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Babazadeh M, Jahani S, Poursangbor T, Cheraghian B. Perceived barriers to early mobilization of intensive care unit patients by nurses in hospitals affiliated to Jundishapur University of Medical Sciences of Ahvaz in 2019. J Med Life 2021; 14:100-104. [PMID: 33767793 PMCID: PMC7982251 DOI: 10.25122/jml-2019-0135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Early mobilization (EM) of patients in the intensive care unit (ICU) is a safe, feasible, and beneficial approach. However, the implementation of EM as a part of routine clinical care can be challenging. As a result, the present study aimed to identify the potential barriers to EM of ICU patients. The statistical population of this descriptive-analytical study included 107 critical care nurses working in hospitals affiliated with the Jundishapur University of Medical Sciences of Ahvaz. The participants were selected using the census method among the eligible critical care nurses, and the researcher-made questionnaire was used for data collection. This questionnaire included a demographic questionnaire and an inventory of barriers to EM. In total, 72% of the nurses had a highly positive attitude towards EM implementation, whereas relatively few had a slightly positive attitude. The major human-resource-related barriers included the lack of trained staff (76.6%), inadequate shift nurses (74%), and inadequate time for this procedure (57.9%). Approximately 88.9%, 82.2%, 62%, and 57.9% of the nurses reported coma or a deep degree of sedation, mobilization of obese patients, mobilization of patients with agitation, and pain, respectively, as the major patient-related barriers. The lack of EM implementation and recording according to the checklist (90.4%), the lack of an approved EM implementation protocol (88.8%), and inadequate equipment for the mobilization of mechanically ventilated patients (58%) were among the major equipment-related barriers. The participating nurses were aware of the EM advantages, and the majority of them had a highly positive attitude towards its implementation in the ICU. However, nurses believed that the actual EM implementation is associated with challenges such as human resources limitations, equipment-related barriers, and patient-related barriers.
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Affiliation(s)
- Mahbubeh Babazadeh
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Simin Jahani
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Tayebeh Poursangbor
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Bahaman Cheraghian
- Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Bergman L, Chaboyer W. Early mobilization of intensive care unit patients: It's not that simple but can be done. Nurs Crit Care 2021; 25:337-338. [PMID: 33225548 DOI: 10.1111/nicc.12556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Lina Bergman
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
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Quality Improvement Versus Evidence-Based Practice in Early Mobilization Programs-Must We Choose? Pediatr Crit Care Med 2021; 22:439-442. [PMID: 33790214 DOI: 10.1097/pcc.0000000000002646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ghafoor S, Fan K, Williams S, Brown A, Bowman S, Pettit KL, Gorantla S, Quillivan R, Schwartzberg S, Curry A, Parkhurst L, James M, Smith J, Canavera K, Elliott A, Frett M, Trone D, Butrum-Sullivan J, Barger C, Lorino M, Mazur J, Dodson M, Melancon M, Hall LA, Rains J, Avent Y, Burlison J, Wang F, Pan H, Lenk MA, Morrison RR, Kudchadkar SR. Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit. Front Oncol 2021; 11:645716. [PMID: 33763377 PMCID: PMC7982584 DOI: 10.3389/fonc.2021.645716] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/01/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Children with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population. Methods We describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission. Results Between January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (p<0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (p=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff. Conclusions Our experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.
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Affiliation(s)
- Saad Ghafoor
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kimberly Fan
- Department of Pediatric Critical Care, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sarah Williams
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Amanda Brown
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sarah Bowman
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kenneth L Pettit
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Shilpa Gorantla
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Rebecca Quillivan
- Office of Quality and Patient Care, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sarah Schwartzberg
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Amanda Curry
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Lucy Parkhurst
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Marshay James
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jennifer Smith
- Department of Child Life, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Kristin Canavera
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Andrew Elliott
- Division of Psychiatry, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Michael Frett
- Division of Anesthesiology, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Deni Trone
- Department of Pharmaceutical Services, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jacqueline Butrum-Sullivan
- Department Critical Care/Pulmonary Medicine-Respiratory Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Cynthia Barger
- Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mary Lorino
- Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jennifer Mazur
- Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mandi Dodson
- Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Morgan Melancon
- Department of Nursing Administration- Nursing Education, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Leigh Anne Hall
- Department of Inpatient Units-Nursing, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jason Rains
- Department Critical Care/Pulmonary Medicine-Respiratory Therapy, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Yvonne Avent
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jonathan Burlison
- Department of Pharmaceutical Sciences- Patient Safety, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Fang Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Haitao Pan
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Mary Anne Lenk
- Department of Quality Improvement Education and Training, Cincinnati Children's Hospital- James M. Anderson Center for Health Systems Excellence, Cincinnati, OH, United States
| | - R Ray Morrison
- Division of Critical Care Medicine, Department of Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Sapna R Kudchadkar
- Departments of Anesthesiology and Critical Care Medicine, Pediatrics and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Koch J. Neurologische Frührehabilitation bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-020-01106-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tadyanemhandu C, van Aswegen H, Ntsiea V. Organizational structures and early mobilization practices in South African public sector intensive care units-A cross-sectional study. J Eval Clin Pract 2021; 27:42-52. [PMID: 32141685 PMCID: PMC7483254 DOI: 10.1111/jep.13378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/15/2020] [Accepted: 02/03/2020] [Indexed: 12/12/2022]
Abstract
RATIONALE Understanding current early mobilization practice of patients in intensive care unit (ICU) is critical to the design and implementation of strategies to facilitate its application in a diverse population of critically ill patients encountered in public sector hospitals. AIM To evaluate the organizational structures of South African public sector hospital ICUs and to describe early mobilization practices in these units. METHODS A cross-sectional survey was done in participating public hospitals from eight provinces in South Africa. Convenience sampling was done. Data collected included hospital and ICU structure, adult patient demographic and clinical data, and mobilization activities done in ICU over the previous 24 hours prior to the day of the survey. RESULTS A total of 29 ICUs from 13 participating hospitals were surveyed resulting in 205 patient records. Majority of the surveyed ICUs were "open" type (n = 16; 55.2%). A standardized sedation scoring system was used in 18 units (62.1%) and only two units (6.9%) had an early mobilization protocol in place. Mean age of the patients surveyed was 43.5 (±17.7) years and 148 (72.2%) patients were on mechanical ventilation. Primary reasons for admission to ICU included traumatic injury (n = 86; 42%) and postoperative care (n = 33; 16.1%). Mobilization activities performed in the previous 24 hours included turning the patient in bed (n = 88; 42.9%), marching on the spot (n = 9; 4.4%) and walking (n = 10; 4.9%). Out-of-bed mobilization was done in only 40 (19.5%) patients. The most common barriers to early mobilization included patient unresponsiveness (n = 50; 24.4%) and hemodynamic instability (n = 42; 20.5%). The type of ventilation was found to have a significant positive relationship with out-of-bed patient mobilization (P = .000). CONCLUSIONS A small proportion of patients attained their highest level of mobilization in ICU. The type of ventilation influenced early mobilization practices in public sector ICUs in South Africa.
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Affiliation(s)
- Cathrine Tadyanemhandu
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Daloia LMT, Pinto ACPN, Silva ÉPD. Barreiras e facilitadores da mobilização precoce na unidade de terapia intensiva pediátrica: revisão sistemática. FISIOTERAPIA E PESQUISA 2021. [DOI: 10.1590/1809-2950/20026728032021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O objetivo desta revisão sistemática foi identificar as barreiras e facilitadores para a implementação da mobilização precoce em unidades de terapia intensiva pediátrica. Realizou-se uma busca sistemática baseada em estudos que abordassem barreiras e/ou facilitadores para mobilização precoce em crianças e adolescentes. Foram incluídos estudos publicados até junho de 2019 nas bases de dados MEDLINE®, Physiotherapy Evidence Database, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Cochrane Library, Scientific Electronic Library Online. A seleção e a avaliação da qualidade metodológica foram realizadas por dois revisores independentes. Dados que pudessem ser identificados como barreiras e/ou facilitadores foram extraídos para análise. Foram encontrados 358 registros nas bases de dados, dos quais foram incluídos 13 artigos. Foram citadas 18 barreiras, sendo as mais citadas o número insuficiente de profissionais, e insegurança da equipe. Dos 11 facilitadores citados, os mais frequentes foram treinamento/educação da equipe multidisciplinar e a instituição de diretriz/consenso. Existem muitas barreiras a serem quebradas para que a mobilização precoce seja efetiva, porém alguns facilitadores já são conhecidos e podem ser implementados, tornando viável a sua implementação para a população pediátrica.
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Quality Improvement Methodology to Optimize Safe Early Mobility in a Pediatric Intensive Care Unit. Pediatr Qual Saf 2020; 6:e369. [PMID: 33403315 PMCID: PMC7774997 DOI: 10.1097/pq9.0000000000000369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/21/2020] [Indexed: 01/27/2023] Open
Abstract
Supplemental Digital Content is available in the text. Utilization of robust quality improvement methodology in conjunction with traditional interventions to enhance an Early Mobility program (EMP) in a tertiary pediatric intensive care unit (PICU).
