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ORIGINAL ARTICLE
Year : 2020  |  Volume : 14  |  Issue : 2  |  Page : 74-79

Effect of early mobility in mechanically ventilated patients with myasthenia crisis on duration of mechanical ventilation and length of intensive care unit stay


1 Neuro-Physiotherapy Unit, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
2 Department of Therapies and Health Sciences, Manav Rachna International University, Faridabad, Haryana, India
3 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Dr. Shikha Chauhan
(PT), 14 Carmine Drive, Wappingers Falls, NY 12590
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/PJIAP.PJIAP_40_20

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BACKGROUND: Myasthenia crisis (MC) requires mechanical ventilation (MV) which, if prolonged, may lead to multisystem complications. Early mobility, a potent modality, remains underutilized in critically ill patients with neuromuscular diseases. METHODOLOGY: A prospective, pretest–posttest control group study was conducted on thirty mechanically ventilated patients with MC in intensive care setup in a tertiary care teaching hospital. They were randomly divided into experimental group and control group. Both the groups received standard medical care, chest physiotherapy, range of motion exercises, and nursing care. In addition, the experimental group received strengthening exercises for extremities and progressive mobilization to sitting at bedside, standing, marching, and walking at bedside till the patients were transferred to ward. Duration of ventilation, length of intensive care unit (ICU) stay (LOS), and adverse events were recorded. Independent t-test was used to compare the difference between two groups. RESULTS: Out of thirty patients, 15 were randomly divided into each group using a sealed envelope method. One participant in experimental group and three in control group could not be weaned off and were tracheostomized at 3 weeks. An intent to treat analysis was done for duration of ventilation (n = 30). A total of 16 ± 4.32 exercise sessions were given in experimental group. Duration of ventilation (8.93 ± 3.95 vs. 13.31 ± 4.71 days; 95% confidence interval [CI] −7.63 to − 1.13, P = 0.011) and LOS (10.48 ± 2.47 vs. 14.26 ± 3.35 days; 95% CI − 6.22 to − 1.34, P = 0.004) were significantly lower in experimental group as compared to the control group. Relative risk reduction of failure to wean off or need for tracheostomy in early mobility group was 67%. Number needed to treat for the prevention of tracheostomy was 8. CONCLUSION: Early mobilization of mechanically ventilated MC patients is feasible and leads to decrease in the duration of MV, thereby decreasing the length of ICU stay.


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