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Raurell-Torredà M, Regaira-Martínez E, Planas-Pascual B, Ferrer-Roca R, Martí JD, Blazquez-Martínez E, Ballesteros-Reviriego G, Vinuesa-Suárez I, Zariquiey-Esteva G. Early mobilisation algorithm for the critical patient. Expert recommendations. ENFERMERIA INTENSIVA 2021. [PMID: 33745807 DOI: 10.1016/j.enfi.2020.11.001] [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] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. OBJECTIVE To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). METHODOLOGY Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. RESULTS 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. CONCLUSIONS The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.
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Affiliation(s)
- M Raurell-Torredà
- Universidad de Barcelona, Investigadora principal proyecto MoviPre, Barcelona, España
| | - E Regaira-Martínez
- Clínica Universidad de Navarra, Pamplona, España; GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC).
| | - B Planas-Pascual
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, España
| | - R Ferrer-Roca
- Hospital Universitario Vall d'Hebron, Barcelona, España; Presidente de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)
| | - J D Martí
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Clínic de Barcelona, Barcelona, España
| | - E Blazquez-Martínez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario de Bellvitge, L'Hospitalet de Llobgregat, Barcelona, España
| | - G Ballesteros-Reviriego
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, España
| | - I Vinuesa-Suárez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - G Zariquiey-Esteva
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, España
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Yoga-An Alternative Form of Therapy in Patients with Blunt Chest Trauma: A Randomized Controlled Trial. World J Surg 2021; 45:2015-2026. [PMID: 33738521 PMCID: PMC7972014 DOI: 10.1007/s00268-021-06057-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Yoga as alternative form of therapy has shown positive impact on pulmonary functions, exercise capacity, behavioral changes, and inflammation in non-trauma patients. However, the efficacy of Yoga has not been studied in chest trauma patients. METHODS This randomized controlled trial was conducted at level-1 Trauma Centre. Isolated chest injury patients were randomized into either standard physiotherapy or Yogatherapy groups. Patients in physiotherapy group received conventional chest physiotherapy and Yogatherapy group received a set of Yogic exercises in addition to conventional chest physiotherapy. Primary outcome measure was changes in pulmonary function tests (PFT) at 4 weeks of discharge. Secondary outcomes were changes in quality of life (QoL), respiratory muscle strength and endurance, chest wall mobility, and levels of cytokines at 4 weeks. Data were analyzed using STATA v14.0. RESULTS A total of 89 eligible patients were randomized to physiotherapy (n = 46) and Yoga therapy (n = 43) groups. Demographic characteristics were comparable in both the groups. There were statistically significant improvements in PFT in the Yogatherapy group compared with physiotherapy with an increase in Forced vital capacity (p = 0.02) and Forced expiratory volume (p = 0.01) at 4 weeks. In addition, there were significant improvement in physical component of QoL, respiratory muscle endurance (p = 0.003) and axillary cirtometry (p = 0.009) in the Yogatherapy group. However, no statistically significant difference in the trends of cytokine markers seen between the groups. CONCLUSION Yoga was found to be effective in improving pulmonary functions and QoL in patients with chest trauma. (Trial registered at ctri.nic.in/clinicaltrials/login.php, numberREF/2016/05/011,287).
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Wittmer VL, Paro FM, Duarte H, Capellini VK, Barbalho-Moulim MC. Early mobilization and physical exercise in patients with COVID-19: A narrative literature review. Complement Ther Clin Pract 2021; 43:101364. [PMID: 33743391 PMCID: PMC7955568 DOI: 10.1016/j.ctcp.2021.101364] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 02/13/2021] [Accepted: 03/10/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Currently, little is known about early mobilization and exercise in individuals with COVID-19. OBJECTIVE To describe the indication and safety of early mobilization and exercises in mild to severe COVID-19 patients and to investigate the use of telerehabilitation to deliver exercise programs to these patients. METHODS This narrative literature review was conducted performing a comprehensive search of databases. RESULTS 32 articles met the established criteria and the main findings were summarized and described, including indication, contraindication and recommendation for early rehabilitation and exercises prescription. CONCLUSIONS The literature suggests that early mobilization and physical exercise are beneficial for individuals with COVID-19. However, much of what has been published is based on expert opinion due to a lack of randomized trials, which are needed.
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Affiliation(s)
- Veronica Lourenço Wittmer
- Department of Integrated Education on Health, Center of Health Science, Federal University of Espírito Santo (UFES), Vitória, ES, Brazil.
| | - Flavia Marini Paro
- Department of Integrated Education on Health, Center of Health Science, Federal University of Espírito Santo (UFES), Vitória, ES, Brazil.
| | - Halina Duarte
- Department of Integrated Education on Health, Center of Health Science, Federal University of Espírito Santo (UFES), Vitória, ES, Brazil.
| | - Verena Kise Capellini
- Department of Biosciences, Institute of Health and Society, Campus Baixada Santista, Federal University of São Paulo (UNIFESP), Santos, SP, Brazil.
| | - Marcela Cangussu Barbalho-Moulim
- Department of Integrated Education on Health, Center of Health Science, Federal University of Espírito Santo (UFES), Vitória, ES, Brazil.
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Goodwin VA, Allan L, Bethel A, Cowley A, Cross JL, Day J, Drummond A, Hall AJ, Howard M, Morley N, Thompson Coon J, Lamb SE. Rehabilitation to enable recovery from COVID-19: a rapid systematic review. Physiotherapy 2021; 111:4-22. [PMID: 33637294 PMCID: PMC7902208 DOI: 10.1016/j.physio.2021.01.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 12/26/2022]
Abstract
Objectives To establish the evidence for rehabilitation interventions tested in populations of patients admitted to ICU and critical care with severe respiratory illness, and consider whether the evidence is generalizable to patients with COVID-19. Methods The authors undertook a rapid systematic review. Medline (via OvidSP), CINAHL Complete (via EBSCOhost), Cochrane Library, Cochrane Database of Systematic Reviews and CENTRAL (via Wiley), Epistemonikos (via Epistemonikos.org), PEDro (via pedro.org.au) and OTseeker (via otseeker.com) searched to 7 May 2020. The authors included systematic reviews, RCTs and qualitative studies involving adults with respiratory illness requiring intensive care who received rehabilitation to enhance or restore resulting physical impairments or function. Data were extracted by one author and checked by a second. TIDier was used to guide intervention descriptions. Study quality was assessed using Critical Skills Appraisal Programme (CASP) tools. Results Six thousand nine hundred and three titles and abstracts were screened; 24 systematic reviews, 11 RCTs and eight qualitative studies were included. Progressive exercise programmes, early mobilisation and multicomponent interventions delivered in ICU can improve functional independence. Nutritional supplementation in addition to rehabilitation in post-ICU hospital settings may improve performance of activities of daily living. The evidence for rehabilitation after discharge from hospital following an ICU admission is inconclusive. Those receiving rehabilitation valued it, engendering hope and confidence. Conclusions Exercise, early mobilisation and multicomponent programmes may improve recovery following ICU admission for severe respiratory illness that could be generalizable to those with COVID-19. Rehabilitation interventions can bring hope and confidence to individuals but there is a need for an individualised approach and the use of behaviour change strategies. Further research is needed in post-ICU settings and with those who have COVID-19.