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Safety and Efficacy of Early Ambulation on an Alternative Oxygen Delivery Device for Patients Receiving Bedside Heated Humidified High-Flow Nasal Cannula Therapy. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Acosta-Murillo NR. Delirio en niños críticamente enfermos. REVISTA DE LA FACULTAD DE MEDICINA 2020. [DOI: 10.15446/revfacmed.v68n4.77430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El delirio en pacientes críticos es una condición médica que afecta tanto a adultos como a niños; en ambas poblaciones implica graves complicaciones como estancia hospitalaria prolongada, alto riesgo de muerte y deterioro cognitivo a largo plazo, así como mayores costos económicos en cuanto a la prestación de servicios de salud. La principal dificultad de esta condición en la población pediátrica es su adecuado reconocimiento, ya que puede presentarse en edades muy tempranas, incluso en niños lactantes, cuando sus signos y síntomas pueden confundirse o superponerse con otras patologías, tales como el síndrome de abstinencia. En consecuencia, en estos casos el uso de herramientas diagnósticas puede ser una labor compleja que implica múltiples dificultades.Antes de 2011 no había muchos estudios que abordaran la evaluación del delirio en niños. Sin embargo, ese mismo año se estableció la primera escala desarrollada específicamente para el monitoreo de pacientes en unidades de cuidado intensivo pediátrico, lo que llevó a un aumento significativos del número de casos de delirio en niños menores de 5 años críticamente enfermos; esta situación hizo que los pediatras se interesaran más en estudiar esta importante patología.La presente reflexión, basada en una revisión de la literatura, busca actualizar el amplio espectro fisiopatológico del delirio en niños críticamente enfermos y, de esta forma, mejorar su tamizaje, diagnóstico e intervenciones terapéuticas tempranas en todas las edades pediátricas, incluso en menores de 5 años.
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Kanejima Y, Shimogai T, Kitamura M, Ishihara K, Izawa KP. Effect of Early Mobilization on Physical Function in Patients after Cardiac Surgery: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197091. [PMID: 32998202 PMCID: PMC7578990 DOI: 10.3390/ijerph17197091] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022]
Abstract
The objective effects of early mobilization on physical function in patients after cardiac surgery remain unknown. The purpose of the present study was to clarify the effects of early mobilization on physical function in patients after cardiac surgery through meta-analysis. Four electronic databases were searched on 2 August 2019. We used search keywords related to “early mobilization”, “cardiac surgery”, and “randomized controlled trials”. All randomized controlled trials conducting early mobilization after cardiac surgery were included. We defined early mobilization as the application of physical activity within the first five postoperative days. Citations and data extraction were independently screened in duplicate by two authors. The meta-analysis was conducted using random-effects modeling with EZR software. The primary outcome was the distance walked during the six-minute walking test at hospital discharge. Six randomized controlled trials comprising 391 patients were included following screening of 591 studies. All studies included coronary artery bypass grafting as the cardiac surgery conducted. Early mobilization started on postoperative days 1–2 and was conducting twice daily. Early mobilization showed a trend of being combined with respiratory exercise or psychoeducation. The meta-analysis showed that the distance walked during the 6-min walking test improved by 54 m (95% confidence interval, 31.1–76.9; I2 = 52%) at hospital discharge. The present study suggested that early mobilization after cardiac surgery may improve physical function at discharge.
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Affiliation(s)
- Yuji Kanejima
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan; (Y.K.); (T.S.); (M.K.); (K.I.)
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
| | - Takayuki Shimogai
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan; (Y.K.); (T.S.); (M.K.); (K.I.)
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
| | - Masahiro Kitamura
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan; (Y.K.); (T.S.); (M.K.); (K.I.)
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Physical Therapy, Kokura Rehabilitation College, 2-10 Kuzuharahigashi 2-chome, Kokuraminami-ku, Kitakyushu 800-0206, Japan
| | - Kodai Ishihara
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan; (Y.K.); (T.S.); (M.K.); (K.I.)
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Department of Rehabilitation, Sakakibara Heart Institute of Okayama, 5-1 Nakaicho 2-chome, Kita-ku, Okayama 700-0804, Japan
| | - Kazuhiro P. Izawa
- Department of Public Health, Graduate School of Health Sciences, Kobe University, Kobe 654-0142, Japan; (Y.K.); (T.S.); (M.K.); (K.I.)
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan
- Correspondence: ; Tel.: +81-78-796-4566
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Hemphill S, Nguyen A, Rodriguez ST, Menendez M, Wang E, Lawrence K, Caruso TJ. Mobilization and calibration of the HTC VIVE for virtual reality physical therapy. Digit Health 2020; 6:2055207620950929. [PMID: 32963801 PMCID: PMC7488919 DOI: 10.1177/2055207620950929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 07/28/2020] [Indexed: 01/13/2023] Open
Abstract
Aims The HTC VIVE virtual reality (VR) system is a potential tool for collecting kinematic data during inpatient and outpatient physical therapy (PT). When validated against research-grade systems, the VIVE has a reported translational error between 1.7 mm-2.0 cm. Our purpose was to portabilize the VIVE for room to room PT and validate the motion tracking software. Methods The VIVE was configured on a mobile cart. To validate the motion tracking software, the VIVE sensors (motion tracker, controller, headset) were mounted on a rigid linear track and driven through 10, one-meter translations in the X, Y, and Z axes. Results The mean translational error for all three sensors was below 4.9 cm. While error is greater than that reported for research-grade systems, motion tracking software on the portable VIVE unit appears to be a valid means of tracking aggregate movement. Conclusion Some therapy may require more precise measurements, however, the advantages of portability and accessibility to patients may outweigh the limitation of reduced precision.
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Affiliation(s)
- Sydney Hemphill
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Alan Nguyen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Samuel T Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Maria Menendez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Kiley Lawrence
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, USA
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Anderson CC, Johnson JL, deBoisblanc BP, Jolley SE. Care erosion in sedation assessment: A prospective comparison of usual care Richmond Agitation-Sedation Scale assessment with protocolized assessment for medical intensive care unit patients. J Nurs Manag 2020; 29:206-213. [PMID: 32881119 DOI: 10.1111/jonm.13140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/06/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine concordance between an explicit protocolized assessment of the Richmond Agitation-Sedation Scale and an assessment performed during usual care nursing practice. RESEARCH DESIGN In an urban, safety-net hospital, intensive care nurses previously trained in sedation assessment recorded a bedside Richmond Agitation-Sedation Scale assessment, while study investigators used an explicit script to perform the assessment at a similar time point. Kappa indices determined concordance of the assessments. Bivariate analyses explored factors associated with discordance and unresponsiveness. RESULTS Twenty-one subjects with 38 observations were analysed. Bedside nursing assessment was poorly concordant with protocolized assessment (ƙ = 0.21) with the former reporting significantly lighter sedation (median -2 vs. -5, p = .01). Bedside assessment was significantly less likely than protocolized assessment to categorize subjects as unresponsive (29 vs. 50%, p = .02). CONCLUSION Methods used in usual clinical practice to assess adequacy of sedation frequently led to oversedation. We propose that care erosion, the deterioration of skills over time, may help explain this finding. IMPLICATIONS FOR NURSING MANAGEMENT Results suggest sedation assessment may be particularly vulnerable to care erosion. Nurse managers should monitor for signs of care erosion and consider utilization of explicit scripts during sedation assessment and/or frequent education to ensure sedation assessment accuracy.
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Affiliation(s)
- Christopher Charles Anderson
- Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jessica L Johnson
- Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Xavier University of Louisiana College of Pharmacy, New Orleans, LA, USA
| | - Bennett P deBoisblanc
- Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Sarah E Jolley
- Section of Pulmonary and Critical Care Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Söderberg A, Karlsson V, Ahlberg BM, Johansson A, Thelandersson A. From fear to fight: Patients experiences of early mobilization in intensive care. A qualitative interview study. Physiother Theory Pract 2020; 38:750-758. [PMID: 32787479 DOI: 10.1080/09593985.2020.1799460] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Early mobilization (EM) in intensive care is frequently used to prevent physical and psychological complications, with promising results. However, the patient´s perception of EM has been sparsely investigated. Purpose: To investigate the experience of EM in patients treated in intensive care. Method: Nineteen former patients who had been treated in intensive care were interviewed. The interviews were analyzed using qualitative, inductive content analysis. Results: The analysis resulted in three categories; 1) Facing the impossible - a too demanding situation; 2) Struggling successfully on the way back; and 3) Need of having dedicated supporters. Conclusion: A considerable variety of experiences of EM were described in this study, both negative and positive. Prominent features were that pleasant emotions and great physical effort occurred simultaneously and that interaction and cooperation with the caregivers was paramount. To regain independence was another prominent feature, with EM considered to be of great importance in the recovery process. Moving to an upright position and ambulating appears to be beneficial to both body and mind. EM should therefore be among the first priorities in intensive care. EM should be practiced with respect and support, while encouraging and challenging the patient to strive for independence.
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Affiliation(s)
- Annika Söderberg
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Physiotherapy, Skaraborgs Hospital Skövde, Skövde, Sweden
| | | | | | - Anita Johansson
- Research and Development Centre, Skaraborg Hospital Skövde, Skövde, Sweden
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Gomes TT, Schujmann DS, Fu C. Rehabilitation through virtual reality: physical activity of patients admitted to the intensive care unit. Rev Bras Ter Intensiva 2020; 31:456-463. [PMID: 31967219 PMCID: PMC7008986 DOI: 10.5935/0103-507x.20190078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/09/2019] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the level of activity that Nintendo WiiTM can elicit in intensive care unit patients and its associated safety and patient satisfaction. Methods Experimental, single-center study performed at a tertiary care hospital. Patients ≥ 18 years old who were admitted to the intensive care unit, participated in videogames as part of their physical therapy sessions and did not have mobility restrictions were included. Th exclusion criteria were the inability to comprehend instructions and the inability to follow simple commands. We included n = 60 patients and performed 100 sessions. We used the Nintendo WiiTM gaming system in the sessions. An accelerometer measured the level of physical activity of patients while they played videogames. We evaluated the level of activity, the modified Borg scale scores, the adverse events and the responses to a questionnaire on satisfaction with the activity. Results One hundred physical therapy sessions were analyzed. When the patients played the videogame, they reached a light level of activity for 59% of the session duration and a moderate level of activity for 38% of the session duration. No adverse events occurred. A total of 86% of the patients reported that they would like to play the videogame in their future physical therapy sessions. Conclusion Virtual rehabilitation elicited light to moderate levels of activity in intensive care unit patients. This therapy is a safe tool and is likely to be chosen by the patient during physical therapy.
