Hospital ICU Over-utilization Impairs Patient Outcomes

Hospital ICU Over-utilization Impairs Patient Outcomes. Patients end up being admitted in the Intensive Care Unit (ICU) following critical and life threatening situations such as illness, injuries and surgery that require careful monitoring by doctors and nurses, and specialized support from highly trained specialists such as Anesthetics. The ICU is meant to support the patient’s health until the patient recovers to a certain degree that the body can support its own normal physical abilities like breathing on its own, normal cardiac functioning and at least normal healing ability. However, prolonged stay in the ICU may have permanent or semi-permanent effects on the overall patient’s quality of life, including cardiac issues.

First of all, the body’s inability to comprehend its own health threats, such as critical injury, to a point that it requires life support, will definitely have an effect to the normal bodily functions in the long run. The conscious part of the mind, is most often in an “offline” mode. Only the subconscious part of the mind is functional at the time The two are meant to work hand in hand, but with the conscious acting as the pilot. The subconscious only kicks in when the conscious has gone into a natural rest-phase, such as when you go to sleep. Therefore, a situation in which the conscious goes into a relatively non-natural rest-phase, like medical sedation or an unconscious state owing to injury or such life threatening conditions, alters the normal working mechanism of the mind and body in general. This will have a substantial effect to the body even after recovery.

Hospital-Patient

Recent study shows that contrary to what medical practitioners thought, sedation and bed rest in an intensive care unit may have negative effects in the long-term. Associate Medicine Professor from Johns Hopkins University School of Medicine and Senior Author of the Critical Care Medicine, Dr. Dale M. Needham, M.D., Ph.D., conducted a research on the matter and discovered that for every bed rest in the ICU, the patient’s muscle strength dropped between 3% and 11% over the following months and years. In his book, Critical Care Medicine, he stated, “We previously thought that bed rest and sedation in the ICU was helpful to patients, but now findings project that this approach to care is harmful to the long-term recovery”. More study shows that these long-term recovery effects have implications on their health such as muscle wasting, poor mobility, polyneuropathies and Cardiac issues. Here is a detailed breakdown of each.

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Muscle Wasting:

 

Research by medical practitioners and medical professors gave findings that the duration in which patients stayed under sedation and bed rest in the ICU had overall effect on their muscle health. Patients in the intensive care unit lose an average of 2% of their muscle mass every 24 hours. The muscle tissues grow and maintain mass due to constant everyday use Just as working out at the gym increases muscle mass, the reverse is true when a muscle is not put into use.

 

Patients can end up losing as much as 50% of their total muscle mass during their stay. This is one of the reasons why patients waking up from long periods of sedation and bed rest in the ICU feel overall body weakness. Regaining such muscle mass may take long, and in some cases, may require physiotherapy to aid muscle recovery. That is why it is advised that patients stay a medically-necessary amount of time in the intensive care unit. As soon as the patient is deemed strong enough to survive without the life support, the mind should be allowed to take over and manage recovery on its own.

 

Poor Mobility:

 

Muscle wasting leads to an overall weakening of the affected muscle. Prolonged or over-utilization of the ICU impairs the patient’s muscular functioning. In severe cases, deteriorated muscle is unfit to support the skeletal structure that connect it through the tendons. Take for instance, the human leg. A health effect from over-utilization of the ICU leads to poor mobility of the leg muscles. The patient needs to regain the wasted muscle, regain strength and hopefully learn how to use his or her own legs to walk again. In most severe cases, physiotherapy is recommended to achieve overall muscular normal functioning and restore normal mobility.

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Cardiac Implications:

 

It is clear how over-utilization of the intensive care unit leads to muscular waste and in turn, poor mobility. This also has implication on the patient’s cardiac health as the heart is also a muscular organ. The ventilation and monitoring machines keep the heart beating. Since the body is too weak to assume normal cardiac functioning, it renders this right to the life support system. Prolonged stay at the ICU, though necessary for the patient’s survival, may lead to weakening of the cardiac muscles and in the long run, subject the patient to more cardiac related risks like cardiac arrest.

 

It is advised that everything possible is done to ensure the patient’s health recovers as soon as humanly possible to avoid prolonged and over-utilization of the ICU. This is because the sooner the patient’s health improves to a certain degree that it can assume recovery without the life support, the sooner the mind assumes control and works out the cardiac muscle. Weak cardiac muscle pose a greater risk to the patient’s health, especially in cases where the patient has a history of cardiac complications and high

blood pressure.

 

Polyneuropathies:

 

Polyneuropathies are disorders that affect the motor and sensory nerves in your system. Causes of this are mainly alcoholism, critical illness and diabetes. However, research shows that prolonged sedated bed rest in the ICU accelerates polyneuropathies especially in older patients. Polyneuropathies are closely related to muscular functioning of the body. This explains why muscular wasting accelerates sensory nerves disorders. The mind is responsible for decoding neural receptors of the body. Therefore, patients on life support render this ability to the ICU machines which offer the life support to patients. That is why the patients in a comma cannot perceive pain when pinched or have a knee-jerk reaction when subjected to such a situation. The longer the period a patient stays under intensive care unit, the loner the mind stays free of being in charge of its own sensory peripheral nerves.

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This may cause permanent health damage to its ability to perceive nervous reception. In some cases, it was observed that patients left with muscle weakness also developed prolonged reduced sensory function. The symptoms are evident even as far as a year since the critical illness that led to prolonged stay in the ICU. In the long run, the mind may have to learn to decode the sensory peripheral nerves signals, as the patient recovers muscle mass.

 

Conclusion:

 

The Intensive care unit is a necessary evil, critical for patient’s survival. As much as its good over weighs its bad, care and more medical research should be taken to ensure over-utilization of the ICU is minimized.

 

Author Bio:

Sathya Kumar is the Founder & CEO at Techindia Infoway Pvt Ltd., Chennai. Techindia is Asia’s largest provider of healthcare management solutions for sleep scoring services, exceptional remote healthcare diagnostics and cardiac rhythm interpretation services, with a proven track of high performance for highly regulated healthcare industries and for the patients globally.

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