Registration: Open Science Framework https://osf.io/prc2y
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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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Hansell L, Milross M, Delaney A, Tian DH, Ntoumenopoulos G. Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: a systematic review. J Physiother 2021; 67:41-48. [PMID: 33353830 DOI: 10.1016/j.jphys.2020.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
QUESTION In mechanically ventilated adults in intensive care, what is the accuracy of lung ultrasound (LUS) for the diagnosis of pleural effusion, lung consolidation and lung collapse when compared with chest radiograph (CXR) and lung auscultation, with computed tomography (CT) as the reference standard? DESIGN Systematic review with meta-analysis of prospective cohort studies. PARTICIPANTS Adult patients admitted to intensive care, with diagnostic uncertainty at enrolment regarding pleural effusion, lung consolidation and/or collapse/atelectasis. INDEX TEST The diagnostic accuracy of LUS as the index test was estimated against CXR and/or lung auscultation as comparators, with thoracic CT scan as the reference standard. OUTCOME MEASURES Measures of diagnostic accuracy. RESULTS Seven eligible studies were identified, five of which (with 253 participants) were included in the meta-analysis. It was found that LUS had a pooled sensitivity of 92% and 91% in the diagnosis of consolidation and pleural effusion, respectively, and pooled specificity of 92% for both pathologies. CXR had a pooled sensitivity of 53% and 42% and a pooled specificity of 78% and 81% in the diagnosis of consolidation and pleural effusion, respectively. A meta-analysis for lung auscultation was not possible, although a single study reported a sensitivity and specificity of 8% and 100%, respectively, for diagnosing consolidation, and a sensitivity and specificity of 42% and 90%, respectively, for diagnosing pleural effusion. CONCLUSION This systematic review with meta-analysis demonstrated high sensitivity of LUS compared with CXR, with similar specificities when diagnosing pleural effusion and lung consolidation/collapse. REGISTRATION PROSPERO CRD42018095555.
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Affiliation(s)
- Louise Hansell
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
| | - Maree Milross
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anthony Delaney
- Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Division of Critical Care, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia; ANZIC Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - David H Tian
- Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
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van der Lee L, Hill AM, Jacques A, Patman S. Efficacy of Respiratory Physiotherapy Interventions for Intubated and Mechanically Ventilated Adults with Pneumonia: A Systematic Review and Meta-Analysis. Physiother Can 2021; 73:6-18. [PMID: 35106019 PMCID: PMC8774958 DOI: 10.3138/ptc-2019-0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Purpose: A systematic review was conducted to investigate the effect of respiratory physiotherapy on mortality, quality of life, functional recovery, intensive care length of stay, duration of ventilation, oxygenation, secretion clearance, and pulmonary mechanics for invasively ventilated adults with pneumonia. Method: Five databases were searched for randomized trials published between January 1995 and November 2018. Study quality was assessed using a standardized Joanna Briggs Institute critical appraisal tool, and Review Manager software was used to pool the studies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the level of certainty of the evidence. Results: A total of 14 studies of moderate quality included 251 subjects with pneumonia. Eight studies were pooled for meta-analysis. Interventions that increased inspiratory volume appeared to benefit secretion clearance by nearly 2 grams (mean difference [MD] 1.97; 95% CI: 0.80, 3.14; very low GRADE evidence) and increase static lung compliance immediately after treatment by more than 5 millilitres/centimetre H20 (MD 5.40 mL/cm H2O; 95% CI: 2.37, 8.43; very low GRADE evidence) or by more than 6 millilitres/centimetre H2O after a 20- to 30-minute delay (MD 6.86 mL/cm H2O; 95% CI: 2.86, 10.86; very low GRADE evidence). No adverse events were found. Conclusions: Respiratory physiotherapy that increases tidal volume may benefit secretion clearance and lung compliance in invasively ventilated adults with pneumonia, but its impact on other outcomes, including mortality, length of stay, and other patient-centred outcomes, is unclear, and further research is required.
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Affiliation(s)
- Lisa van der Lee
- School of Physiotherapy
- Physiotherapy Department, Fiona Stanley Hospital, Murdoch
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, W.A., Australia
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame, Fremantle
- School of Physiotherapy and Exercise Science, Curtin University, Perth, W.A., Australia
| | - Shane Patman
- Physiotherapy Department, Fiona Stanley Hospital, Murdoch
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Alqahtani M, Kashoo F, Alzhrani M, Ahmad F, Seyam MK, Ahmad M, Alhusaini AA, Melam GR, Buragadda S. Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multicentre Cross-Sectional Survey. Crit Care Res Pract 2020; 2020:6610027. [PMID: 33457013 PMCID: PMC7785395 DOI: 10.1155/2020/6610027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia. AIM To determine the current standard of ICU PT practice, attitude, and barriers. METHODS A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU. RESULTS The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (n = 111, 89%) and stroke (n = 102, 82.3%) as compared to congestive heart failure (n = 20, 16.1%) and pulmonary infections (n = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (n = 102, 82.2%) and positioning (n = 73, 58.8%), whereas functional electrical stimulation (n = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (n = 89, 71.7%) followed by inadequate training (n = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (n = 8, 6.4%). CONCLUSION PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.
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Affiliation(s)
- Mazen Alqahtani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Faizan Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Msaad Alzhrani
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Fuzail Ahmad
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mohammed K. Seyam
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Mehrunnisha Ahmad
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Adel A. Alhusaini
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ganeswara Rao Melam
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Syamala Buragadda
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Matsuki R, Kojima N, Watanabe K, Hotta A, Kubori Y, Oura K, Morisawa T, Koyama H, Ebisu T, Hashino T. Impact of a Rehabilitation Protocol and a Dedicated Therapist in the Intensive Care Unit on Physical Function and Activities of Daily Living. Prog Rehabil Med 2020; 5:20200027. [PMID: 33163685 PMCID: PMC7641868 DOI: 10.2490/prm.20200027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/21/2020] [Indexed: 01/23/2023] Open
Abstract
Objectives: The goal of this study was to determine the effects of an intensive care unit (ICU) rehabilitation protocol with dedicated therapists on the physical function and activities of daily living (ADL) of patients on discharge from the ICU. Methods: This retrospective study included patients who started rehabilitation during their ICU stay. Patients were divided into three groups: the Usual Care group (before the introduction of the rehabilitation protocol), the Protocol group (after the introduction of the rehabilitation protocol), and the PT + Protocol group (with a dedicated therapist in addition to the rehabilitation protocol). The standard interventions in the Protocol group and the PT + Protocol group were set according to the protocol based on the level of consciousness and strength of each individual patient. Patients’ age, APACHE II score, length of ICU stay, length of hospital stay, and the Functional Status Score for the ICU (FSS-ICU) and Medical Research Council score (MRC score) on discharge from the ICU were compared among the three groups. Results: There were no significant differences among the three groups in age and APACHE II score. The MRC and FSS-ICU scores were significantly higher in the PT + Protocol and Protocol groups than in the Usual Care group. Furthermore, the lengths of ICU stay and hospital stay were lower in the PT + Protocol group than in the Usual Care group. Conclusions: Introduction of the rehabilitation protocol improved the limb strength and ADL of patients. Moreover, the presence of dedicated therapists in addition to the protocol reduced the lengths of ICU and hospital stays.