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Affiliation(s)
- Tamires Teixeira Gomes
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Debora Stripari Schujmann
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
| | - Carolina Fu
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Brasil
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66
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Schujmann DS, Annoni R. Papel da fisioterapia no atendimento a pacientes com Covid-19 em unidades de terapia intensiva. FISIOTERAPIA E PESQUISA 2020. [DOI: 10.1590/1809-2950/00000027032020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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67
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Effect of Early Mobilization on Respiratory and Limb Muscle Strength and Functionality of Nonintubated Patients in Critical Care: A Feasibility Trial. Crit Care Res Pract 2020. [DOI: 10.1155/2020/3526730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose. To assess the potential effectiveness or efficacy of early mobilization on respiratory and peripheral muscle strengths and functionality in nonintubated patients. Methods. For 40 nonintubated patients over 18 years of age with over 24-hour intensive care unit (ICU) stay allocated to a single intervention, an incremental mobilization protocol was initiated. Maximal inspiratory and expiratory pressures (MIP and MEP), peripheral muscle strength (handgrip strength (HGS) and Medical Research Council scale (MRC-s)), and functionality (FIM, ICF-BMS, PFIT-s, and FSS-ICU scales) were evaluated at ICU admission and discharge. Results. All outcomes were significantly improved (pre vs. post values): MIP (43.93 ± 21.95 vs. 54.12 ± 21.68 cmH2O; P<0.001), MEP (50.32 ± 28.65 vs. 60.30 ± 21.23; P=0.002), HGS (25.5 (9.58) vs. 27.5 (9.48); P=0.046), MRC-s (58.52 ± 2.84 vs. 59.47 ± 1.81; P=0.023), FIM (54.4 ± 22.79 vs. 69.48 ± 12.74), ICF-BMS (28.63 ± 16.19 vs. 14.03 ± 11.15), PFIT-s (9.55 ± 2.34 vs. 11.18 ± 1.32) (P<0.001), and FSS-ICU (28.7 ± 9.1 vs. 32.6 ± 5.0; P=0.001). The ceiling effect at admission/discharge was in MRC-s (60/82.5%), FSS-ICU (50/70%), and FIM (35/62.5%). The floor effect occurred at discharge in ICF-BMS (7.5/52.5%). Conclusions. The early mobilization protocol seemed effective at maintaining/increasing the respiratory muscle strength and functionality of nonintubated patients in critical care. Ceiling effect was high for MRC-s, FSS-ICU, and FIM scales.
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68
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McKendry J, Thomas ACQ, Phillips SM. Muscle Mass Loss in the Older Critically Ill Population: Potential Therapeutic Strategies. Nutr Clin Pract 2020; 35:607-616. [PMID: 32578900 DOI: 10.1002/ncp.10540] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/29/2020] [Accepted: 05/16/2020] [Indexed: 12/14/2022] Open
Abstract
Skeletal muscle plays a critical role in everyday life, and its age-associated reduction has severe health consequences. The pre-existing presence of sarcopenia, combined with anabolic resistance, protein undernutrition, and the pro-catabolic/anti-anabolic milieu induced by aging and exacerbated in critical care, may accelerate the rate at which skeletal muscle is lost in patients with critical illness. Advancements in intensive care unit (ICU)-care provision have drastically improved survival rates; therefore, attention can be redirected toward other significant issues affecting ICU patients (e.g., length of stay, days on ventilation, nosocomial disease development, etc.). Thus, strategies targeting muscle mass and function losses within an ICU setting are essential to improve patient-related outcomes. Notably, loading exercise and protein provision are the most compelling. Many older ICU patients seldom meet the recommended protein intake, and loading exercise is difficult to conduct in the ICU. Nevertheless, the incorporation of physical therapy (PT), neuromuscular electrical stimulation, and early mobilization strategies may be beneficial. Furthermore, a number of nutrition practices within the ICU have been shown to improve patient-related outcomes ((e.g., feeding strategy [i.e., oral, early enteral, or parenteral]), be hypocaloric (∼70%-80% energy requirements), and increase protein provision (∼1.2-2.5 g/kg/d)). The aim of this brief review is to discuss the dysregulation of muscle mass maintenance in an older ICU population and highlight the potential benefits of strategic nutrition practice, specifically protein, and PT within the ICU. Finally, we provide some general guidelines that may serve to counteract muscle mass loss in patients with critical illness.
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Affiliation(s)
- James McKendry
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Aaron C Q Thomas
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Stuart M Phillips
- Exercise Metabolism Research Group, Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
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69
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Sioshansi PC, Byrne E, Freccero A, Meister KD, Sidell DR. Risk Assessment and Early Mobilization Pathway Following Pediatric Tracheostomy: A Pilot Study. Laryngoscope 2020; 131:E653-E658. [PMID: 32438519 DOI: 10.1002/lary.28748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/02/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To confirm the standard of care pertaining to postoperative mobilization practices following initial tracheostomy, to establish face validity of novel early mobilization tools, and to conduct a safety and feasibility pilot study. STUDY DESIGN Multi-institutional survey and prospective cohort study. METHODS Experts at our tertiary-care children's hospital developed an Early Pediatric Mobility Pathway for tracheostomy patients utilizing a novel risk-assessment tool. Surveys were distributed to professional colleagues in similar children's hospitals to establish face validity and incorporate respondent feedback. Additional surveys were disseminated to tertiary-care children's hospitals across the country to establish the current standard of care, and a pilot study was conducted. RESULTS Seventy-seven percent of respondents from tertiary hospitals across the country confirmed the standard of care to defer mobilization until the first trach change. Greater than 83% of the respondents used to establish face validity of the tools agreed with the clinical components and scoring structure. The safety and feasibility of early mobilization prior to initial trach change was confirmed with a pilot of 10 pediatric patients without any adverse events. CONCLUSIONS Mobilization of pediatric patients prior to initial trach change is feasible and can be safe when risk factors are assessed by a multidisciplinary team. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E653-E658, 2021.
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Affiliation(s)
- Pedrom C Sioshansi
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Eilish Byrne
- Lucile Packard Children's Hospital Stanford, Department of Rehabilitation Services, Stanford, California, U.S.A
| | - Allison Freccero
- Lucile Packard Children's Hospital Stanford, Department of Rehabilitation Services, Stanford, California, U.S.A
| | - Kara D Meister
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A.,Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital Stanford, Stanford, California, U.S.A
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70
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Rawat N, Rao V, Peven M, Shrock C, Reiter A, Saria S, Ali H. Comparison of Automated Activity Recognition to Provider Observations of Patient Mobility in the ICU. Crit Care Med 2020; 47:1232-1234. [PMID: 31162207 DOI: 10.1097/ccm.0000000000003852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare noninvasive mobility sensor patient motion signature to direct observations by physicians and nurses. DESIGN Prospective, observational study. SETTING Academic hospital surgical ICU. PATIENTS AND MEASUREMENTS A total of 2,426 1-minute clips from six ICU patients (development dataset) and 4,824 1-minute clips from five patients (test dataset). INTERVENTIONS None. MAIN RESULTS Noninvasive mobility sensor achieved a minute-level accuracy of 94.2% (2,138/2,272) and an hour-level accuracy of 81.4% (70/86). CONCLUSIONS The automated noninvasive mobility sensor system represents a significant departure from current manual measurement and reporting used in clinical care, lowering the burden of measurement and documentation on caregivers.
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Affiliation(s)
- Nishi Rawat
- Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Vishal Rao
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
| | - Michael Peven
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
| | | | - Austin Reiter
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
| | - Suchi Saria
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Computer Science, Johns Hopkins University, Baltimore, MD.,Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Haider Ali
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
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71
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Takahashi Y, Akiho M, Aono H, Tsugitomi R, Tamura T. Evaluation of factors associated with the timing of pulmonary rehabilitation during hospitalisation in patients with interstitial lung disease: a two-centre retrospective study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2019.1578826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Yuta Takahashi
- Department of Rehabilitation, St. Luke’s International Hospital, Tokyo, Japan
| | - Mitsutoshi Akiho
- Department of Rehabilitation, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hiromi Aono
- Department of Pulmonary Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | - Ryosuke Tsugitomi
- Department of Pulmonary Medicine, St. Luke’s International Hospital, Tokyo, Japan
| | - Tomohide Tamura
- Department of Pulmonary Medicine, St. Luke’s International Hospital, Tokyo, Japan
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72
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New Approaches to Respiratory Assist: Bioengineering an Ambulatory, Miniaturized Bioartificial Lung. ASAIO J 2020; 65:422-429. [PMID: 30044238 DOI: 10.1097/mat.0000000000000841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Although state-of-the-art treatments of respiratory failure clearly have made some progress in terms of survival in patients suffering from severe respiratory system disorders, such as acute respiratory distress syndrome (ARDS), they failed to significantly improve the quality of life in patients with acute or chronic lung failure, including severe acute exacerbations of chronic obstructive pulmonary disease or ARDS as well. Limitations of standard treatment modalities, which largely rely on conventional mechanical ventilation, emphasize the urgent, unmet clinical need for developing novel (bio)artificial respiratory assist devices that provide extracorporeal gas exchange with a focus on direct extracorporeal CO2 removal from the blood. In this review, we discuss some of the novel concepts and critical prerequisites for such respiratory lung assist devices that can be used with an adequate safety profile, in the intensive care setting, as well as for long-term domiciliary therapy in patients with chronic ventilatory failure. Specifically, we describe some of the pivotal steps, such as device miniaturization, passivation of the blood-contacting surfaces by chemical surface modifications, or endothelial cell seeding, all of which are required for converting current lung assist devices into ambulatory lung assist device for long-term use in critically ill patients. Finally, we also discuss some of the risks and challenges for the long-term use of ambulatory miniaturized bioartificial lungs.
