Early Active Exercise

Approximately 13–20 million people receive treatment in ICUs worldwide annually; in New Zealand that number sits around 40,000. Patients receiving invasive mechanical ventilation, also known as ‘life support’ are typically confined to bed rest with no active exercise. As technology and science evolve, more patients are surviving episodes of critical illness who once would have died.

The weakness that develops in ICU patients can affect the ability to walk and perform simple activities like washing and using the toilet without assistance. This weakness can sometimes persist for many years or even last for the rest of a person’s life.

Active exercise is a form of physiotherapy in which the patient is encouraged to use their muscles and includes activities ranging from movement in bed to walking independently. Early active exercising often begins as early as 24-48 hours after arrival in ICU.

The TEAM trial compared the effect of early active exercise with usual care on recovery in adults on life support in ICUs. The study showed that there was no significant difference in the number of days alive and out of hospital between those who received early active physiotherapy and those who received the usual care level of in-ICU mobilisation.

Early active physiotherapy did not reduce the risk of functional impairment or impaired quality of life due to weakness at six months. Adverse events such as arrhythmia and low blood pressure were also more common in the early active exercise group. These findings are important because they will prevent patients receiving a treatment that does not benefit them and can cause harm.

Intravenous fluid therapy is one of the most commonly used treatments in patients who are acutely ill. Every day millions of litres of intravenous fluid are administered to patients all around the world. Whether to use saline or balanced crystalloids for such fluid therapy has long been a subject of debate. Collaborative research with the MRINZ has resolved this long-standing debate and has demonstrated that using balanced crystalloids reduces the risk of dying for almost all critically ill patients. Importantly it also showed that balanced solutions should not be used in patients with traumatic brain injuries.

— PROFESSOR SIMON FINFER, PROFESSORIAL FELLOW CRITICAL CARE DIVISION AT THE GEORGE INSTITUTE FOR GLOBAL HEALTH AND CHAIR OF CRITICAL CARE, SCHOOL OF PUBLIC HEALTH, IMPERIAL COLLEGE LONDON