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Affiliation(s)
- Ryosuke Matsuki
- Department of Rehabilitation Medicine, Kansai Electric Power Hospital, Osaka, Japan.,Division of Rehabilitation Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan
| | - Noriaki Kojima
- Department of Rehabilitation Medicine, Kansai Electric Power Hospital, Osaka, Japan.,Division of Rehabilitation Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan
| | - Koki Watanabe
- Department of Rehabilitation Medicine, Kansai Electric Power Hospital, Osaka, Japan
| | - Akira Hotta
- Department of Rehabilitation Medicine, Kansai Electric Power Hospital, Osaka, Japan
| | - Yohei Kubori
- Department of Rehabilitation Medicine, Kansai Electric Power Hospital, Osaka, Japan
| | - Keisuke Oura
- Department of Rehabilitation Medicine, Kansai Electric Power Hospital, Osaka, Japan.,Division of Rehabilitation Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan
| | - Tomoyuki Morisawa
- Faculty of Health Science, Department of Physical Therapy, Juntendo University, Tokyo, Japan
| | - Hidehiko Koyama
- Division of Rehabilitation Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan.,Department of Critical Care Center, Kansai Electric Power Hospital, Osaka, Japan
| | - Toshihiko Ebisu
- Department of Rehabilitation Medicine, Kansai Electric Power Hospital, Osaka, Japan.,Division of Rehabilitation Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan
| | - Takuya Hashino
- Division of Rehabilitation Medicine, Kansai Electric Power Medical Research Institute, Osaka, Japan.,Department of Critical Care Center, Kansai Electric Power Hospital, Osaka, Japan
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Battaglini D, Robba C, Caiffa S, Ball L, Brunetti I, Loconte M, Giacobbe DR, Vena A, Patroniti N, Bassetti M, Torres A, Rocco PR, Pelosi P. Chest physiotherapy: An important adjuvant in critically ill mechanically ventilated patients with COVID-19. Respir Physiol Neurobiol 2020; 282:103529. [PMID: 32818606 PMCID: PMC7430249 DOI: 10.1016/j.resp.2020.103529] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/06/2020] [Accepted: 08/12/2020] [Indexed: 02/08/2023]
Abstract
In late 2019, an outbreak of a novel human coronavirus causing respiratory disease was identified in Wuhan, China. The virus spread rapidly worldwide, reaching pandemic status. Chest computed tomography scans of patients with coronavirus disease-2019 (COVID-19) have revealed different stages of respiratory involvement, with extremely variable lung presentations, which require individualized ventilatory strategies in those who become critically ill. Chest physiotherapy has proven to be effective for improving long-term respiratory physical function among ICU survivors. The ARIR recently reported the role of chest physiotherapy in the acute phase of COVID-19, pointing out limitation of some procedures due to the limited experience with this disease in the ICU setting. Evidence on the efficacy of chest physiotherapy in COVID-19 is still lacking. In this line, the current review discusses the important role of chest physiotherapy in critically ill mechanically ventilated patients with COVID-19, around the weaning process, and how it can be safely applied with careful organization, including the training of healthcare staff and the appropriate use of personal protective equipment to minimize the risk of viral exposure.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Medicine, University of Barcelona (UB), Barcelona, Spain.
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Salvatore Caiffa
- Intensive Care Respiratory Physiotherapy, Rehabilitation and Functional Education, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Iole Brunetti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Maurizio Loconte
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Nicolò Patroniti
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Antoni Torres
- Department of Medicine, University of Barcelona (UB), Barcelona, Spain; Division of Animal Experimentation, Department of Pulmonology, Hospital Clinic, Barcelona, Spain; Centro de investigacion en red de enfermedades respiratorias (CIBERES), Madrid, Spain; Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Patricia Rm Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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Spanish Experience of Pulmonary Rehabilitation Efficacy for Patients Affected by the Novel SARS-CoV-2 (COVID-19). TOPICS IN GERIATRIC REHABILITATION 2020. [DOI: 10.1097/tgr.0000000000000283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, Pandit U, Shetye JV, Diwate A, Damke U, Ravindra S, Patil P, Nagarwala RM, Gaikwad P, Agarwal S, Madan K, Jacob P, Surendran PJ, Swaminathan N. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020; 24:905-913. [PMID: 33281313 PMCID: PMC7689134 DOI: 10.5005/jp-journals-10071-23564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND With the Wuhan pandemic spread to India, more than lakhs of population were affected with COVID-19 with varying severities. Physiotherapists participated as frontline workers to contribute to management of patients in COVID-19 in reducing morbidity of these patients and aiding them to road to recovery. With infrastructure and patient characteristics different from the West and lack of adequate evidence to existing practices, there was a need to formulate a national consensus. MATERIALS AND METHODS Recommendations were formulated with a systematic literature search and feedback of physiotherapist experiences. Expert consensus was obtained using a modified Delphi method. RESULTS The intraclass coefficient of agreement between the experts was 0.994, significant at p < 0.001. CONCLUSION This document offers physiotherapy evidence-based consensus and recommendation to planning physiotherapy workforce, assessment, chest physiotherapy, early mobilization, preparation for discharge planning, and safety for patients and therapist in acutec are COVID 19 setup of India. The recommendations have been integrated in the algorithm and are intended to use by all physiotherapists and other stakeholders in management of patients with COVID-19 in acute care settings. HOW TO CITE THIS ARTICLE Jiandani MP, Agarwal B, Baxi G, Kale S, Pol T, Bhise A, et al. Evidence-based National Consensus: Recommendations for Physiotherapy Management in COVID-19 in Acute Care Indian Setup. Indian J Crit Care Med 2020;24(10):905-913.
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Affiliation(s)
- Mariya P Jiandani
- Physiotherapy School and Centre, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Bela Agarwal
- Department of Physiotherapy, MGM School of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Gaurang Baxi
- Department of Physiotherapy, Dr. DY Patil College of Physiotherapy, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India
| | - Sudeep Kale
- Department of Cardiorespiratory Physiotherapy, Terna Physiotherapy College, Navi Mumbai, Maharashtra, India
| | - Titiksha Pol
- Department of Physiotherapy, DY Patil University, School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | - Anjali Bhise
- Department of Physiotherapy, Government Physiotherapy College and Spine Institute, Civil Hospital, Ahmedabad, Gujarat, India
| | - Unnati Pandit
- Department of Physiotherapy, DY Patil University, School of Physiotherapy, Navi Mumbai, Maharashtra, India
| | - Jaimala V Shetye
- Physiotherapy School and Centre, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India
| | - Abhijit Diwate
- Department of Physiotherapy, Dr. Vithalrao Vikhe Patil Foundations College of Physiotherapy, Ahmednagar, Maharashtra, India
| | - Umanjali Damke
- Physiotherapy School and Center, Government Medical College, Nagpur, Maharashtra, India
| | - Savita Ravindra
- COO-Centre for Rehabilitation, M.S. Ramaiah Medical College and Hospitals, Bengaluru, Karnataka, India
| | - Prajakta Patil
- Department of Cardiorespiratory Physiotherapy, Smt. Kashibai Navale College of Physiotherapy, Pune, Maharashtra, India
| | - Raziya M Nagarwala
- Cardiovascular and Respiratory Physiotherapy Department, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
| | - Pratibha Gaikwad
- Department of Physiotherapy, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra, India
| | | | - Kushal Madan
- Department of Cardiology, Dharma Vira Heart Center, Sir Ganga Ram Hospital, New Delhi, India
| | - Prasobh Jacob
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Praveen J Surendran
- Cardiac Rehabilitation Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Narasimman Swaminathan
- Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Yasmeen I, Krewulak KD, Grant C, Stelfox HT, Fiest KM. The Effect of Caregiver-Mediated Mobility Interventions in Hospitalized Patients on Patient, Caregiver, and Health System Outcomes: A Systematic Review. Arch Rehabil Res Clin Transl 2020; 2:100053. [PMID: 33543080 PMCID: PMC7853382 DOI: 10.1016/j.arrct.2020.100053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To synthesize the evidence examining caregiver-mediated mobility interventions in a hospital setting and whether they improve patient, caregiver, or health system outcomes. DATA SOURCES We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases from inception to September 7, 2018. STUDY SELECTION Two reviewers independently selected original research in inpatient settings that reported on an intervention delivered by a caregiver (eg, family, friend, paid worker) and directed to the patient's mobility. Mobility interventions were categorized based on the level of caregiver engagement using a 3-category framework: inform (provision of education on patient's condition and management), activate (prompting caregivers to take action in patient care), and collaborate (encouraging interaction with providers or other caregivers). DATA EXTRACTION One reviewer extracted data, and another checked the data. Quality was assessed using the Cochrane Collaboration's risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluation approach. DATA SYNTHESIS Forty studies met the inclusion criteria; most were randomized controlled trials (n=16/40, 40.0%) and investigated older adults (n=18/40, 45.0%) with stroke (n=20/40, 50.0%). Inform (n=2) and activate (n=4) interventions and combined inform-activate (n=5/6, 83.3%) and inform-activate-collaborate (n=6/10, 60.0%) interventions were reported to improve patient mobility. Inform-activate and inform-collaborate interventions were reported to improve caregiver outcomes (eg, burden) (n=13/19, 68.4%). Studies that engaged caregivers in all 3 strategies (inform-activate-collaborate) were reported to improve health system outcomes (eg, hospital readmission) (n=4/6, 66.7%). Most studies were of unclear (n=22/40, 55.0%) or low risk of bias (n=11/40, 27.5%) for most domains. CONCLUSIONS Engaging caregivers in mobility of hospitalized patients may improve patient mobility as well as caregiver and health system outcomes.