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73
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Schujmann DS, Teixeira Gomes T, Lunardi AC, Zoccoler Lamano M, Fragoso A, Pimentel M, Peso CN, Araujo P, Fu C. Impact of a Progressive Mobility Program on the Functional Status, Respiratory, and Muscular Systems of ICU Patients: A Randomized and Controlled Trial. Crit Care Med 2020; 48:491-497. [PMID: 32205595 DOI: 10.1097/ccm.0000000000004181] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The aim was to investigate whether patients who participated in a mobility program in the ICU performed better on functional status, muscle, mobility, and respiratory assessments upon discharge than patients who received conventional physiotherapy. DESIGN Randomized controlled trial. SETTING Blind evaluation. PATIENTS Adults with previous functional independence and without contraindications for mobilization were eligible. INTERVENTIONS The intervention group participated in an early and progressive mobility program with five levels of activity. The control group underwent the conventional treatment without a preestablished routine. We evaluated functional status, level of activity, respiratory status, muscle strength, and mobility at ICU discharge. MEASUREMENTS AND MAIN RESULTS We analyzed 49 patients in the control group and 50 patients in the intervention group. Our data showed patients with better functional status and more functionally independent patients in the intervention group compared with those in the control group (96% vs 44%; p < 0.001). The results of the sit-to-stand and 2-minute walk tests, as well as the results of the maximum voluntary ventilation tests, also varied between the groups. The intervention group had shorter ICU stays than the control group. Higher Barthel index scores were associated with the amount of activity and participation in the protocol. The benefits to functional status remained during follow-up. CONCLUSIONS Patients who participated in an ICU mobility program had better functional status at discharge from the ICU. The other benefits of the program included better performance in the mobility tests and improved maximum voluntary ventilation performance.
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Affiliation(s)
- Debora Stripari Schujmann
- Department of Physiotherapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Tamires Teixeira Gomes
- Department of Physiotherapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Adriana Claudia Lunardi
- Department of Physiotherapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Murilo Zoccoler Lamano
- Department of Physiotherapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Aretha Fragoso
- Department of Physiotherapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Mayara Pimentel
- Department of Physiotherapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Claudia Neri Peso
- Department of Physiotherapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Priscila Araujo
- Department of Physiotherapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, Hospital das Clinicas of University of Sao Paulo, Sao Paulo, Brazil
| | - Carolina Fu
- Department of Physiotherapy, Communication Sciences and Disorders and Occupational Therapy, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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74
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Parke S, Hough CL, E Bunnell A. The Feasibility and Acceptability of Virtual Therapy Environments for Early ICU Mobilization. PM R 2020; 12:1214-1221. [PMID: 32107863 DOI: 10.1002/pmrj.12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/04/2020] [Accepted: 02/14/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early mobilization in critically ill patients has been documented to reduce neuromuscular complications, but access to rehabilitation services is often limited in the intensive care unit (ICU). Virtual platforms that deliver therapy may increase access to rehabilitation services and improve patient motivation to participate. Xbox Kinect Jintronix software delivers interventions using games and activities designed for therapy. OBJECTIVE To determine the feasibility of the Jintronix virtual therapy system in an ICU setting by observing outcomes related to patient satisfaction, adverse events, and technical applicability. DESIGN Prospective observational feasibility study. SETTING Medical ICU at a Level 1 Trauma Center within an academic medical center. PARTICIPANTS Twenty adults admitted to ICU. INTERVENTION Participants engaged in one therapy session with a maximum of 14 Jintronix modules targeting arm, leg, and/or trunk strength, range of motion, and endurance. OUTCOME MEASURES A trained physician-observer recorded events related to adverse events and technical applicability. Participants completed a survey to determine patient satisfaction. RESULTS A total of 188 modules were completed. Participants completed a median of nine modules each. Five participants completed the maximum of 14 modules. Fatigue was the most common reason for cessation. Mean intervention time was 29 minutes. There were no falls, lines dislodged, or medical events. Participants required physical assistance or verbal cues in 36% of modules. Technical errors affected 25% of modules and led to activity cessation in one case. Nearly all participants reported the activity was enjoyable, comfortable, safe, easy to understand, would improve range of motion and strength, and would motivate them to continue. CONCLUSIONS Use of a virtual therapy environment in an intensive care setting is feasible.
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Affiliation(s)
- Sara Parke
- Department of Rehabilitation Medicine, Department of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Catherine L Hough
- Department of Rehabilitation Medicine, Department of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Aaron E Bunnell
- Department of Rehabilitation Medicine, Department of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA
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75
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Cambiaso-Daniel J, Parry I, Rivas E, Kemp-Offenberg J, Sen S, Rizzo JA, Serghiou MA, Kowalske K, Wolf SE, Herndon DN, Suman OE. Strength and Cardiorespiratory Exercise Rehabilitation for Severely Burned Patients During Intensive Care Units: A Survey of Practice. J Burn Care Res 2020; 39:897-901. [PMID: 29579311 DOI: 10.1093/jbcr/iry002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Minimizing the deconditioning of burn injury through early rehabilitation programs (RP) in the intensive care unit (ICU) is of importance for improving the recovery time. The aim of this study was to assess current standard of care (SOC) for early ICU exercise programs in major burn centers. We designed a survey investigating exercise RP on the ICU for burn patients with >30% total burned surface area. The survey was composed of 23 questions and submitted electronically via SurveyMonkey® to six major (pediatric and adult) burn centers in Texas and California. All centers responded and reported exercise as part of their RP on the ICU. The characteristics of exercises implemented were not uniform. All centers reported to perform resistive and aerobic exercises but only 83% reported isotonic and isometric exercises. Determination of intensity of exercise varied with 50% of centers using patient tolerance and 17% using vital signs. Frequency of isotonic, isometric, aerobic, and resistive exercise was reported as daily by 80%, 80%, 83%, and 50% of centers, respectively. Duration for all types of exercises was extremely variable. Mobilization was used as a form of exercise by 100% of burn centers. Our results demonstrate that although early RP seem to be integral during burn survivor's ICU stay, no SOC exists. Moreover, early RP are inconsistently administered and large variations exist in frequency, intensity, duration, and type of exercise. Thus, future prospective studies investigating the various components of exercise interventions are needed to establish a SOC and determine how and if early exercise benefits the burn survivor.
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Affiliation(s)
- Janos Cambiaso-Daniel
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.,Department of Surgery, Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Austria
| | - Ingrid Parry
- Shriners Hospitals for Children, Northern California, Sacramento, California
| | - Eric Rivas
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas.,Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
| | - Jennifer Kemp-Offenberg
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas
| | - Soman Sen
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas.,Department of Surgery, Division for Burn Surgery, University of California, Davis, California
| | - Julie A Rizzo
- The United States Army Institute of Surgical Research, San Antonio, Texas.,Uniformed Services University of Health Sciences, Bethesda MD
| | | | - Karen Kowalske
- University of Texas Southwest Medical Center, Dallas, Texas
| | - Steven E Wolf
- University of Texas Southwest Medical Center, Dallas, Texas
| | - David N Herndon
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas
| | - Oscar E Suman
- Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children, Galveston, Texas
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76
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Early Mobilization Interventions in the Intensive Care Unit: Ongoing and Unpublished Randomized Trials. Crit Care Res Pract 2020; 2020:3281394. [PMID: 32399292 PMCID: PMC7201471 DOI: 10.1155/2020/3281394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/06/2019] [Indexed: 12/22/2022] Open
Abstract
Background Critical care societies recommend early mobilization (EM) as standard practice in the intensive care unit (ICU) setting. However, there is limited randomized controlled trial (RCT) evidence supporting EM's effectiveness. Our objective was to identify ongoing or completed RCTs assessing EM's effectiveness in the ICU. Method We searched ClinicalTrials.gov and the Australian New Zealand Clinical Trials Registry for ongoing or completed but not published RCTs in an ICU setting with objective outcome measures. Results There were 14 RCTs included in the analysis. All studies were in the general or mixed ICU setting (N=14). Half of the studies (N=7) were small RCTs (<100 projected participants) and half (N=7) were medium-sized RCTs (100–999 participants). Inclusion criteria included mechanical ventilation use or expected use (N=13) and prehospital functional status (N=7). Primary EM interventions were standard physiotherapist-based activities (N=4), cycling (N=9), and electrical muscle stimulation (N=1). Only one study involved nurse-led EM. The most common assessment tool was the 6-minute walk test (N=6). Primary outcome measures were physiological (N=3), clinical (N=3), patient-centered (N=7), and healthcare resource use (N=1). Most studies (N=8) involved post-ICU follow-up measures up to 1-year posthospitalization. There were no studies targeting older adults or people with acute cardiac disease. Conclusion Identified studies will further the evidence base for EM's effectiveness. There is a need for studies looking at specific patient populations that may benefit from EM, such as older adults and cardiac patients, as well as for novel EM delivery strategies, such as nurse-led EM.
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77
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Ohlsson‐Nevo E, Andersson G, Nilsing Strid E. In the hands of nurses: A focus group study of how nurses perceive and promote inpatients' needs for physical activity. Nurs Open 2020; 7:334-344. [PMID: 31871718 PMCID: PMC6917955 DOI: 10.1002/nop2.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 01/02/2023] Open
Abstract
Aims To describe how nurses perceive and promote inpatients' needs for physical activity during their stay at the ward. Design A qualitative descriptive design was employed providing an exploration of how nurses perceive and promote inpatients' need for physical activity. Methods Seven semi-structured focus group discussions were held between November 2016 and February 2017 with 29 nurses in three hospitals in Sweden. Both interaction analysis and content analysis of the data were conducted. Results Patients are dependent on nurses' prioritizations and promotions to be sufficiently physically active during their stay at the ward. The external environment and the integration of physical activity affected the promotion of physical activity. The nurses perceived that understanding the patient's expectations was important and that promotion of physical activity was a joint responsibility of patient, relatives and healthcare professionals. The interaction analysis revealed no clear hierarchical pattern as all members in each focus group took initiative to open the discussions. The Registered Nurses contributed with more new ideas.
