Case Western Reserve University Study to Help Patients on Ventilators Put Some Muscle into Recovery

Few people have thought about providing an exercise regimen in the intensive care unit, especially for patients on ventilators, but a researcher from the Frances Payne Bolton School of Nursing at Case Western Reserve University will be doing some bedside coaching to get patients stretching and flexing their muscles.

Chris Winkelman, assistant professor of nursing, will study the benefits of a range of exercises for people who are bed-bound-awake or comatose-and hooked to ventilators for breathing to see if the routines improve their physical and mental health.

"No one likes to be sick and stay in bed," Winkelman said. "It feels good when you are healthy to exercise, and we think ICU patients can also benefit from exercising."

Non-ventilated ICU patients are encouraged to get up and start moving around, but it takes longer for those on ventilators. Bed-bound patients who are in the ICU and on assisted breathing for more than five days can experience profound weakness from muscle loss and contraction of unused tendons.

Intensive care patients will be getting some exercise for at least 20 minutes a day during what is called "sedation vacations" —the times when patients are brought out of sedation to assess how well they are doing. Whether patients are comatose, semi-comatose, alert or ready to get out of bed, they will receive a level of exercise that provides some movement to their muscles and tendons to prevent the tightening of the limbs. The idea is a holistic approach in helping a person recover so he or she won't face grave physical challenges after overcoming the medical ones.

Half of the 99 ICU patients that Winkelman will study at University Hospitals Case Medical Center will exercise during one wake period and the other half will exercise twice: when awake a second time or during a sedated time, depending on how well the patient is recovering.

The research team will also take blood samples and test for biomarkers such as IL-6, IL-10 or C-reactive protein (CRP) that measure for levels of inflammation. Winkelman plans to see if exercise lowers inflammation systematically, and if so, will provide evidence of the positive impact of exercising while recovering.

Funds for the two-year, $250,000 National Institute of Nursing Research study titled "Dose of Early Therapeutic Mobility: Does Type and Frequency Matter?" come through the American Recovery and Reinvestment Act and will enable Winkelman to hire three research nurses to conduct exercise sessions with the ICU patients.