title: Feasibility and Safety of Physical Therapy during Continuous Renal Replacement Therapy in the Intensive Care Unit.
abstract: Early rehabilitation in an intensive care unit is associated with improved physical functioning and patient outcomes. However, relatively few data have been reported on physical therapy interventions during continuous renal replacement therapy (CRRT) for patients in intensive care units.
  
  
  
  To evaluate the feasibility and safety of physical therapy interventions, delivered as part of routine clinical care, for patients undergoing CRRT in an intensive care unit.
  
  
  
  Consecutive patients in the adult medical intensive care unit of one large tertiary care hospital who received physical therapy sessions while on CRRT were prospectively evaluated over 13 months. Physical therapy sessions were individualized on the basis of patients' physical impairments and activity tolerance, with patients' highest level of mobility recorded. Data on 15 different physiological abnormalities and potential safety events, including bleeding, dislodgement, or dysfunction of the CRRT catheter or circuit, were prospectively collected.
  
  
  
  Eleven physical therapists delivered 268 rehabilitation sessions to 57 patients while they were receiving CRRT, with the following highest levels of mobility achieved during individual sessions: 78 (29%) bed exercises, 72 (27%) supine cycle ergometry, 80 (30%) sitting at edge of bed, 13 (5%) transfer to chair, and 25 (9%) standing or marching in place. No CRRT-specific safety events occurred (0%; 95% upper confidence interval, 6.3%). There were six non-CRRT-related potential safety events (2.2% of all physical therapy sessions; 95% confidence interval, 0.6-8.2%), all of which were transient changes in blood pressure.
  
  
  
  In this prospective observational study at one adult medical intensive care unit, we found that provision of bedside physical therapy while patients underwent CRRT is feasible, and appears safe.
authors.affiliation: 1 Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland.|2 Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Toonstra
authors.affiliation: 1 Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland.|3 Department of Physical Medicine and Rehabilitation.|2 Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Zanni
authors.affiliation: 4 Division of Nephrology, Johns Hopkins University, School of Medicine, Baltimore, Maryland.
authors.forename: C John
authors.initials: CJ
authors.lastname: Sperati
authors.affiliation: 5 Division of Pulmonary and Critical Care Medicine, and.|2 Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Archana
authors.initials: A
authors.lastname: Nelliot
authors.affiliation: 5 Division of Pulmonary and Critical Care Medicine, and.|2 Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Earl
authors.initials: E
authors.lastname: Mantheiy
authors.affiliation: 6 Western Health, Footscray, Victoria, Australia.|7 Department of Physiotherapy, Monash University, Frankston, Victoria, Australia; and.|8 Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Skinner
authors.affiliation: 3 Department of Physical Medicine and Rehabilitation.|5 Division of Pulmonary and Critical Care Medicine, and.|2 Outcomes After Critical Illness and Surgery Group, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Dale M
authors.initials: DM
authors.lastname: Needham
mesh_terms: D058186:Acute Kidney Injury / Q000534:rehabilitation*; D000368:Aged; D001315:Australia; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D061214:Patient Safety; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D062606:Tertiary Care Centers
keywords: acute renal failure; intensive care units; rehabilitation