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Affiliation(s)
- Emma Ohlsson‐Nevo
- Department of SurgeryÖrebro UniversityÖrebroSweden
- Faculty of Medicine and HealthUniversity Health Care Research CentreÖrebro UniversityÖrebroSweden
| | - Gunnel Andersson
- Faculty of Medicine and HealthSchool of Health SciencesÖrebro UniversityÖrebroSweden
| | - Emma Nilsing Strid
- Faculty of Medicine and HealthUniversity Health Care Research CentreÖrebro UniversityÖrebroSweden
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78
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Chen B, You X, Lin Y, Dong D, Xie X, Zheng X, Li D, Lin W. A systematic review and meta-analysis of the effects of early mobilization therapy in patients after cardiac surgery: A protocol for systematic review. Medicine (Baltimore) 2020; 99:e18843. [PMID: 31977881 PMCID: PMC7004682 DOI: 10.1097/md.0000000000018843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prolonged hospitalization and immobility of critical care patients elevates the risk of long-term physical and cognitive impairments. However, the therapeutic effects of early mobilization have been difficult to interpret due to variations in study populations, interventions, and outcome measures. This systematic review and meta-analysis aims to assess the effects of early mobilization therapy for non-emergency cardiac surgery patients in the intensive care unit (ICU). METHODS The following databases will be used to search for relevant keywords: PubMed, Embase, CINAHL, PEDro, and the Cochrane Library from inception to September 2018 by 2 researchers independently. Randomized controlled trials (RCTs), will be included if patients are adults (≥18 years) admitted to any ICU for cardiac surgery due to cardiovascular disease and who are treated with experimental physiotherapy initiated in the ICU (pre, post, or perioperative). The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous outcomes will be presented as the weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence interval (CI), while dichotomous data will be expressed as relative risk (RR) with 95% CI. If the included studies have existing heterogeneity (P < 0.1), a random-effects model will be used. Otherwise, we will calculate using a fixed effects model. RESULTS This review will evaluate the effects of early mobilization on length of ICU and hospital stay, physical function and adverse events in patients with cardiac surgery patients in the ICU. CONCLUSION This systematic review will comprehensively provide conclusive evidence of the therapeutic effect of early mobilization on cardiac surgery patients in the ICU.PROSPERO Research registration identifying number: CRD42019135338.
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79
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Abstract
OBJECTIVES Early mobility in the PICU is safe and feasible. However, PICUs continue to meet barriers to implementing early mobility. PICU providers were surveyed before and after initiating an early mobility protocol to determine perceived barriers and continued challenges in performing early mobility. DESIGN This single-center prospective study surveyed PICU providers regarding 26 potential barriers to early mobility using a five-point Likert scale. A survey was distributed 1 month prior to and 6 months after beginning an early mobility protocol. SETTING Free-standing academic tertiary care children's hospital. SUBJECTS PICU providers of various professions. INTERVENTIONS Implementation of PICU-wide early mobility protocol. MEASUREMENTS AND MAIN RESULTS Paired pre- and post-early mobility protocol implementation surveys from 97 providers were compared. System-based barriers decreased after implementation of the early mobility protocol, such as lack of guidelines (75-20%; p < 0.01), inadequate training (74-33%; p < 0.01), lack of early mobility orders (72-30%; p < 0.01), and delayed recognition of early mobility candidates (68-35%; p < 0.01). Difficulty coordinating early mobility sessions, although significantly decreased, still remained a concern for 66% of providers in the postsurvey. Lack of resources, specifically staff (85-82%; p = 0.68) and equipment (67-60%; p = 0.36), also remained significant barriers. Presence of an endotracheal tube was a barrier for only 29% of providers' post-early mobility protocol, compared with 69% prior (p < 0.01). Clinical instability remained a top concern (82-79%; p = 0.63) as well as agitation (74-67%; p = 0.23). Day shift providers, with more early mobility exposure, perceived fewer barriers compared with night shift providers. Ninety percentage of post-early mobility survey participants felt that early mobility positively impacted their patients. CONCLUSIONS Implementation of an early mobility protocol significantly changed provider perceptions regarding barriers to early mobility. Certain factors, such as staff availability, coordination difficulty, equipment shortage, and patient clinical factors, continue to be significant challenges to early mobility in the PICU population.
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Clinical Frailty Scale Score Before ICU Admission Is Associated With Mobility Disability in Septic Patients Receiving Early Rehabilitation. Crit Care Explor 2019; 1:e0066. [PMID: 32166247 PMCID: PMC7063928 DOI: 10.1097/cce.0000000000000066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
To clarify the relationship between mobility disability at the time of discharge from the ICU and clinical factors evaluated at ICU admission in septic patients.
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Therapist perceptions of a rehabilitation research study in the intensive care unit: a trinational survey assessing barriers and facilitators to implementing the CYCLE pilot randomized clinical trial. Pilot Feasibility Stud 2019; 5:131. [PMID: 31741746 PMCID: PMC6849178 DOI: 10.1186/s40814-019-0509-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/01/2019] [Indexed: 01/02/2023] Open
Abstract
Background Rehabilitation interventions, including novel technologies such as in-bed cycling, could reduce critical illness-associated morbidity. Frontline intensive care unit (ICU) therapists often implement these interventions; however, little is known about their perceptions of engaging in clinical research evaluating these technologies. Objective To understand frontline therapist perceptions of barriers and facilitators to implementing a pilot randomized controlled trial (RCT) of early in-bed cycling with mechanically ventilated patients in the ICU and outcome measures (CYCLE Pilot RCT; NCT02377830). Methods We developed a 115-item, self-administered, electronic survey informed by 2 complementary knowledge translation (KT) models: the Capability-Opportunity-Motivation-Behaviour (COM-B) system and the Theoretical Domains Framework (TDF). We included demographics and 3 sections: Rehabilitation Practice and Research, Cycling, and Physical Outcome Measures. Each section contained items related to the COM-B system and TDF domains. Item formats included 7-point Likert-type scale questions (1 = strongly disagree, 7 = strongly agree) and free-text responses. We invited therapists (physiotherapists, occupational therapists, and therapy assistants) who participated in the international, multi-center, CYCLE Pilot RCT to complete this cross-sectional survey. We descriptively analyzed results by survey section, COM-B attribute, TDF domain, and individual question within and across sections. We identified barriers based on items with median scores < 4/7. Results Our response rate was 85% (45/53). Respondents were from Canada (67%), the USA (21%), and Australia (11%). The majority had a physiotherapy background (87%) and previous research experience (87%). By section, Rehabilitation Practice and Research (85%; 95% confidence interval (CI) [82%, 87%]) was higher than Cycling (77%; 95% CI [73%, 80%]) and Outcome Measures (78%; 95% CI [75%, 82%]). Across the 3 sections, Motivation was lower than Capability and Opportunity. The most common Motivation barrier was the emotion TDF domain, related to the time required to conduct cycling and outcome measures (median [1st, 3rd quartiles] 3/7 [2, 6]). Conclusions Frontline ICU therapists had positive perceptions of research engagement. However, we identified barriers related to Motivation, and concerns regarding time to implement the research protocol. Our results can inform specific KT strategies to engage frontline ICU therapists and optimize protocol implementation in critical care rehabilitation research.
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Factors Affecting Discharge to Home of Medical Patients Treated in an Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224324. [PMID: 31698814 PMCID: PMC6887772 DOI: 10.3390/ijerph16224324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to examine the factors affecting the discharge to home of medical patients treated in an intensive care unit, including elements of in-hospital rehabilitation and prehospital movement ability. The participants of this retrospective cohort study were medical patients treated in an intensive care unit (ICU) and who began rehabilitation in ICU. We assessed the participants in the ICU and analyzed data on patient background, hospitalization, and rehabilitation status. There were 155 ICU patients available for analysis. A multivariable logistic regression model identified the four variables of age (OR 1.06, 95% CI 1.02–1.09), APACHE II score (OR 1.12, 95% CI 1.04–1.24), independence in home life before admission (OR 7.10, 95% CI 1.65–30.44), and standing within 5 days of admission (OR 6.58, 95% CI 2.60–16.61) as factors significantly related to discharge from hospital to home. Independence of home life before admission and early start of standing were identified as factors strongly related to discharge to home. The degree of independence in living before hospital admission and progress toward early mobilization are helpful when considering an ICU patient’s discharge destination.
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Young DL, Seltzer J, Glover M, Outten C, Lavezza A, Mantheiy E, Parker AM, Needham DM. Identifying Barriers to Nurse-Facilitated Patient Mobility in the Intensive Care Unit. Am J Crit Care 2019; 27:186-193. [PMID: 29716904 DOI: 10.4037/ajcc2018368] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Nurse-facilitated mobility of patients in the intensive care unit can improve outcomes. However, a gap exists between research findings and their implementation as part of routine clinical practice. Such a gap is often attributed, in part, to the barrier of lack of time. The Translating Evidence Into Practice model provides a framework for research implementation, including recommendations for identifying barriers to implementation via direct observation of clinical care. OBJECTIVES To report on design, implementation, and outcomes of an approach to identify and understand lack of time as a barrier to nurse-facilitated mobility in the intensive care unit. METHODS An interprofessional team designed the observational process and evaluated the resulting data by using qualitative content analysis. RESULTS During three 4-hour observations of 2 nurses and 1 nursing technician, 194 distinct tasks were performed (ie, events). A total of 4 categories of nurses' work were identified: patient care (47% of observation time), provider communication (25%), documentation (18%), and down time (10%). In addition, 3 types of potential mobility events were identified: in bed, edge of bed, and out of bed. The 194 observed events included 34 instances (18%) of potential mobility events that could be implemented: in bed (53%), edge of bed (6%), and out of bed (41%). CONCLUSIONS Nurses have limited time for additional clinical activities but may miss potentially important opportunities for facilitating patient mobility during existing patient care. The proposed method is feasible and helpful in empirically investigating barriers to nurse-facilitated patient mobility in the intensive care unit.
