia, P. P., Schneider, V. S., LeBlanc, A. D., Krebs, J. M., Kasson, C., & Pientok, C. Bed rest effect on extremity muscle torque in healthy men. Archives of Physical Medicine and Rehabilitation, 1988; 69(12), 1030-1032.
Trudel, G., & Uhthoff, H. K. Contractures secondary to immobility: is the restriction articular or muscular? An experimental longitudinal study in the rat knee. Archives of Physical Medicine and Rehabilitation, 2005; 86(3), 368-373.
Beckman, S. M., & Buchanan, T. S. Ankle inversion injury and hypermobility: effect on hip and ankle muscle electromyography onset latency. Archives of Physical Medicine and Rehabilitation, 1995; 76(12), 1138-1143.
Nicholas, J. A., Hershman, E. B., & Colosimo, A. J. The role of exercise in the treatment of ankle sprains. The American Journal of Sports Medicine, 1976; 4(6), 308-313.
Topp, R., Ditmyer, M., King, K., Doherty, K., Hornyak, J. The effect of bed rest and potential of prehabilitation on patients in the intensive care unit. AACN Advanced Critical Care, 2002; 13(2), 263-276.
Hermans, G., & Van den Berghe, G. Clinical review: Intensive care unit acquired weakness. Critical Care, 2015; 19, 274. doi: 10.1186/s13054-015-0993-7.
Bailey, P., Thomsen, G. E., Spuhler, V. J., etal., Early activity is feasible and safe in respiratory failure patients. Critical Care Medicine, 2007; 35(1), 139-145. doi: 10.1097/01.CCM.0000251130.69568.87.
Schweickert, W. D., Pohlman, M. C., Pohlman, etal., Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet, 2009; 373(9678), 1874-1882. doi: 10.1016/S0140-6736(09)60658-9.
Truong, A. D., Fan, E., Brower, R. G., & Needham, D. M. Bench-to-bedside review: Mobilizing patients in the intensive care unit--from pathophysiology to clinical trials. Critical Care, 2009;13(4), 216. doi: 10.1186/cc7885.
Herridge, M. S., Tansey, C. M., Matté, A., Tomlinson, G., Diaz-Granados, N., Cooper, A., & Canadian Critical Care Trials Group. Functional disability 5 years after acute respiratory distress syndrome. New England Journal of Medicine, 2011; 364(14), 1293-1304. doi: 10.1056/NEJMoa1011802.
Needham, D. M., Davidson, J., Cohen, H., Hopkins, R. O., Weinert, C., Wunsch, H., Harvey, M. A. Improving long-term outcomes after discharge from intensive care unit: Report from a stakeholders' conference. Critical Care Medicine, 2012; 40(2), 502-509. doi: 10.1097/CCM.0b013e318232da75.
Hodgson, C. L., Berney, S., Harrold, M., Saxena, M., Bellomo, R., & Davidson, B. Clinical review: Early patient mobilization in the ICU. Critical Care, 2013; 17, 207. doi: 10.1186/cc11820.
Thomas, P., Baldwin, C., Bissett, B., Boden, et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. Journal of Physiotherapy, 2020; 66(2), 73-82. doi: 10.1016/j.jphys.2020.03.011.
Winkelman, C. Inactivity and inflammation in the critically ill patient. Critical Care Clinics, 2009; 25(3), 439-458. doi: 10.1016/j.ccc.2009.04.001.