Magnitude and time course of physical deconditioning in severely injured or critically ill patients; A clinimetric evaluation

Patients stay at an intensive care ward for support of their vital functions.
In most cases patients need mechanical ventilation and intensive monitoring of
vital functions after severe trauma, sepsis, multiple organ failure, after
cardiac surgery, infection (multi organ failure), primary and secondary
pulmonary insufficiency and spinal cord injury. Since these patients are not
stable their vital situation may change quickly and therefore they need
intensive monitoring and care. Bed rest is a commonly prescribed activity
restriction among patients in the ICU. Although bed rest may promote rest,
recovery and safety, inactivity related to bed rest also may lead to
complications and adverse outcomes. In the period that patients are bedridden
there is a quick loss of physical condition with a decrease of muscle power and
capability to move (Winkelman 2007). In combination with inflammatory diseases,
the neuromuscular abnormalities culminating in skeletal muscle weakness are
even more pronounced (Deem 2006, Ferrando et al 2006), in combination with
SIRS (Systemic Inflammatory Response Syndrome) critical illness polyneuropathy
may develop in 20% to 50% of patients in major ICU*s (Bolton 2005).
Furthermore, critically ill patients become more susceptible for tromboembolic
complications, pneumonia and pressure ulcers (Robson et al 2003). It is known
from studies that even in healthy volunteers 2 weeks of bed rest results in a
reduction of muscle size, length and strength (Mulder et al 2006, Akima et al
1997). In cases of inactivity it has been shown that the muscle architecture
shifts from slow twitch (aerobic) to fast twitch (anaerobic) fibres so that
after the bed rest subjects lose endurance capacity (Gallagher et al 2005,
Bigard et al 1998). Researchers in our own group found that bed rest causes a
deterioration of the shape of the cardiovascular system (De groot et al 2006)
and induces a reduction of blood vessel diameters (Bleeker et al 2004 and
2005). Patients with a major trauma or critically illness will lose even more
since they are often in catabolic conditions caused by wounds and inflammation.
In addition, bedridden patients on intensive care units become frequently
mentally disturbed. They lose their sense of day and night and they are exposed
to an environment that is frightening with surrounding noises all day and night
(Walder et al 2007). Patients that stay longer than 1 week on an intensive care
have 50% chance to come into a state of delirium that is called intensive care
psychosis (Ouimet et al 2007, Pandharipande 2005, 2006).
The current management to counteract this physical and mental deterioration
consists of single daily physiotherapy sessions of approximately 20 min. This
intensity of training is not sufficient to counteract above-mentioned negative
physiological processes. Early and more intensive physical training is needed.

Before a countermeasure or training can be developed to counteract physical
deconditioning it is important to investigate more in detail the magnitude and
time course of physical deconditioning and to investigate which outcome measure
is most indicative for physical deconditioning In this study we will
investigate the size of the population on an intensive care ward of an academic
hospital that is at risk of physical deconditioning. In addition we will
investigate the extent and time course of physical deconditioning.

prospective clinometric evaluation

Al measurements are non-invasive. The burden for each patient is the physical
examination and measurement of condition.