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Affiliation(s)
- Daniel L Young
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Jason Seltzer
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Mary Glover
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Caroline Outten
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Annette Lavezza
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Earl Mantheiy
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Ann M Parker
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University
| | - Dale M Needham
- Daniel L. Young is an associate professor, Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada, and a visiting scientist, Department of Physical Medicine and Rehabilitation, and Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland. Jason Seltzer is intensive care unit rehabilitation team coordinator, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital, Baltimore, Maryland. Annette Lavezza is therapy manager, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins Hospital. Mary Glover is a nurse clinician, medical intensive care unit, Johns Hopkins Hospital. Caroline Outten is a nurse clinician, Department of Medicine, Johns Hopkins Hospital. Earl Mantheiy is senior clinical coordinator, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Ann M. Parker is an assistant professor, Division of Pulmonary and Critical Care Medicine, and OACIS Group, Johns Hopkins University. Dale M. Needham is a professor, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, and OACIS Group, Johns Hopkins University.
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Higgins SD, Erdogan M, Coles SJ, Green RS. Early mobilization of trauma patients admitted to intensive care units: A systematic review and meta-analyses. Injury 2019; 50:1809-1815. [PMID: 31526602 DOI: 10.1016/j.injury.2019.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of early mobilization (EM) in trauma patients admitted to the ICU. Outcomes of interest included mortality, hospital and ICU length of stay (LOS), and duration of mechanical ventilation. METHODS We performed a systematic review of 4 electronic databases (Ovid MEDLINE, Embase, CINAHL, Cochrane Library) and the grey literature. Eligible study designs included randomized control trials, prospective cohorts, or retrospective cohorts. Studies must have compared EM to usual care (i.e., delayed or no mobilization) in trauma patients admitted to ICU. Overall, there were 2982 articles screened and 9 were included in the analysis. Two authors independently performed data extraction using a standardized form. Pertinent study design and population characteristics were recorded, as were prespecified outcome measures. Meta-analyses were performed using random effects models. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS Study cohorts ranged from 15 to 1132 patients (median 63) and varied in their inclusion criteria. Most studies utilized a progressive mobility protocol as their intervention. Mortality was reported in 5 studies, of which 3 observed a lower rate with EM; however, meta-analysis showed no difference in mortality between patients mobilized early and those receiving usual care. Eight studies reported on LOS (in-hospital and ICU); although all 8 studies found EM reduced LOS, the difference in LOS was not significant on meta-analysis. Finally, 3 studies reported on ventilator days, all of which observed a reduction in the EM group. On meta-analysis, duration of mechanical ventilation was significantly lower with EM (mean difference -1.18 days, 95% CI, -2.17 - -0.19). CONCLUSIONS Few studies have investigated the effects of EM in trauma ICU patients. The available evidence suggests that patients who receive EM require fewer days of mechanical ventilation, but have similar mortality and LOS compared to those receiving usual care.
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Affiliation(s)
- Sean D Higgins
- Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada; Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Mete Erdogan
- Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Sherry J Coles
- Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada; Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Robert S Green
- Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada; Departments of Emergency Medicine and Critical Care, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
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Santos GO, Queiroz RSD, Jesus CSD, Carneiro JAO, Faria LMDA, Fernandes MH, Matos JMT. Pacientes internados em unidade de terapia intensiva que não adotam postura antigravitacional apresentam maiores chances de óbito. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17027526032019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Ainda há poucos marcadores de desempenho funcional com capacidade de predizer óbito em unidades de terapia intensiva (UTI). O objetivo do presente estudo foi identificar a associação entre a não adoção de postura antigravitacional e óbito em pacientes internados em uma UTI adulto. Trata-se de um estudo retrospectivo e analítico, realizado através da análise de prontuários. A associação entre a não adoção de postura antigravitacional e óbito foi testada por regressão logística múltipla ajustada por sexo, idade, gravidade da doença (mensurada pelo Acute Physiology and Chronic Health Classification System II [Apache II]), tempo de ventilação mecânica invasiva (VMI) e tempo de sedação. A odds ratio (OR) foi estimada com intervalo de confiança de 95%. Foram incluídos no estudo 92 pacientes sequenciais. Houve forte associação entre a não adoção de postura antigravitacional em UTI e óbito (ORajustada=37,7; IC=4,76-293; p=0,001). Conclui-se que pacientes que não adotaram postura antigravitacional durante o internamento em UTI apresentaram chances muito mais elevadas de mortalidade. Essa simples estratégia de classificação da capacidade funcional de pacientes críticos pode ser utilizada rotineiramente por equipes de saúde como uma variável simples e dicotômica de prognóstico de mortalidade em UTI.
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86
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Chen J, Martin C, McIntyre CW, Ball IM, Duffin J, Slessarev M. Impact of Graded Passive Cycling on Hemodynamics, Brain, and Heart Perfusion in Healthy Adults. Front Med (Lausanne) 2019; 6:186. [PMID: 31552250 PMCID: PMC6736571 DOI: 10.3389/fmed.2019.00186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/05/2019] [Indexed: 01/28/2023] Open
Abstract
Purpose: Passive in-bed cycling (PC) can provide the benefits of early mobilization to critically ill patients who are unable to exercise actively. However, the effect of PC on global hemodynamics and perfusion of ischemia-prone organs, such as the brain and the heart, is unknown. Therefore, prior to studying the effects of PC in hemodynamically fragile critically ill patients, we characterized hemodynamic, brain blood flow, and cardiac function responses to a graded increase in PC cadence in a cohort of healthy subjects. Methods: We measured global hemodynamic indices, middle cerebral artery velocity (MCAv), and cardiac function in response to a graded increase in PC cadence. Using 5 min stages, we increased cadence from 5 to 55 RPM in increments of 10 RPM, preceded and followed by 5 min baseline and recovery periods at 0 RPM. The mean values obtained during the last 2 min of each stage were compared within and between subjects for all metrics using repeated measures ANOVA. Results: 11 healthy subjects (6 females) completed the protocol. Between subjects, there was no change in MCAv, cardiac function or hemodynamics with the graded increase in cadence with one exception. There was a 7% increase in mean arterial pressure (MAP) from baseline to 55RPM, that persisted through the recovery period. Across subjects, responses were heterogeneous, with some experiencing reduction in cardiac index, cerebral blood flow (CBF) and cardiac function, especially at higher cadence. Conclusions: In healthy adults, increasing PC cadence increased MAP in all subjects, while cardiac index, CBF, and cardiac function responses varied between subjects. Application of PC to critically ill patients must therefore consider individual variation in responses and tailor the PC to the patient. It is essential to further characterize these responses to PC in the critically ill prior to wide-scale clinical implementation.
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Affiliation(s)
- Jennifer Chen
- Departments of Medical Biophysics, Western University, London, ON, Canada
| | - Claudio Martin
- Departments of Medicine, Western University, London, ON, Canada
| | - Christopher W McIntyre
- Departments of Medical Biophysics, Western University, London, ON, Canada.,Departments of Medicine, Western University, London, ON, Canada
| | - Ian M Ball
- Departments of Medicine, Western University, London, ON, Canada.,Departments of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - James Duffin
- Departmet of Physiology, University of Toronto, Toronto, ON, Canada
| | - Marat Slessarev
- Departments of Medical Biophysics, Western University, London, ON, Canada.,Departments of Medicine, Western University, London, ON, Canada
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Magalhães P, Figueirêdo BB, Vasconcelos A, de Andrade ÉM, Dornelas de Andrade A, Reinaux C. Is transcutaneous electrical muscle stimulation an alternative for preventing acquired muscle weakness in the pediatric intensive care unit? A scoping review. Pediatr Pulmonol 2019; 54:1108-1116. [PMID: 31134767 DOI: 10.1002/ppul.24293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/25/2019] [Accepted: 02/04/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Transcutaneous electrical muscle stimulation (TEMS) has been progressively used as add-on therapy to reduce muscle atrophy in adults unable to carry out active mobilization in the intensive care unit (ICU). There are no studies addressing TEMS in the pediatric ICU. Therefore, we decided to develop a scoping review, a type of knowledge synthesis, which unlike systematic review, identify gaps in the literature to aid the planning and commissioning of future research. OBJECTIVE To provide current perspectives on the application of TEMS for combating pediatric intensive care unit acquired weakness (PICUAW). METHODS Online databases were used to identify papers published 2006-2016, from which we selected those used musculoskeletal and cardiorespiratory performance as a primary or secondary outcome variable in participants under 18 years. RESULTS The publications reported six clinical trials from 218 outpatients with 9.5 ± 8 years old. There were differences in current modulation and duration of TEMS sessions, with a predominance of high intensity and short duration in which a muscle contraction is triggered. The main use of TEMS was in pediatric neurological disorders. TEMS was more effective when compared with SHAM on spasticity, bone mineral density, disability, and gait. One study regarding spine injury showed improvement in VO2 (P = 0.035) when combined cycling with TEMS. CONCLUSION TEMS was an effective and safe treatment for musculoskeletal impairments and cardiorespiratory performance in children with neurological disorders. Although the physiopathology is different in outpatients, an individualized protocol with TEMS might be promising for preventing PICUAW. Its effectiveness, however, deserves further investigation.
