Does Standard Physical Therapy Increase Quadriceps Strength in Chronically Ventilated Patients? A Pilot Study*

Abstract

Supplemental Digital Content is available in the text.

Physical Rehabilitation in the ICU: Is It Worth the Effort?*

“…Delivery of physical rehabilitation may itself be insufficient. This possibility is supported by the novel observations of Supinski et al (7) who recorded leg electromyograms during exercise in patients requiring prolonged mechanical ventilation. During exercise, electromyogram signals indicated that patients failed to sustain high levels of muscle activation necessary for muscle training, resulting in the waste of large portions of the training sessions.…”

“…The finding that functional exercises did not result in an improvement in physical function compared with controls is intriguing. Several overlapping mechanisms may explain this finding (7). Muscle necrosis or neurotransmission defects, which can occur in critical illness, can lead to reduced excitability of the muscle (4).…”

“…Does the psychological response to physical rehabilitation impact patients’ outcomes? Could improvements in physical function be amplified by monitoring muscle activation using electromyogram recordings during training (7)? These challenges are formidable, but now is the time to tackle them.…”

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“…A potential explanation is that shorter sessions were more intensive with less breaks in-between. Alternatively, repeated muscle activation might be limited in the critically ill leading to early onset of muscle fatigue and patient inactivity [26]. From a training perspective, shorter and more frequent sessions might therefore be preferred to achieve an adequate training response.…”