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Affiliation(s)
- Israt Yasmeen
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D. Krewulak
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Grant
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Kirsten M. Fiest
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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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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Greve JMD, Brech GC, Quintana M, Soares ALDS, Alonso AC. IMPACTS OF COVID-19 ON THE IMMUNE, NEUROMUSCULAR, AND MUSCULOSKELETAL SYSTEMS AND REHABILITATION. REV BRAS MED ESPORTE 2020. [DOI: 10.1590/1517-869220202604esp002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
ABSTRACT The new coronavirus, which causes the infectious disease named COVID-19 by the World Health Organization (WHO), was notified in 2020 in China. The main clinical manifestations in infected patients are fever, cough and dyspnoea. These patients are prone to developing cardiac changes, diffuse myopathy, decreased pulmonary function, decreased inspiratory muscle strength, and a deterioration in functional capacity. Thus, it is expected that patients affected by COVID-19 will suffer musculoskeletal consequences as a result of the inflammatory process and loss of muscle mass caused by immobility, generating motor incapacities that are not yet quantifiable. It is important to understand the clinical implications caused by COVID-19, in order to have better rehabilitation strategies for these patients. The aim of this study was to conduct a reflective analysis of the impact of COVID-19 on the immune, neuromuscular and musculoskeletal systems, and its rehabilitation process. This is a reflexive analysis, developed in the Laboratory for the Study of Movement of the Institute of Orthopaedics’ and Traumatology, at the Universidade de São Paulo School of Medicine, SP, Brazil. In this analysis, we reflect on the following topics related to COVID-19: immunological mechanisms, impact on the neuromuscular and musculoskeletal systems, and the rehabilitation of patients. Level of evidence V; Opinion of the specialist.
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Affiliation(s)
| | | | - Marília Quintana
- Universidade São Judas Tadeu, Brazil; Universidade Anhembi Morumbi, Brazil
| | | | - Angelica Castilho Alonso
- Universidade de São Paulo, Brazil; Universidade São Judas Tadeu, Brazil; Universidade Anhembi Morumbi, Brazil
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66
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Martí JD, McWilliams D, Gimeno-Santos E. Physical Therapy and Rehabilitation in Chronic Obstructive Pulmonary Disease Patients Admitted to the Intensive Care Unit. Semin Respir Crit Care Med 2020; 41:886-898. [PMID: 32725615 DOI: 10.1055/s-0040-1709139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive lung condition that affects a person's ability to exercise and undertake normal physical function due to breathlessness, poor physical fitness, and muscle fatigue. Patients with COPD often experience exacerbations due to pulmonary infections, which result in worsening of their symptoms, more loss of function, and often require hospital treatment or in severe cases admission to intensive care units. Recovery from such exacerbations is often slow, and some patients never fully return to their previous level of activity. This can lead to permanent disability and premature death.Physical therapists play a key role in the respiratory management and rehabilitation of patients admitted to intensive care following acute exacerbation of COPD. This article discusses the key considerations for respiratory management of patients requiring invasive mechanical ventilation, providing an evidence-based summary of commonly used interventions. It will also explore the evidence to support the introduction of early and structured programs of rehabilitation to support recovery in both the short and the long term, as well as active mobilization, which includes strategies to minimize or prevent physical loss through early retraining of both peripheral and respiratory muscles.
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Affiliation(s)
- Joan Daniel Martí
- Cardiovascular Surgery Intensive Care Unit, Hospital Clínic de Barcelona, Spain
| | - David McWilliams
- Therapy Services, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
| | - Elena Gimeno-Santos
- Respiratory Department, Hospital Clinic de Barcelona, Spain.,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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67
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Laurent H, Aubreton S, Vallat A, Pereira B, Souweine B, Constantin JM, Coudeyre E. Very early exercise tailored by decisional algorithm helps relieve discomfort in ICU patients: an open-label pilot study. Eur J Phys Rehabil Med 2020; 56:756-763. [PMID: 32667148 DOI: 10.23736/s1973-9087.20.06274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Existing algorithms do not allow for setting up finely tuned progression or intensity for exercise training in intensive care units (ICUs). AIM We aimed to assess the feasibility and tolerance of a very early exercise program tailored by using decisional algorithm that integrated both progression and intensity. DESIGN Open-label pilot study. SETTING ICU. POPULATION Thirty adults hospitalized in ICU. METHODS Once a day, patients performed manual range of motion, cycloergometry, and functional training exercises. The progression and intensity of training were standardized by using the constructed algorithm. The main outcome, discomfort on a 0-100 Visual Analog Scale, was assessed before and after each exercise session. Secondary outcomes were muscle strength, ICU length of stay and adverse events related to exercise. RESULTS Overall, 125 exercise sessions were performed. Discomfort during exercise sessions decreased significantly by the fifth session (P=0.049). Early exercise sessions were feasible and did not produce major adverse events. CONCLUSIONS We confirmed the safety and feasibility of very early exercise programs in ICUs. Early exercise tailored by using a decisional algorithm helps relieve the discomfort of ICU patients. CLINICAL REHABILITATION IMPACT In everyday practice, the use of decisional algorithms should be encouraged to initiate and standardize early exercise in ICUs.
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Affiliation(s)
- Hélène Laurent
- Unit of Human Nutrition (UNH), University of Clermont Auvergne, National Institute for Research on Agriculture (INRAE), Clermont-Ferrand, France - .,Service of Physical and Rehabilitation Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France -
| | - Sylvie Aubreton
- Service of Physical and Rehabilitation Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Aurélie Vallat
- Service of Physical and Rehabilitation Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Bruno Pereira
- Center for Clinical Research and Innovation (DRCI), Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Bertrand Souweine
- Service of Medical Resuscitation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Service of Surgical Resuscitation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Unit of Human Nutrition (UNH), University of Clermont Auvergne, National Institute for Research on Agriculture (INRAE), Clermont-Ferrand, France.,Service of Physical and Rehabilitation Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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68
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Poletti V, Capozzolo A. Respiratory Rehabilitation in the COVID-19 Era. Respiration 2020; 99:461-462. [PMID: 32659774 PMCID: PMC7445383 DOI: 10.1159/000509558] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy, .,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark,
| | - Alberto Capozzolo
- ICS Maugeri, Pavia, Italy.,Institute of Respiratory Diseases, University of Bari, Bari, Italy
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69
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Coughlan C, Nafde C, Khodatars S, Jeanes AL, Habib S, Donaldson E, Besi C, Kooner GK. COVID-19: lessons for junior doctors redeployed to critical care. Postgrad Med J 2020; 97:188-191. [PMID: 32581082 DOI: 10.1136/postgradmedj-2020-138100] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/28/2022]
Abstract
Approximately 4% of patients with coronavirus disease 2019 (COVID-19) will require admission to an intensive care unit (ICU). Governments have cancelled elective procedures, ordered new ventilators and built new hospitals to meet this unprecedented challenge. However, intensive care ultimately relies on human resources. To enhance surge capacity, many junior doctors have been redeployed to ICU despite a relative lack of training and experience. The COVID-19 pandemic poses additional challenges to new ICU recruits, from the practicalities of using personal protective equipment to higher risks of burnout and moral injury. In this article, we describe lessons for junior doctors responsible for managing patients who are critically ill with COVID-19 based on our experiences at an urban teaching hospital.
