Related Conditions

Prolonged ICU-stays and Orthostatic Intolerance

"Orthostatic Intolerance is a common consequence of bed rest."¹ There are many changes in the body as it adapts to bed rest. (See Prolonged Bedrest and Prolonged Bedrest and OI) Low blood pressure with standing or sitting up can lead to a cycle of less activity and more body changes from bedrest (deconditioning). It becomes a downward cycle.

In the last few years, there has been more attention being paid to the effect of long ICU-stays on people. There are studies reporting what happens to people in the years after being in the ICU – how it affects their lives, how much they recover or don’t recover^1-5. 

Those who survive a prolonged stay in an ICU often have limitations in their ability to function every day (functional ability) and in their thinking (cognitive).that last long after they go home from the hospital.¹ The prolonged effect is more likely to be present in those people who were in the ICU between 7 and 30 days.

History of Bedrest and Hospitals

Doctors have known that being on bedrest in the hospital or at home for even a week “deconditions” a person but bedrest was still recommended in the hospital, and even for people with orthostatic hypotension.  The rule of thumb was for every 1 day of bedrest, it takes 5 days to recover. In fact, in the early 80's, people who had open heart surgery were kept in the ICU for days and in the hospital for a couple of weeks.  They didn’t get up for a day or two.  Now, they sit up the first day, are out of the ICU in hours and are out of the hospital in days! The same things happens with of surgeries now.

Long-term Effects After Prolonged ICU Stays

The effects of prolonged bedrest are described in more detail in Prolonged Bedrest and Prolonged Bedrest and OI. However, there are some effects that happen more often in person who also were on a ventilator and received different medications used to treat them while they were in the ICU.

Cognitive Effect: Many experience continued memory problems and a decrease in their ability to solve problems.¹> They may have more problems because of medications used for sedation while in the ICU especially on ventilators. If a person had delirium (not knowing where they are, what is going on, what day it is) during the ICU stay, it has been linked to more problems afterward.

Recovering from ICU Stays

In addition to the issues with their primary problem, often ARDS (Acute Respiratory Distress Syndrome), they have multiple other problems like muscle atrophy, nerve damage, memory problems and disruption of their circadian rhythm. Many of these problems can be related to the effects of bedrest and deconditioning on the body. This has become a national priority in Australia^6-8 and the US⁹!

 The research is looking at 2 things:

    1)    things to do that would help people recover including outpatient rehab programs^6-8 and

     2)   ways to prevent or limit how deconditioned people become. For example, use of passive exercising and walking patients while they are still on a ventilator^3,4

If you have had a long ICU stay, could you have orthostatic intolerance?

If you had a prolonged ICU stay, there is a good chance that some of the challenges you have had in recovering your physical stamina are due to an orthostatic problem.

You might want to review some of the information provided and then speak with your doctor about your findings.

Take a look at the topics in the menu and follow your own curiosity.

Otherwise, start with Do I have OI? and Symptoms of Orthostatic Intolerance?

If you have questions you would like us to research on the topic, please let us know. Ask Us

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Author's Note: We will be exploring the type of exercise programs/movement they are using with the ICU patients to prevent long-term problems to see what might help those confined to bed at home. We will be looking for practical things to reduce the impact bedrest has when it is necessary.

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References

1. Winkelman, Chris RN, PhD, CCRN ACNP.   Bed Rest in Health and Critical Illness: A Body Systems Approach. AACN Advanced Critical Care: 2009; 20(3); 254-266. Abstract.
2. Herridge MS.  Legacy of intensive care unit-acquired weakness.Crit Care Med. 2009 Oct;37(10 Suppl):S457-61. Abstract.
3. Brower, RG.  Consequences of bed rest. Crit Care Med. 2009 Oct;37(10 Suppl):S422-8.Abstract.
4. Winkelman C, Johnson KD, Hejal R, Gordon NH, Rowbottom J, Daly J, Peereboom K, Levine AD.  Examining the positive effects of exercise in intubated adults in ICU: A prospective repeated measures clinical study. Intensive Crit Care Nurs. 2012 Mar 27. [Epub ahead of print] Abstract.
5. Combes A, Costa MA, Trouillet JL, Baudot J, Mokhtari M, Gibert C, Chastre J.   Morbidity, mortality, and quality-of-life outcomes of patients requiring >or=14 days of mechanical ventilation. Crit Care Med. 2003 May;31(5):1373-81. Abstract.
6. Elliott D, McKinley S, Alison J, Aitken LM, King M, Leslie GD, Kenny P, Taylor P, Foley R, Burmeister E.   Health-related quality of life and physical recovery after a critical illness: a multi-centre randomised controlled trial of a home-based physical rehabilitation program.Crit Care. 2011 Jun 9;15(3):R142. Abstract.
7. Denehy L, Berney S, Skinner E, Edbrooke L, Warrillow S, Harthorne Graeme and Morris ME.   Evaluation of exercise rehabilitation for survivors of intensive care: Protocol for a single blind randomized controlled trial.The Open Critical Care Medicine Journal 2008; 1: 39-47.
8. Berney S, Haines KJ, and Denehy L.   Physiotherapy in Critical Care in Australia. Cardiopulmonary Physical Therapy Journal. 2012; 23(1):19-25.
9. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, Zawistowski C, Bemis-Dougherty A, Berney SC, Bienvenu OJ, Brady SL, Brodsky MB, Denehy L, Elliott D, Flatley C, Harabin AL, Jones C, Louis D, Meltzer W, Muldoon SR, Palmer JB, Perme C, Robinson M, Schmidt DM, Scruth E, Spill GR, Storey CP, Render M, Votto J, Harvey MA. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conferenceCrit Care Med. 2012 Feb;40(2):502-9.Abstract.
10. Angel MJ, Bril V, Shannon P, Herridge MS.  Neuromuscular function in survivors of the acute respiratory distress syndrome. Can J Neurol Sci. 2007 Nov;34(4):427-32.Can J Neurol Sci. 2007 Nov;34(4):427-32. Abstract.
11. Fletcher SN, Kennedy DD, Ghosh IR, Misra VP, Kiff K, Coakley JH, Hinds CJ.Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illness. Crit Care Med. 2003 Apr;31(4):1012-6. Abstract