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Braeunig J.1, Ellger B.2, Gottschalk A.2
1University Hospital Muenster, Department of Physiotherapy, Muenster, Germany, 2University Hospital Muenster, Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Muenster, Germany
Background: Early goal-directed physiotherapy (EGDP) takes an important position in the promotion of critically ill patients. Focus lies on the reduction of secondary complications (pneumonia, contractures, decubiti) and the improvement of the functional prognosis. Also for patients on extracorporeal cardiac life support (ECLS) early rehabilitative interventions appear to be meaningful. It cannot be expected that the prognosis of the basic/underlying condition can be improved, but it is to be conjecturable that secondary complications can be avoided and rehabilitation be improved.
Purpose: During an application observation it was examined whether patients treated with a structured physical therapy algorithm already benefit under ECLS up to the point of complete mobilization and whether these interventions accompanied by risks and complications.
Methods: During an observation period of 6 months, 29 consecutive patients under constant veno-arterial ECLS-therapy (indication became: cardiogenic shock, post-pump failures) were submitted to an early, standardized and active physical therapy in accordance with a simple algorithm. The patients received analgesia as required and were not continuously sedated (aim: alert, cooperative patient). Depending upon stage of the condition and clinical necessity, artificial or spontaneous respiration took place via endotracheal tube, nasotracheal tube or via naturalis. The algorithm covered specific, condition-dependent physical therapy goals including exercise treatments in upside-down position or at bedside, transfer-training and active locomotion-training up to the walking in the room. Intensity was increased in stages but continuously on the basis of the specific algorithm. Even after weaning from ECLS the therapy was continued in accordance with the algorithm. Patients who were treated at our hospital before the implementation of the algorithm served as the control group.
Results: Lethality (45%) did not differ in both groups. The ECLS-period spent with the patients of the experimental group with on the average 8 days, was significantly lower with 12 days difference than in the control group with on the average 20 days (p=0.02). There were no complications, such as dislocation of the cannulas, bleedings, thrombo-embolisms or cardiovascular- insufficiencies.
Conclusion(s): Even in high risk patients under ECLS therapy an EGDP is a safe therapy option. It requires professional interaction from an interdisciplinary team able to perform a low-risk and safe handling of transfers.
Implications: Whether physical therapy can improve the (functional) outcomes for this patient group in the long term is at present the subject of further study.
Funding acknowledgements: [1]_Rehder_KJ_et_al._Respir_Care_2013;Aug. 58(8):1291-8,
[2]_Rahimi_RA_et_al._Phys_Ther_2013; Feb. 93(2):248-55,
[3]_Lowman_JD_et_al._Cardiopulm_Phys_Ther_J._2012; Mar. 23(1):30-5,
[4]_Thiagarajan RR_et_al._J_Pediatr_Rehabil_Med. 2012; 5(1):47-52,
[5]_Turner_DA_et_al._Crit_Care_Med. 2011; Dec. 39(12):2593-8.
[2]_Rahimi_RA_et_al._Phys_Ther_2013; Feb. 93(2):248-55,
[3]_Lowman_JD_et_al._Cardiopulm_Phys_Ther_J._2012; Mar. 23(1):30-5,
[4]_Thiagarajan RR_et_al._J_Pediatr_Rehabil_Med. 2012; 5(1):47-52,
[5]_Turner_DA_et_al._Crit_Care_Med. 2011; Dec. 39(12):2593-8.
Topic: Critical care
Ethics approval: Ethics Committee of the Medical Association of Westphalia-Lippe and the Westfaelic Wilhelms-University Muenster, Germany
All authors, affiliations and abstracts have been published as submitted.