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Affiliation(s)
- Charles Coughlan
- Cardiac Intensive Care Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK .,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Chaitanya Nafde
- Cardiac Intensive Care Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Shaida Khodatars
- Cardiac Intensive Care Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Aimi Lara Jeanes
- Cardiac Intensive Care Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sadia Habib
- Cardiac Intensive Care Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elouise Donaldson
- Cardiac Intensive Care Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Christina Besi
- Cardiac Intensive Care Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gurleen Kaur Kooner
- Cardiac Intensive Care Unit, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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70
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van der Lee L, Hill AM, Patman S. Clinical validation of expert consensus statements for respiratory physiotherapy management of invasively ventilated adults with community-acquired pneumonia: A qualitative study. Intensive Crit Care Nurs 2020; 60:102854. [PMID: 32448631 DOI: 10.1016/j.iccn.2020.102854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To conduct multidisciplinary peer-review of expert consensus statements for respiratory physiotherapy for invasively ventilated adults with community-acquired pneumonia, to determine clinical acceptability for development into a clinical practice guideline. RESEARCH METHODOLOGY A qualitative study was undertaken using focus groups (n = 3) conducted with clinician representatives from five Australian states. Participants were senior intensive care physiotherapists, nurses and consultants. Thematic analysis was used, with a deductive approach to confirm clinical validity, and inductive analysis to identify new themes relevant to the application of the 38 statements into practice. SETTING Adult intensive care. FINDINGS Senior intensive care clinicians from physiotherapy (n = 16), medicine (n = 6) and nursing (n = 4) participated. All concurred that the consensus statements added valuable guidance to practice; twenty-nine (76%) were deemed relevant and applicable for the intensive care setting without amendment, with modifications suggested for remaining nine statements to enhance utility. Overarching themes of patient safety, teamwork and communication and culture were identified as factors influencing clinical application. Cultural differences in practice, particularly related to patient positioning, was evident between jurisdictions. Participants raised practicality and safety concerns for two statements related to the use of head-down patient positioning. CONCLUSION Multidisciplinary peer-review established clinical validity of expert consensus statements for implementation with invasively ventilated adults with community-acquired pneumonia.
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Affiliation(s)
- Lisa van der Lee
- The University of Notre Dame Australia, School of Physiotherapy, 19 Mouat Street (PO Box 1225), Fremantle, WA 6959, Australia; Fiona Stanley Hospital Perth, Intensive Care Unit, Locked Bag 100, Palmyra DC, WA 6961, Australia.
| | - Anne-Marie Hill
- Curtin University, School of Physiotherapy and Exercise Science, Kent Street, Bentley Perth, WA 6102, Australia
| | - Shane Patman
- The University of Notre Dame Australia, School of Physiotherapy, 19 Mouat Street (PO Box 1225), Fremantle, WA 6959, Australia
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71
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Early Mobilization of Patients Receiving Vasoactive Drugs in Critical Care Units: A Systematic Review. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW This review summarizes the results from long-term intensive care outcome research over the past 50 years. Key findings from early studies are reflected in citations of contemporary research. RECENT FINDINGS The postintensive care syndrome (PICS) is a multifaceted entity of residual disability and complications burdening survivors of critical illness. Some interventions applied early in the history of outcomes research have now been confirmed as effective in counteracting specific PICS components. SUMMARY Interest in patient-centred outcomes has been present since the beginning of modern intensive care. Findings from early long-term studies remain valid even in the face of contemporary large registries that facilitate follow-up of larger cohorts. A further understanding of the mechanisms leading to experienced physical and psychological impairment of PICS will be essential to the design of future intervention trials.
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73
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Aswegen HV, Reeve J, Beach L, Parker R, Olsèn MF. Physiotherapy management of patients with major chest trauma: Results from a global survey. TRAUMA-ENGLAND 2020. [DOI: 10.1177/1460408619850918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Aim Major chest trauma is associated with significant morbidity and mortality. Management of patients with major chest trauma includes pain relief, ventilatory management, surgical fixation and early rehabilitation to improve both short- and long-term outcomes. Physiotherapy is widely considered an integral component of the multidisciplinary trauma team and aims to improve respiratory status and reduce the sequelae associated with immobility and reduced physical function. Despite this there is scarce evidence describing or investigating physiotherapy interventions and how these practices vary worldwide. The aim of this study was to ascertain the current physiotherapy management of patients having sustained major chest trauma and to investigate how such practices varied internationally. Methods A purpose designed online survey was administered to a group of experienced physiotherapists who work in the field of trauma. Results Response rate was 51% ( n = 49) and respondents represented all five continents. Respondents reported focussing on active coughing ( n = 46, 96%, r = 0.5, p = 0.98), body positioning ( n = 43, 94%, r = 0.7, p = 0.41), deep breathing exercises ( n = 44, 94%, r = 0.8, p = 0.66) and early mobilisation ( n = 47, 98%, r = 1, p = 0.64). Ambulation in hospital was reported to be common ( n = 46, 98%, r = 0.2, p = 0.99) but rehabilitation to address longer term sequelae following hospital discharge was reported to be rare ( n = 4, 8%). Conclusion This survey has highlighted those practices used by physiotherapists worldwide which aim to address the complications associated with major chest trauma. Having established global practice, the study provides a platform for future research investigating the efficacy of such interventions in improving both short- and long-term outcomes for patients following major chest injury.
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Affiliation(s)
- Heleen van Aswegen
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Julie Reeve
- Department of Physiotherapy, Auckland University of Technology, Auckland, New Zealand
| | - Lisa Beach
- Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Australia
| | - Romy Parker
- Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Monika Fagevik Olsèn
- Department of Physical Therapy, Sahlgrenska University Hospital and Gothenburg University, Gothenburg, Sweden
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Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, Hodgson C, Jones AY, Kho ME, Moses R, Ntoumenopoulos G, Parry SM, Patman S, van der Lee L. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother 2020; 66:73-82. [PMID: 32312646 PMCID: PMC7165238 DOI: 10.1016/j.jphys.2020.03.011] [Citation(s) in RCA: 338] [Impact Index Per Article: 84.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023] Open
Abstract
This document outlines recommendations for physiotherapy management for COVID-19 in the acute hospital setting. It includes: recommendations for physiotherapy workforce planning and preparation; a screening tool for determining requirement for physiotherapy; and recommendations for the selection of physiotherapy treatments and personal protective equipment. It is intended for use by physiotherapists and other relevant stakeholders in the acute care setting caring for adult patients with confirmed or suspected COVID-19.
