Statistically speaking, everybody will be admitted and treated in a hospital at some point in their lives. Most of the people admitted go to a regular ward and will be able to recall the daily routine, but what about the small percentage of people that go to an intensive care unit (ICU)?
They will most likely not be able to answer questions such as: What is the daily routine? How is an ICU-ward set up? Furthermore, they will not have the opportunity to get a coffee or take a walk. The critical question here though is whether these patients are in a good enough condition for their daily routines after they are discharged.
Today’s intensive care medicine allows us to treat patients suffering from life-threatening diseases. Not so long ago, conscious and mobile patients did not fit the daily routine of ICU-treatment. Induced coma, mechanical ventilation or extracorporeal membrane oxygenation were reasons not to mobilize critically ill patients.
Fortunately, the understanding and importance of early mobilization beginning in the ICU is growing and becoming more and more important. Better quality of life and functional independence after hospital discharge does not start after an ICU-stay, but during.
Why would their quality of life be compromised?
The pivotal point is a major organ which most people would not even define as an organ: skeletal muscle.
Renal failure followed by dialysis as a therapy is familiar to the general public. Lesser-known is muscle failure and its associated disabilities, something most people would first seek help for after being discharged from hospital. Communication, locomotion and self-care are considered natural skills which may be compromised after an ICU-stay. Patients perceive the limitation of these basic abilities as a major setback after discharge.
What´s behind this?
During an ICU-stay, muscle wasting and muscle weakness initially appear without any obvious signs. Inflammatory processes, immobilization and other factors decide whether or not this patient will be able to move even if they are on the road to recovery.
We were able to show in clinical studies that a cardinal part of muscle weakness and muscle loss develops in the early stages of critical illness. Rehabilitation can partially improve this condition, but is not able to reconstitute the pre-critical illness state which would enable the patient to lead an independent and autonomous life.
What are the treatment options?
The treatment of this underlying disease is the foundation for further therapies. Recent studies should encourage every member of ICU-staff to work towards a conscious and mobile patient, who can participate during physical therapy or nurse care and can face cognitive challenges.
But what about patients that must be kept in a medically induced coma, or those who cannot participate in active mobilization due to their clinical condition?
Passive physical and respiratory therapy is better than immobilization but it does not activate the skeletal muscle to prevent muscle loss and weakness. The best way to achieve mobilization is a protocol based approach with different predefined levels of activity, as can be seen in recent clinical trials.
Whole-body-vibration therapy might be an alternative that could be implemented into the overall physical therapy concept.
What is whole-body-vibration?
In the 1960s, astronauts used whole-body-vibration as a tool to counteract the loss of gravity in space and prevent muscle atrophy. The basic concept is to achieve maximal training results through high frequency muscle contractions within a short timeframe.
The concept of whole-body-vibration therapy has been established in rehabilitation care, professional athletics and even in regular gym workouts. Investigations regarding the feasibility of vibrational therapy in the ICU-setting however, are lacking.
Is whole-body-vibration possible in the ICU-setting?
In a clinical trial, we treated ICU-patients with whole-body-vibration therapy to investigate its safety, feasibility and its effect on metabolism. Vibrational therapy is thought to induce high frequency muscle contractions through autonomous reflexes. Our understanding is that these high frequency contractions are a muscle-activating stimulus that could help to preserve muscle mass even in patients not actively participating.
Results of the clinical trial
We have shown that whole-body-vibration can be used safely in critically ill patients and moreover, it stimulates muscle metabolism. Whole-body-vibration is a therapeutic option for the prevention of muscle loss and muscle weakness. Ultimately, we hope to identify the ideal intensity and frequencies as well as the best time point to start whole-body-vibration in the ICU-setting. We can then look forward to having another therapeutic option at hand to help our patients return to a more independent and autonomous life after the discharge.