Patients Riding Bikes in Bed in the ICU at Johns Hopkins Bayview

“Strict bedrest is probably one of the most dangerous things medicine ever recommended in the history of man.”

June 28, 2018
by Sandra Gordon for ASA

The multidisciplinary team at Johns Hopkins Bayview Medical Center in eastern Baltimore is taking important steps to prevent postoperative delirium, particularly with critically ill patients in the intensive care unit (ICU).

“One of the most important things seems to be reducing the amount of sedation so patients are awake and alert as soon as possible,” says Karin Neufeld, M.D., M.P.H., clinical director of psychiatry. “Making patients very sedated is probably not good for brains because it results in them staying in bed and not moving,” she says. Getting surgical patients awake, even if they’re intubated, to see if they can tolerate the tube without sedation, offers two major benefits for brain function:

• Patients can interact and communicate with the medical team and visitors. “Cognitive stimulation, such as getting people to engage in conversation, play word games, assemble puzzles and write, is associated with delirium prevention and decreasing the severity of delirium as well,” Neufeld says.
• Patient can get out of bed sooner. “Being up and moving is very important for brain function,” Neufeld says. Early mobilization is one of the major sea changes that has occurred in critical care medicine over the last 10 years that is expected to continue. In fact, Neufeld is working with the Society of Critical Care Medicine to implement guidelines for pain, agitation and delirium, to be released in October 2018. “The main impact is that critically ill patients don’t lie in bed for any period of time. Within 24 hours, they should be getting mobilized or at least doing rehab,” Neufeld says.

Encouraging Patient to Exercise Their Options

To get patients in the ICU, orthopedics and the cardiac surgery unit moving around within 24 hours, Johns Hopkins Bayview physical therapists encourage them to walk to prevent delirium or reduce its severity. “In the ICU, sometimes we see very delirious patients. When physical therapists get them up and walking, it’s interesting to see how much better and more alert they look,” Neufeld says.

Patients who physically can’t get out of bed have options. They can use a supine bicycle in bed to help restore mobility. They can also participate in “Wii-hab,” playing Wii games on the Nintendo Wii gaming console, such as virtual bowling. Once patients regain some mobility “we want to get them out into the sunshine,” Neufeld says.

Overall, “strict bedrest is probably one of the most dangerous things medicine ever recommended in the history of man,” Neufeld says. “Getting people up and moving is one of the biggest advances in the prevention of postoperative delirium. It means you can’t give them medicines to make them sleepy. They have to be awake and alert.”

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