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Affiliation(s)
- Peter Thomas
- Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Claire Baldwin
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Bernie Bissett
- Physiotherapy, University of Canberra, Australia; Physiotherapy Department, Canberra Hospital, Canberra, Australia
| | - Ianthe Boden
- Physiotherapy Department, Launceston General Hospital, Launceston, Australia
| | - Rik Gosselink
- Department of Rehabilitation Sciences, KU Leuven, Belgium; Department of Critical Care, University Hospitals Leuven, Leuven, Belgium
| | | | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Alice Ym Jones
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Canada; St Joseph's Healthcare, Hamilton, Canada; The Research Institute of St Joe's, Hamilton, Canada
| | - Rachael Moses
- Physiotherapy, Lancashire Teaching Hospitals, Preston, United Kingdom
| | | | - Selina M Parry
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Shane Patman
- School of Physiotherapy, The University of Notre Dame Australia, Perth, Australia
| | - Lisa van der Lee
- Physiotherapy Department, Fiona Stanley Hospital, Perth, Australia
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75
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Executive Summary: Post-Intensive Care Syndrome in the Neurocritical Intensive Care Unit. J Neurosci Nurs 2020; 51:158-161. [PMID: 30964847 DOI: 10.1097/jnn.0000000000000438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Matić Z, Platiša MM, Kalauzi A, Bojić T. Slow 0.1 Hz Breathing and Body Posture Induced Perturbations of RRI and Respiratory Signal Complexity and Cardiorespiratory Coupling. Front Physiol 2020; 11:24. [PMID: 32132926 PMCID: PMC7040454 DOI: 10.3389/fphys.2020.00024] [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: 09/29/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022] Open
Abstract
Objective: We explored the physiological background of the non-linear operating mode of cardiorespiratory oscillators as the fundamental question of cardiorespiratory homeodynamics and as a prerequisite for the understanding of neurocardiovascular diseases. We investigated 20 healthy human subjects for changes using electrocardiac RR interval (RRI) and respiratory signal (Resp) Detrended Fluctuation Analysis (DFA, α1RRI, α2RRI, α1Resp, α2Resp), Multiple Scaling Entropy (MSERRI1-4, MSERRI5-10, MSEResp1-4, MSEResp5-10), spectral coherence (CohRRI-Resp), cross DFA (ρ1 and ρ2) and cross MSE (XMSE1-4 and XMSE5-10) indices in four physiological conditions: supine with spontaneous breathing, standing with spontaneous breathing, supine with 0.1 Hz breathing and standing with 0.1 Hz breathing. Main results: Standing is primarily characterized by the change of RRI parameters, insensitivity to change with respiratory parameters, decrease of CohRRI-Resp and insensitivity to change of in ρ1, ρ2, XMSE1-4, and XMSE5-10. Slow breathing in supine position was characterized by the change of the linear and non-linear parameters of both signals, reflecting the dominant vagal RRI modulation and the impact of slow 0.1 Hz breathing on Resp parameters. CohRRI-Resp did not change with respect to supine position, while ρ1 increased. Slow breathing in standing reflected the qualitatively specific state of autonomic regulation with striking impact on both cardiac and respiratory parameters, with specific patterns of cardiorespiratory coupling. Significance: Our results show that cardiac and respiratory short term and long term complexity parameters have different, state dependent patterns. Sympathovagal non-linear interactions are dependent on the pattern of their activation, having different scaling properties when individually activated with respect to the state of their joint activation. All investigated states induced a change of α1 vs. α2 relationship, which can be accurately expressed by the proposed measure-inter-fractal angle θ. Short scale (α1 vs. MSE1-4) and long scale (α2 vs. MSE5-10) complexity measures had reciprocal interrelation in standing with 0.1 Hz breathing, with specific cardiorespiratory coupling pattern (ρ1 vs. XMSE1-4). These results support the hypothesis of hierarchical organization of cardiorespiratory complexity mechanisms and their recruitment in ascendant manner with respect to the increase of behavioral challenge complexity. Specific and comprehensive cardiorespiratory regulation in standing with 0.1 Hz breathing suggests this state as the potentially most beneficial maneuver for cardiorespiratory conditioning.
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Affiliation(s)
- Zoran Matić
- Biomedical Engineering and Technology, University of Belgrade, Belgrade, Serbia
| | - Mirjana M. Platiša
- Faculty of Medicine, Institute of Biophysics, University of Belgrade, Belgrade, Serbia
| | - Aleksandar Kalauzi
- Department for Life Sciences, Institute for Multidisciplinary Research, University of Belgrade, Belgrade, Serbia
| | - Tijana Bojić
- Laboratory for Radiobiology and Molecular Genetics-080, Institute for Nuclear Sciences Vinča, University of Belgrade, Belgrade, Serbia
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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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Righetti RF, Onoue MA, Politi FVA, Teixeira DT, de Souza PN, Kondo CS, Moderno EV, Moraes IG, Maida ALV, Pastore L, Silva FD, de Brito CMM, Baia WRM, Yamaguti WP. Physiotherapy Care of Patients with Coronavirus Disease 2019 (COVID-19) - A Brazilian Experience. Clinics (Sao Paulo) 2020; 75:e2017. [PMID: 32578825 PMCID: PMC7297520 DOI: 10.6061/clinics/2020/e2017] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023] Open
Abstract
Some patients with coronavirus disease (COVID-19) present with severe acute respiratory syndrome, which causes multiple organ dysfunction, besides dysfunction of the respiratory system, that requires invasive procedures. On the basis of the opinions of front-line experts and a review of the relevant literature on several topics, we proposed clinical practice recommendations on the following aspects for physiotherapists facing challenges in treating patients and containing virus spread: 1. personal protective equipment, 2. conventional chest physiotherapy, 3. exercise and early mobilization, 4. oxygen therapy, 5. nebulizer treatment, 6. non-invasive ventilation and high-flow nasal oxygen, 7. endotracheal intubation, 8. protective mechanical ventilation, 9. management of mechanical ventilation in severe and refractory cases of hypoxemia, 10. prone positioning, 11. cuff pressure, 12. tube and nasotracheal suction, 13. humidifier use for ventilated patients, 14. methods of weaning ventilated patients and extubation, and 15. equipment and hand hygiene. These recommendations can serve as clinical practice guidelines for physiotherapists. This article details the development of guidelines on these aspects for physiotherapy of patients with COVID-19.
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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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Anekwe DE, Biswas S, Bussières A, Spahija J. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis. Physiotherapy 2019; 107:1-10. [PMID: 32135387 DOI: 10.1016/j.physio.2019.12.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intensive care unit-acquired weakness (ICUAW) is associated with significant impairments in body structure and function, activity limitation, and participation restriction. The etiology and management of ICUAW remain uncertain. OBJECTIVE To estimate the extent to which early rehabilitation interventions (early mobilization [EM] and/or neuromuscular electrical stimulation [NMES]) compared to usual care reduce the incidence of ICUAW in critically ill patients. DATA SOURCES We searched MEDLINE, EMBASE, CINAHL, Cochrane Central and Physiotherapy Evidence Database databases from inception to May 1st, 2017. ELIGIBILITY CRITERIA Randomized controlled trials of EM and/or NMES interventions in critically ill adults. DATA EXTRACTION AND DATA SYNTHESIS Data on the incidence of ICUAW and secondary outcomes were extracted. Both odds and risk ratios for ICUAW were pooled using the random-effects model. RESULTS We identified 1421 reports after duplicate removal. Nine studies including 841 patients (419 intervention and 422 usual care) were included in the final analysis. The interventions involved EM in five trials, NMES in three trials, and both EM and NMES in one trial. Early rehabilitation decreased the likelihood of developing ICUAW: odds ratio of 0.63 (95% CI: 0.43 to 0.92) in the screened population, and 0.71 (95% CI: 0.53 to 0.95) in the randomized population. CONCLUSION, IMPLICATIONS OF KEY FINDINGS Early rehabilitation was associated with a decreased likelihood of developing ICUAW. Our findings support early rehabilitation in the ICU. While results were consistent in both the screened and randomized populations, the wide confidence intervals suggest that well-conducted trials are needed to validate our findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO registration ID: CRD42017065031.
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Affiliation(s)
- David E Anekwe
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Research Center, CIUSSS du Nord-de-l'Ile-de-Montréal, Sacré-Coeur Hospital, Université de Montréal, Montréal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation in Montreal, CISS du Nord-de-l'Île-de-Montréal, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Sharmistha Biswas
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation in Montreal, CISS du Nord-de-l'Île-de-Montréal, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Jadranka Spahija
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Research Center, CIUSSS du Nord-de-l'Ile-de-Montréal, Sacré-Coeur Hospital, Université de Montréal, Montréal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation in Montreal, CISS du Nord-de-l'Île-de-Montréal, Jewish Rehabilitation Hospital, Laval, Quebec, Canada.