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Affiliation(s)
- Paulo Magalhães
- Department of Physical Therapy, Pernambuco University, Petrolina, Pernambuco, Brazil.,Department of Physical Therapy, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | - Alanna Vasconcelos
- Department of Physical Therapy, Pernambuco University, Petrolina, Pernambuco, Brazil
| | | | | | - Cyda Reinaux
- Department of Physical Therapy, Pernambuco University, Petrolina, Pernambuco, Brazil
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Amundadottir OR, Jónasdóttir RJ, Sigvaldason K, Gunnsteinsdottir E, Haraldsdottir B, Sveinsson T, Sigurdsson GH, Dean E. Effects of intensive upright mobilisation on outcomes of mechanically ventilated patients in the intensive care unit: a randomised controlled trial with 12-months follow-up. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2019.1645880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Olof R. Amundadottir
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Physiotherapy, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Rannveig J. Jónasdóttir
- Department of Anaesthesiology and Intensive Care Medicine, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Kristinn Sigvaldason
- Department of Anaesthesiology and Intensive Care Medicine, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Ester Gunnsteinsdottir
- Department of Physiotherapy, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Brynja Haraldsdottir
- Department of Physiotherapy, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Gisli H. Sigurdsson
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Anaesthesiology and Intensive Care Medicine, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland
| | - Elizabeth Dean
- School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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Abstract
BACKGROUND Safe Patient Handling and Mobility (SPHM) programs reduce staff injuries from lifting and repositioning patients. Early Mobility programs improve many patient-centered outcomes. Reframing SPHM equipment as mobilization tools can help safely mobilize hospitalized patients to their highest abilities. PROBLEM Combining SPHM and Early Mobility programs is logical, but to date, no one has articulated the process of integration. INTERVENTION A quality improvement process was developed at the Phoenix Veterans Affairs Health Care System to integrate an Early Exercise and Progressive Mobility initiative in the intensive care unit into an ongoing SPHM program using the Iowa Model for Evidence-Based Implementation. RESULTS Integration of these programs was possible through extensive collaboration between stakeholders throughout planning, implementation, and refinement phases. Interdisciplinary Early Exercise and Progressive Mobility simulation training, standardized assessment, communication of patient status, and appropriate equipment use facilitated staff confidence to safely mobilize patients. CONCLUSIONS Successful integration of Early Exercise and Progressive Mobility and SPHM was achieved at the Phoenix Veterans Affairs Health Care System.
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Piva TC, Ferrari RS, Schaan CW. Early mobilization protocols for critically ill pediatric patients: systematic review. Rev Bras Ter Intensiva 2019; 31:248-257. [PMID: 31215603 PMCID: PMC6649221 DOI: 10.5935/0103-507x.20190038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/01/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the existing early mobilization protocols in pediatric intensive care units. METHODS A systematic literature review was performed using the databases MEDLINE®, Embase, SciELO, LILACS and PeDRO, without restrictions of date and language. Observational and randomized and nonrandomized clinical trials that described an early mobilization program in patients aged between 29 days and 18 years admitted to the pediatric intensive care unit were included. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Scale, Methodological Index for Non-Randomized Studies and the Cochrane Collaboration. RESULTS A total of 8,663 studies were identified, of which 6 were included in this review. Three studies described the implementation of an early mobilization program, including activities such as progressive passive mobilization, positioning, and discussion of mobilization goals with the team, in addition to contraindications and interruption criteria. Cycle ergometer and virtual reality games were also used as resources for mobilization. Four studies considered the importance of the participation of the multidisciplinary team in the implementation of early mobilization protocols. CONCLUSION In general, early mobilization protocols are based on individualized interventions, depending on the child's development. In addition, the use of a cycle ergometer may be feasible and safe in this population. The implementation of institutional and multidisciplinary protocols may contribute to the use of early mobilization in pediatric intensive care units; however, studies demonstrating the efficacy of such intervention are needed.
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Affiliation(s)
- Taila Cristina Piva
- Programa de Residência Integrada Multiprofissional em Saúde da Criança, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Renata Salatti Ferrari
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Camila Wohlgemuth Schaan
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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91
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Ragland C, Ochoa L, Hartjes T. Early mobilisation in intensive care during renal replacement therapy: A quality improvement project. Intensive Crit Care Nurs 2019; 52:22-27. [DOI: 10.1016/j.iccn.2018.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/26/2018] [Accepted: 12/21/2018] [Indexed: 11/17/2022]
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92
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Dellafiore F, Arrigoni C, Ghizzardi G, Baroni I, Conte G, Turrini F, Castiello G, Magon A, Pittella F, Caruso R. Development and validation of the pressure ulcer management self-efficacy scale for nurses. J Clin Nurs 2019; 28:3177-3188. [PMID: 30938908 DOI: 10.1111/jocn.14875] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/09/2019] [Accepted: 03/23/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND Pressure ulcers (PUs) represent a current issue for healthcare delivery. Nurse self-efficacy in managing PUs could predict patients' outcome, being a proxy assessment of their overall competency to managing PUs. However, a valid and reliable scale of this task-specific self-efficacy has not yet been developed. OBJECTIVES To develop a valid and reliable scale to assess nurses' self-efficacy in managing PUs, that is, the pressure ulcer management self-efficacy scale for nurses (PUM-SES). METHODS This study had a multi-method and multi-phase design, where study reporting was supported by the STROBE checklist (File S1). Phase 1 referred to the scale development, consisting in the items' generation, mainly based on themes emerged from the literature and discussed within a panel of experts. Phase 2 focused on a three-step validation process: the first step aimed to assess face and content validity of the pool of items previously generated (initial version of the PUM-SES); the second aimed to assess psychometrics properties through exploratory factorial analysis; the third step assessed construct validity through confirmative factorial analysis, while concurrent validity was evaluated describing the relationships between PUM-SES and an established general self-efficacy measurement. Reliability was assessed through the evaluation of stability and internal consistency. RESULTS PUM-SES showed evidence of face and content validity, adequate construct and concurrent validity, internal consistency and stability. Specifically, PUM-SES had four domains, labelled as follows: assessment, planning, supervision and decision-making. These domains were predicted by the same second-order factor, labelled as PU management self-efficacy. CONCLUSION PUM-SES is a 10-item scale to measure nurses' self-efficacy in PU management. A standardised 0-100 scoring is suggested for computing each domain and the overall scale. PUM-SES might be used in clinical and educational research. RELEVANCE TO CLINICAL PRACTICE Optimising nurses' self-efficacy in PU management might enhance clinical assessment, determining better outcomes in patients with PUs.
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Affiliation(s)
- Federica Dellafiore
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Cristina Arrigoni
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Greta Ghizzardi
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Irene Baroni
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gianluca Conte
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesca Turrini
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Gianluca Castiello
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Arianna Magon
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Pittella
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Rosario Caruso
- Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Milan, Italy
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93
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Ratcliffe J, Williams B. Impact of a Mobility Team on Intensive Care Unit Patient Outcomes. Crit Care Nurs Clin North Am 2019; 31:141-151. [PMID: 31047089 DOI: 10.1016/j.cnc.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mobility for critically ill patients has been found to be safe, beneficial, and feasible, although a culture of immobility prevails in many adult intensive care units (ICU) because of staffing challenges and lack of physical therapy and occupational therapy involvement. Clinical practice guidelines recommended early mobility for ICU patients to improve long- and short-term outcomes. Addition of a mobility team to the licensed physical therapy and occupational therapy staff and interprofessional ICU team improved patient outcomes and staff satisfaction, and reduced facility cost related to employee injuries.
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94
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Stout K, Ankam NS, Athar MK, Bu P, Dabbish NS, Leiby BE, Melnyk S, Shah SO, Tarkiainen A. Early Mobilization of Patients With External Ventricular Drains: Does Therapist Experience Matter? JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2019. [DOI: 10.1097/jat.0000000000000096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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95
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Nurse-Initiated Mobilization Practices in 2 Community Intensive Care Units: A Pilot Study. Dimens Crit Care Nurs 2019; 37:318-323. [PMID: 30273218 DOI: 10.1097/dcc.0000000000000320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Critical-care nurses play a vital role in promoting safe early mobilization in intensive care unit (ICU) settings to reduce the risks associated with immobility in ICUs, including the risk of delirium, ICU-acquired weakness, and functional decline. OBJECTIVE The purposes of this study were to describe nurse-led mobilization practices in 2 community hospital ICUs and to report differences and similarities between the 2 settings. METHODS This was a cross-sectional exploratory study of 18 nurses (ICU A: n = 12, ICU B: n = 6) and 124 patients (ICU A: n = 50, ICU B: n = 74). Patient-specific therapeutic intervention needs and nurse-initiated mobilization practices were tracked over a 1-month period. RESULTS Differences in patient characteristics and nurse-led mobilization activities were observed between ICUs. After controlling for patient characteristics, we found statistically significant differences in nurse-led mobilization activities between the 2 units, suggesting that factors other than patient characteristics may explain differences in nurse-led mobilization practices.
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96
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Chiarici A, Andrenelli E, Serpilli O, Andreolini M, Tedesco S, Pomponio G, Gallo MM, Martini C, Papa R, Coccia M, Ceravolo MG. An Early Tailored Approach Is the Key to Effective Rehabilitation in the Intensive Care Unit. Arch Phys Med Rehabil 2019; 100:1506-1514. [PMID: 30796918 DOI: 10.1016/j.apmr.2019.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/04/2019] [Accepted: 01/19/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the effectiveness, feasibility, and safety of an evidence-based rehabilitation care pathway in the intensive care unit (ICU) in different patient populations. DESIGN Observational prospective cohort study, with retrospective controls. SETTING ICUs of a university hospital. PARTICIPANTS Patients admitted between April 1, 2015, and June 30, 2015, were compared to a retrospective cohort admitted to the same ICUs during the same 3-month period in 2014. The number of patients studied (N=285) included 152 in the prospective group and 133 in the retrospective group. INTERVENTIONS The prospective cohort benefited of a rehabilitation care pathway based on (1) interdisciplinary teamwork; (2) early customized and goal-oriented rehabilitation; (3) daily functional monitoring and treatment revision; (4) agreed discharge policy; and (5) continuity of care. The retrospective cohort underwent usual care. MAIN OUTCOME MEASURES Included the following: (1) proportions of patients undergoing rehabilitation team evaluation; (2) latency between patient admission to ICUs and rehabilitation team assessment; (3) proportions of patients undergoing rehabilitation treatment during ICU stay; (4) latency between the patient admission to ICUs and rehabilitation start; (5) ICU stay and total acute hospital stay; and (5) proportion of ventilator-free days out of ICU stay. RESULTS The novel rehabilitation care pathway led to (1) an increased proportion of patients receiving rehabilitative assessment (P<.0001); (2) a decreased latency from ICU admission to both rehabilitation team assessment and rehabilitation start (P<.0001); (3) an increased proportion of patients undergoing rehabilitation (P<.0001); (4) a shorter length of stay in ICUs (P<.0001) and in hospital (P=.047); and (5) a shorter mechanical ventilation duration (P<.02). A direct relationship between rehabilitation start latency and ICU length of stay was observed. CONCLUSIONS An early, interdisciplinary team approach, providing a customized dynamic planning of physiotherapy programs, increases ventilator-free time and reduces total hospital stay, especially in patients admitted to the ICU after general surgery. This rehabilitation care pathway can be generalized to different geopolitical scenarios, being feasible, safe and cost effective.
