A Tactic to Cut I.C.U. Trauma: Get Patients Up

[groovedaddy]

For years, doctors thought they had done their jobs if patients came out of an intensive care unit alive.

Now, though, 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.

http://www.nytimes.com/2009/01/12/health/12icu.html?th&emc=th

[crikkett]

1. That gave me a disturbing mental image.

:hi:

[kickysnana]

2. This is nuts. Anybody who can get up already gets up.

All this will do is torture the people worse and make them weaker.

Last January they got my Mom up to "walk" the day she could stand three days after collapsing with respiratory failure end stage COPD. However they had her on an EMPTY oxygen container (valve was defective) and when she was failing they kept urging her to try again.

Then they insisted, despite my objections, that she was well enough to be transferred to a nursing home that same day. The lung doctor told us that same day she had up to 5 years to live but, surprise, she collapsed and died at the nursing home.

NOBODY informs hospitals of outcomes. Until I wrote a formal letter of complaint they had NO IDEA SHE HAD DIED.

The insurance company writes this shit as policy.

[grasswire]

3. this sounds profit driven to me

Insurers want people out of ICU, apparently. Bastards.

[Horse with no Name]

4. There have been things that I have seen. The first being ICU Psychosis

It has to do with the actual setup of the ICU. It turns sane people into psychotic messes. There are several reasons. First of all it is never dark in ICU. Full bright lights. Patients who are in varying degrees of consciousness lose track of day and night because it is the same routine 24/7. Most patients are assessed and medicated every couple of hours.
The other is the ones that are intubated that are kept sedated. In pediatric patients...keeping them sedated is paramount to healing...however, many have to be weaned off of methadone when they leave the unit. Adults are generally just weaned off the machines and not so much off of the medications.
I can see PTSD being something that could occur here. I just never thought of it.

[mopinko]

5. makes sense to me. they certainly have found it to be true in post-surgery

patients. several years ago, i doubt that anyone would have recommended having someone who had broken 3 vertebrae in his neck to get out of bed, but that is what they did with my brother. he recovered very well. same thing after my double disc fusion.
and for that matter, after having a baby. when my oldest sister was born, it was accepted wisdom that moms stay in bed for 10 days. they didn't even get her up to go to the bathroom. when she got home and tried to walk around, she couldn't. it sure ain't like that any more.

[uppityperson]

6. Having worked in ICUs, I can see a reason for this.

Get them some stimulation beyond ICU noises, getting them up can help prevent pneumonia from laying down too long and not fully aerating lungs. Even standing up a couple times a day can help someone (literally) get their feet back under them faster.

[TwilightGardener]

7. I am of two minds on this, having been an ICU nurse.

There is a very strong push to get patients out of bed quickly, especially after surgery--we sat our fresh uncomplicated open-hearts up about 4-6 hours post-op, even got them to stand up on a scale or got them into a chair. It's good for them--reduces post-op complications. Getting people moving as soon as possible, in general, seems to be the best principle. However, increasing somebody's cardiac-output and oxygen demands and causing blood-pressure shifts (by getting them up and moving) may not be a good idea, depending on what's wrong with them. Plus, now you've got at least one nurse and an aide and possibly a respiratory therapist tied up for quite a while, no different than having to take a critical patient to MRI or CT (a giant and risky pain in the ass with many ICU patients), and the very real possibility of something going wrong with the patient while walking--doctors love this shit because they simply order it and walk away, and it sounds great in the abstract, but they're not the ones who are actually repsonsible for running the circus and ensuring the patient's safety.