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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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Effects of Different Rehabilitation Protocols in Inpatient Cardiac Rehabilitation After Coronary Artery Bypass Graft Surgery. J Cardiopulm Rehabil Prev 2019; 39:E19-E25. [DOI: 10.1097/hcr.0000000000000431] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Christakou A, Seitaridi A, Koutsioumba E, Papaioannou S, Spinou A, Anaouni E, Grigoriadis K, Mpempeletsi P, Rekliti E, Patsaki E. Current physiotherapy practice in Greek intensive care units: a national study. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2019. [DOI: 10.1080/21679169.2018.1523459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Anna Christakou
- First Critical Care Department, General Hospital “Evagelismos”, University of Athens, Athens, Greece
- Department of Physiotherapy, University of Western Attica, Athens, Greece
| | | | | | | | - Arietta Spinou
- Health, Sports and Bioscience, University of East London, London, UK
| | | | - Konstantinos Grigoriadis
- Department of Physiotherapy, University of Western Attica, Athens, Greece
- General University Hospital of Attikon, Athens, Greece
| | | | - Eleni Rekliti
- General Hospital Nosematon Thorakos “Sotiria”, Athens, Greece
| | - Eirini Patsaki
- First Critical Care Department, General Hospital “Evagelismos”, University of Athens, Athens, Greece
- Department of Physiotherapy, University of Western Attica, Athens, Greece
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The Process of Implementing a Mobility Technician in the General Medicine and Surgical Population to Increase Patient Mobility and Improve Hospital Quality Measures: A Pilot Study. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2019. [DOI: 10.1097/jat.0000000000000110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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85
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Impact of Very Early Physical Therapy During Septic Shock on Skeletal Muscle: A Randomized Controlled Trial. Crit Care Med 2019; 46:1436-1443. [PMID: 29957714 PMCID: PMC6110624 DOI: 10.1097/ccm.0000000000003263] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives: As the catabolic state induced by septic shock together with the physical inactivity of patients lead to the rapid loss of muscle mass and impaired function, the purpose of this study was to test whether an early physical therapy during the onset of septic shock regulates catabolic signals and preserves skeletal muscle mass. Design: Randomized controlled trial. Setting: Tertiary mixed ICU. Patients: Adult patients admitted for septic shock within the first 72 hours. Interventions: Patients were assigned randomly into two groups. The control group benefited from manual mobilization once a day. The intervention group had twice daily sessions of both manual mobilization and 30-minute passive/active cycling therapy. Measurements and Main Results: Skeletal muscle biopsies and electrophysiology testing were performed at day 1 and day 7. Muscle biopsies were analyzed for histology and molecular components of signaling pathways regulating protein synthesis and degradation as well as inflammation markers. Hemodynamic values and patient perception were collected during each session. Twenty-one patients were included. Three died before the second muscle biopsy. Ten patients in the control and eight in the intervention group were analyzed. Markers of the catabolic ubiquitin-proteasome pathway, muscle atrophy F-box and muscle ring finger-1 messenger RNA, were reduced at day 7 only in the intervention group, but without difference between groups (muscle atrophy F-box: –7.3% ± 138.4% in control vs –56.4% ± 37.4% in intervention group; p = 0.23 and muscle ring finger-1: –30.8% ± 66.9% in control vs –62.7% ± 45.5% in intervention group; p = 0.15). Muscle fiber cross-sectional area (µm2) was preserved by exercise (–25.8% ± 21.6% in control vs 12.4% ± 22.5% in intervention group; p = 0.005). Molecular regulations suggest that the excessive activation of autophagy due to septic shock was lower in the intervention group, without being suppressed. Markers of anabolism and inflammation were not modified by the intervention, which was well tolerated by the patients. Conclusions: Early physical therapy during the first week of septic shock is safe and preserves muscle fiber cross-sectional area.
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Holdar U, Eriksson F, Siesage K, Corner EJ, Ledström V, Svensson-Raskh A, Kierkegaard M. Cross-cultural adaptation and inter-rater reliability of the Swedish version of the Chelsea critical care assessment tool (CPAX-Swe) in critically ill patients. Disabil Rehabil 2019; 43:1600-1604. [PMID: 31558043 DOI: 10.1080/09638288.2019.1668971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To translate and culturally adapt the Chelsea Critical Care Physical Assessment Tool into Swedish and to test the inter-rater reliability of the Swedish version in critically ill patients. DESIGN This is an observational study. METHODS Translation and cross-cultural adaptation was performed in line with international recommendations, including forward and backward translation and expert round table discussions. The inter-rater reliability of the Chelsea Critical Care Physical Assessment Tool - Swedish was then explored in 50 critically ill adult patients, pragmatically recruited, in a University Hospital clinical setting. Reliability was calculated using intraclass correlation coefficient for aggregated scores and quadratic weighted Cohen's kappa analysis for individual items. RESULTS The expert round table discussion group agreed that the translation was a satisfactory equivalent to the original version and applicable for use within the clinical setting. Reliability of aggregated scores and individual items were very good (intraclass correlation coefficient of 0.97 and quadric weighted kappa values ranging from 0.88 to 0.98). The measurement error for aggregated scores was low, with a standard error of measurement of 1.79, smallest detectable change of 4.95, and limits of agreement of 5.20 and -4.76. The percentage agreement for individual items ranged from 64% to 88%. CONCLUSION The Chelsea Critical Care Physical Assessment Tool - Swedish was found applicable and appropriate for assessment of functioning in critically ill patients in an acute setting in Sweden, and it displayed high inter-rater reliability. This implies that the Swedish version can be used as assessment tool within intensive care and acute wards in Sweden.Implications for rehabilitationThere is a lack of validated instruments to test the functional status of critically ill patients in Sweden.The Chelsea Critical Care Physical Assessment Tool is validated and reliable in English.The Chelsea Critical Care Physical Assessment Tool - Swedish is considered reliable for use by physiotherapist in intensive care settings in Sweden.The Swedish version is feasible for use within clinical practice due to its simplicity and strong clinical relevance.
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Affiliation(s)
- Ulrika Holdar
- Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Frances Eriksson
- Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Katinka Siesage
- Department of Physical Therapy, Södersjukhuset, Stockholm, Sweden
| | - Evelyn J Corner
- Department of Clinical Sciences, Brunel University London, London, UK.,Rehabilitation and Therapies, The Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Viktor Ledström
- Department of Physical Therapy, Örebro University Hospital, Örebro, Sweden
| | - Anna Svensson-Raskh
- Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Marie Kierkegaard
- Function Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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Estado actual de la labor de los fisioterapeutas en las unidades de cuidados intensivos de adultos del área metropolitana de Barcelona. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.ft.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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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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González-Seguel F, Camus-Molina A, Jasmén Sepúlveda A, Pérez Araos R, Molina Blamey J, Graf Santos J. Settings and monitoring of mechanical ventilation during physical therapy in adult critically ill patients: protocol for a scoping review. BMJ Open 2019; 9:e030692. [PMID: 31455713 PMCID: PMC6720146 DOI: 10.1136/bmjopen-2019-030692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Early mobilisation has been extensively advocated to improve functional outcomes in critically ill patients, even though consistent evidence of its benefits has remained elusive. These conflicting results could be explained by a lack of knowledge on the optimal dosage of physical therapy and a mismatch between ventilatory support and exercise-induced patient ventilatory demand. Modern mechanical ventilators provide real-time monitoring of respiratory/metabolic variables and ventilatory setting that could be used for physical therapy dosage or ventilatory support titration, allowing individualised interventions in these patients. The aim of this review is to comprehensively map and summarise current knowledge on adjustments of respiratory support and respiratory or metabolic monitoring during physical therapy in adult critically ill mechanically ventilated patients. METHODS AND ANALYSIS This is a scoping review protocol based on the methodology of the Joanna-Briggs-Institute. The search strategy will be conducted from inception to 30 June 2019 as a cut-off date in PubMed, CINAHL, Rehabilitation & Sport Medicine, Scielo Citation Index, Epistemónikos, Clinical Trials, PEDro and Cochrane Library, performed by a biomedical librarian and two critical care physiotherapists. All types of articles will be selected, including conference abstracts, clinical practice guidelines and expert recommendations. Bibliometric variables, patient characteristics, physical therapy interventions, ventilator settings and respiratory or metabolic monitoring will be extracted. The identified literature will be analysed by four critical care physiotherapists and reviewed by a senior critical care physician. ETHICS AND DISSEMINATION Ethical approval is not required. The knowledge-translation of the results will be carried out based on the End-of-Grant strategies: diffusion, dissemination and application. The results will be published in a peer-review journal, presentations will be disseminated in relevant congresses, and recommendations based on the results will be developed through training for mechanical ventilation and physical therapy stakeholders.