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Affiliation(s)
- Alice Chiarici
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy.
| | - Oletta Serpilli
- Neurorehabilitation Clinic, United Hospitals of Ancona, Ancona, Italy
| | - Matteo Andreolini
- Neurorehabilitation Clinic, United Hospitals of Ancona, Ancona, Italy
| | - Silvia Tedesco
- Department of Clinical and Molecular Science, Internal Medicine, Marche Polytechnic University, Ancona, Italy
| | - Giovanni Pomponio
- Department of Clinical and Molecular Science, Internal Medicine, Marche Polytechnic University, Ancona, Italy
| | - Maria Mattea Gallo
- Clinical Management Directorate, United Hospitals of Ancona, Ancona, Italy
| | - Claudio Martini
- Clinical Management Directorate, United Hospitals of Ancona, Ancona, Italy
| | - Roberto Papa
- Clinical Management Directorate, United Hospitals of Ancona, Ancona, Italy
| | - Michela Coccia
- Neurorehabilitation Clinic, United Hospitals of Ancona, Ancona, Italy
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy
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97
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Abstract
OBJECTIVE To evaluate the impact of early mobilization after pediatric liver transplantation in the PICU. DESIGN A 70-month retrospective before-after study. SETTING Medical and surgical PICU with 20 beds at a tertiary children's hospital. PATIENTS Seventy-five patients 2-18 years old who underwent liver transplantation and could walk before surgery. INTERVENTION We meticulously planned and implemented an early mobilization intervention, a multifaceted framework for early mobilization practice in the PICU focusing on a multidisciplinary team approach. MEASUREMENTS AND MAIN RESULTS There was a significant increase in the proportion of patients who received physical therapy in the PICU (66% vs 100%; p < 0.001), especially within the first 48 hours after transplantation (9% vs 78%; p < 0.001). Furthermore, the time spent for physical therapy per eligible patient and per eligible PICU day increased (8.1 min [interquartile range, 0-10.6 min] vs 17.4 min [13.2-26.6 min]; p < 0.001). Compared with patients in the pre-early mobilization period, patients in the post-early mobilization period were able to walk again for more than 50 yards without a rolling walker earlier (28 [16-66] vs 23 [19-31] postoperative days; p = 0.015 by the Gray test), and the length of hospital stay of the post-early mobilization group was shorter than that of the pre-early mobilization group (55 [37-99] vs 40 [31-54] postoperative days; p = 0.012). CONCLUSIONS Through implementation of early mobilization for pediatric patients who underwent liver transplantation, the duration from liver transplantation to regaining the ability to walk again without a rolling walker became shorter. Early mobilization intervention was beneficial for pediatric patients who underwent liver transplantation and could walk before surgery.
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98
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Yue M, Ma ZY, Lei MJ, Cui CY, Jin Y. Early mobilization for mechanically ventilated patients in the intensive care unit: a systematic review and meta-analysis. FRONTIERS OF NURSING 2018. [DOI: 10.1515/fon-2018-0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Abstract
Background
Early mobilization (EM) is a regimen that was carried out by physiotherapists in a relatively early stage. It has been investigated by an increasing number of researchers. However, there has not been a meta-analysis concerning whether EM could benefit the clinical outcomes of critically ill patients requiring mechanical ventilation (MV). The present systematic review aims to evaluate the effect of EM compared with immobilization for mechanically ventilated patients.
Methods
A computerized literature search was performed in six databases for related articles from inception to June 2017. We included randomized controlled trials and controlled clinical trials and used the Physiotherapy Evidence Database scale to assess the quality of included studies. Primary outcomes were measures of muscle function, duration of MV, and incidence of mortality. Secondary outcomes were adverse effects and length of stay (LOS) in intensive care unit (ICU) and hospital.
Results
Eight trials were included; of those, only one study without standard EM reported that the intervention was invalid to improve the outcomes. The result of meta-analysis indicated that EM shortened the duration of MV; however, it had no positive effect on mortality and LOS in ICU.
Conclusions
This review suggests that EM improves the muscle function and ventilation duration. Further research highlighting standard intervention and specific groups is needed.
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Affiliation(s)
- Meng Yue
- Department of Nursing, Tianjin Huanhu Hospital , Tianjin , Tianjin 300350 , China
| | - Zhan-Ying Ma
- Department of Nursing, Tianjin Huanhu Hospital , Tianjin , Tianjin 300350 , China
| | - Meng-Jie Lei
- Graduate College, Tianjin University of Traditional Chinese Medicine , Tianjin , Tianjin 300193 , China
| | - Chu-Yun Cui
- Graduate College, Tianjin University of Traditional Chinese Medicine , Tianjin , Tianjin 300193 , China
| | - Yi Jin
- Department of Nursing, Tianjin Huanhu Hospital , Tianjin , Tianjin 300350 , China
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99
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Zhu YP, Xia LX, Li GH. Management of early mobilization in intensive care units: a multicenter cross-sectional study. FRONTIERS OF NURSING 2018. [DOI: 10.1515/fon-2018-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
The aim of this study was to assess the management of early mobilization (EM) in Chinese intensive care units (ICUs).
Methods
This survey used a cross-sectional, observational design. A total of 65 tertiary and secondary hospitals were enrolled by convenience sampling and investigated using self-designed questionnaires.
Results
We identified 69 ICUs in Jiangsu, China (response rate: 94.2%). 74.2% (1,004/1,353) of the nurses and nursing managers from 65 ICUs reported mobility practice. For the mobility level, 98.1% (1,327) reported use of in-bed exercise, 5.7% (77) sitting on a side of bed, 21.7% (294) transfer to chair, and 2.4% (33) walking. The most frequently reported barriers to early mobility were unplanned extubation, nursing resource, and absence of physical therapist. Nurses’ educational backgrounds, nursing experience, the lack of nursing resources, absence of physician, and the weakness of patient were the factors that influenced ICU early rehabilitation (P<0.01).
Conclusions
Although implementation rates for EM in critically ill patients are high, the activity level is generally poor in most of the involved ICUs.
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Affiliation(s)
- Yan-Ping Zhu
- Intensive Care Units, Zhongda Hospital , Southeast University , Nanjing , Jiangsu 210009 , China
| | - Li-Xia Xia
- Department of Nursing , Jiangsu Provincial Hospital , Nanjing , Jiangsu 210009 , China
| | - Guo-Hong Li
- Department of Nursing , Zhongda Hospital , Southeast University , Nanjing , Jiangsu 210009 , China
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100
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Shinoda T, Nishihara H, Shimogai T, Ito T, Takimoto R, Seo R, Kanai M, Izawa KP, Iwata K. Relationship between Ventilator-Associated Events and Timing of Rehabilitation in Subjects with Emergency Tracheal Intubation at Early Mobilization Facility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15122892. [PMID: 30562993 PMCID: PMC6313321 DOI: 10.3390/ijerph15122892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/12/2018] [Accepted: 12/14/2018] [Indexed: 11/24/2022]
Abstract
The present study aimed to investigate the relationship between the occurrence of ventilator-associated events (VAE) in the intensive care unit and the timing of rehabilitation intervention. We included subjects who underwent emergency tracheal intubation and received rehabilitation. We performed rehabilitation according to our hospital’s protocol. We assessed the mechanical ventilation parameters of inspired oxygen fraction and positive-end expiratory pressure, and a VAE was identified if these parameters stabilized or decreased for ≥2 days and then had to be increased for ≥2 days. We defined time in hours from tracheal intubation to the first rehabilitation intervention as Timing 1 and that to first sitting on the edge of the bed as Timing 2. Data were analyzed by the t-test and χ2 tests. We finally analyzed 294 subjects. VAE occurred in 9.9% and high mortality at 48.3%. Median values of Timing 1 and Timing 2 in the non-VAE and VAE groups were 30.3 ± 24.0 and 30.0 ± 20.7 h, and 125.7 ± 136.6 and 127.9 ± 111.4 h, respectively, and the differences were not significant (p = 0.95 and p = 0.93, respectively). We found no significant relationship between the occurrence of VAE leading to high mortality and timing of rehabilitation intervention.
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Affiliation(s)
- Taku Shinoda
- Department of Rehabilitation, Division of Physical Therapy, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan.
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan.
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan.
| | - Hiromasa Nishihara
- Department of Rehabilitation, Division of Physical Therapy, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan.
| | - Takayuki Shimogai
- Department of Rehabilitation, Division of Physical Therapy, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan.
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan.
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan.
| | - Tsubasa Ito
- Department of Rehabilitation, Division of Physical Therapy, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan.
| | - Ryuya Takimoto
- Department of Rehabilitation, Division of Physical Therapy, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan.
| | - Ryutaro Seo
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan.
| | - Masashi Kanai
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan.
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan.
| | - Kazuhiro P Izawa
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan.
- Cardiovascular Stroke Renal Project (CRP), Kobe 654-0142, Japan.
| | - Kentaro Iwata
- Department of Rehabilitation, Division of Physical Therapy, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan.
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