Bed Rest Syndrome

Cardiovascular system

Increased resting heart rate

Venous thrombosis

Early increased cardiac stroke

Respiratory system

Reduced tidal volume

Potential permanent restrictive pulmonary disease due to fixed contractures of the costovertebral joints

Reduced FVC and FEV1

Loss of elastic recoil as a result of structural changes within the lungs

Tendency for mucus to pool in the lower part of the airway

Collapse of airways and small areas of lung tissue (atelectasis), which reduces the area available for gaseous exchange

Musculoskeletal system

Atrophy of postural muscles, leading to an increased risk of falls and disability [15]

Reduction of bone mass in the spine and lower limbs

Gastrointestinal system

Decreased gastric bicarbonate secretion and increased acidity within the stomach

Symptoms associated with gastroesophageal reflux disease (GERD)

Increased transit time and constipation

Urinary system

Release of ANP and increased diuresis

Transient increase in plasma and urinary urea, a decrease in plasma creatinine, and no change in urinary creatinine

Rise of urinary calcium excretion

Incomplete emptying and urinary stasis, due to weakened abdominal and pelvic floor musculature

Renal and bladder stones and infections


Higher risk of pressure sores

Endocrine system

Depressed levels of aldosterone and antidiuretic hormone

Sodium loss during diuresis and hyponatremia with subsequent increased plasma renin activity and increased plasma aldosterone levels

Progressive loss of potassium in the urine due to aldosterone secretion

Increased cortisol secretion, onset of insulin resistance, impaired glucose tolerance, and the subsequent development of type 2 diabetes

Central and peripheral nervous system

Dysfunctions in mental status (confusion, sleep disorders, drowsiness)

Difficulties in posture and balance in sitting and standing position

Development of polyneuropathies

8.2 Prevention of Bed Rest Syndrome

Patients in the intensive care unit (ICU) could be the paradigm of the management of bed rest via mobilization. They are often sedated, critical/frail patients, with obvious difficulty in changing position, sitting or walking. Immobilization in complex patients in the ICU, together with systemic inflammation, is a strong independent risk factor for the development of intensive care unit-acquired weakness (ICUAW) [9].

Evidence indicates that functionally significant joint limitations are shown by more than a third of patients admitted to ICU for over 2 weeks.

It is noteworthy that enough damage to create the basis for a decubitus ulcer is done after as little as 2 h of immobility. Susceptibility to pressure ulcers comes from a combination of external factors (pressure, friction, shear force, and moisture) and internal factors (e.g., fever, malnutrition, anemia, and endothelial dysfunction).

Although a few years ago, early physical rehabilitation of critically ill patients was considered unsafe, in the last decade growing literature has shown the safety and feasibility of mobilizing ICU patients to prevent impairments, adverse events, in-hospital infections, and functional limitations [10].

In order to address these aspects, components of the ABCDE bundle include: Awaken from sedation, Breathe independently without a ventilator, Choice of sedation, Delirium management, and Early mobilization [11].

While preliminary data regarding early mobilization of ICU patients has been shown to be safe, feasible, and beneficial, in one multicenter, observational Italian study, postural changes and early mobilization were prescribed in about two thirds of the cases, suggesting that these treatments are not yet widely practiced [12].

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Mar 29, 2020 | Posted by in GERIATRICS | Comments Off on Bed Rest Syndrome
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