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Affiliation(s)
- Felipe González-Seguel
- Servicio de Medicina Física y Rehabilitación, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Agustín Camus-Molina
- School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmén Sepúlveda
- Bibliotecas Biomédicas, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Rodrigo Pérez Araos
- Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Jorge Molina Blamey
- School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Jerónimo Graf Santos
- Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
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Freynet A, Decloedt C, Grandet P, Ouattara A, Fleureau C. Décubitus ventral et kinésithérapie respiratoire : y a-t-il une indication ? Description d’un cas clinique. MEDECINE INTENSIVE REANIMATION 2019. [DOI: 10.3166/rea-2019-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Contexte : Le décubitus ventral (DV) est appliqué dans un objectif de recrutement alvéolaire, dans le cadre de syndrome de détresse respiratoire aiguë (SDRA). Le DV mobilise parfois des sécrétions bronchiques, interrogeant l’intérêt d’une kinésithérapie de désencombrement.
Matériel et méthode : Une femme de 43 ans, myopathe de Steinert, est hospitalisée pour une insuffisance hépatique aiguë. À j3, elle présente une pneumopathie d’inhalation, suivie d’un SDRA. Le positionnement en DV est réalisé, mobilisant des sécrétions bronchiques. Une séance de kinésithérapie respiratoire est alors appliquée.
Résultats : Après la mise en DVet la séance de kinésithérapie, la quantité de sécrétions recueillies est de 2,4 g. Le rapport entre la pression partielle en oxygène et la fraction inspirée en oxygène (PaO2/FiO2) s’améliore, passant de 64 à 180 au bout de 11 heures de DV. La pression motrice et la pression de plateau sont restées inférieures aux valeurs délétères au cours de la séance de kinésithérapie, celle-ci n’ayant pas généré d’hypoxie pendant ou après la séance.
Discussion : Le positionnement en DV libère les parties postérieures des poumons, permettant une amélioration du rapport PaO2/FiO2. La clairance mucociliaire a été améliorée, mais il n’est pas possible de discriminer les effets du DVou de la kinésithérapie. Dans la littérature, la kinésithérapie respiratoire n’a pas montré son efficacité pour ces patients, même si aucun effet délétère n’a été observé à travers ce cas clinique. Les risques de dé-recrutement alvéolaire restent importants.
Conclusion : Il est difficile de recommander en pratique courante la kinésithérapie respiratoire de désencombrement en DV. Des études ultérieures sont nécessaires, dans un objectif de recherche centré plutôt sur le recrutement alvéolaire que sur le désencombrement, chez ces patients fragiles.
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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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[PROtocol-based MObilizaTION on intensive care units : Design of a cluster randomized pilot study]. Med Klin Intensivmed Notfmed 2019; 113:581-592. [PMID: 29026932 DOI: 10.1007/s00063-017-0358-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Despite convincing evidence for early mobilization of patients on intensive care units (ICU), implementation in practice is limited. Protocols for early mobilization, including in- and exclusion criteria, assessments, safety criteria, and step schemes may increase the rate of implementation and mobilization. HYPOTHESIS Patients (population) on ICUs with a protocol for early mobilization (intervention), compared to patients on ICUs without protocol (control), will be more frequently mobilized (outcome). METHODS A multicenter, stepped-wedge, cluster-randomized pilot study is presented. Five ICUs will receive an adapted, interprofessional protocol for early mobilization in randomized order. Before and after implementation, mobilization of ICU patients will be evaluated by randomized monthly one-day point prevalence surveys. Primary outcome is the percentage of patients mobilized out of bed, operationalized as a score of ≥3 on the ICU Mobility Scale. Secondary outcome parameters will be presence and/or length of mechanical ventilation, delirium, stay on ICU and in hospital, barriers to early mobilization, adverse events, and process parameters as identified barriers, used strategies, and adaptions to local conditions. EXPECTED RESULTS Exploratory evaluation of study feasibility and estimation of effect sizes as the basis for a future explanatory study.
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93
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Nydahl P, Günther U, Diers A, Hesse S, Kerschensteiner C, Klarmann S, Borzikowsky C, Köpke S. PROtocol-based MObilizaTION on intensive care units: stepped-wedge, cluster-randomized pilot study (Pro-Motion). Nurs Crit Care 2019; 25:368-375. [PMID: 31125163 DOI: 10.1111/nicc.12438] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/06/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Early mobilization of patients in intensive care units (ICUs) improves patient recovery, but implementation remains challenging. Protocols may enhance the rate of out-of-bed mobilizations. AIM To evaluate the effect of implementing a protocol for early mobilization on the rate of out-of-bed mobilizations and other outcomes of ICU patients. STUDY DESIGN Multicentre, stepped-wedge, cluster-randomized pilot study. METHODS After a control period, five ICUs were allocated to the implementation of an inter-professional protocol for early mobilization in a randomized, monthly order. Mobilization of ICU patients was evaluated by monthly 1-day point prevalence surveys using the ICU Mobility Scale. The primary outcome was the percentage of patients mobilized out of bed, defined as level 3 on the ICU Mobility Scale (sitting on edge of bed) or higher. Secondary outcomes were mechanical ventilation, delirium and ICU- and hospital-days, as well as unwanted safety events. RESULTS Out-of-bed mobilizations increased non-significantly from 36·2% (n = 55) of 152 patients during the control period to 45·8% (n = 55) of 120 patients during the intervention period (difference 9·6%; 95% confidence interval -2·1 to 21·3%). Of 55 mobilized patients per group, more patients were mobilized once per day during the intervention period (intervention: n = 41 versus control: n = 23 patients). Multiple daily mobilizations decreased (control: n = 32 control versus intervention: n = 14 patients). Secondary outcomes, such as days with mechanical ventilation, delirium and in ICU and hospital, did not significantly differ. Adherence to the protocol was >90%; unwanted safety events were rare. CONCLUSIONS Implementing a protocol for early mobilization of ICU patients showed a trend towards more patients being mobilized. Without additional staff in participating ICUs, a significant increase in ICU mobilizations was not to be anticipated. More research should address whether more staff would increase the number of frequent mobilizations and if this is relevant to outcomes. RELEVANCE TO CLINICAL PRACTICE Implementing inter-professional protocols for mobilization is feasible and safe and may contribute to an increase of ICU patients mobilized out of bed.
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Affiliation(s)
- Peter Nydahl
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Schleswig-Holstein, Kiel, Kiel, Germany
| | - Ulf Günther
- University Clinic of Anaesthesiology, Intensive Care, Emergency Medicine, Pain Therapy, Klinikum Oldenburg AöR, and European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Anja Diers
- University Clinic of Anaesthesiology, Intensive Care, Emergency Medicine, Pain Therapy, Klinikum Oldenburg AöR, and European Medical School Oldenburg-Groningen, Oldenburg, Germany
| | - Stephanie Hesse
- Department of Intensive Care, Städtisches Krankenhaus, Kiel, Germany
| | | | - Silke Klarmann
- Department of Physical Therapy, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sascha Köpke
- Nursing Research Unit, Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
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Reply: Are No, or Late, Mobility Practices Taken in Intensive Care Units without an Early Mobility Protocol? Ann Am Thorac Soc 2019; 14:150. [PMID: 28035874 DOI: 10.1513/annalsats.201610-762le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Evaluation of the effectiveness of physiotherapy in patients after oncological breast cancer treatment based on spirometric indicators. Contemp Oncol (Pozn) 2019; 23:47-51. [PMID: 31061637 PMCID: PMC6500393 DOI: 10.5114/wo.2019.82929] [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: 12/04/2018] [Accepted: 01/07/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study is to evaluate the effects of physiotherapy in patients who underwent oncological treatment including spirometric indicators: FEV1, VC, FVC, PEF, FEV1/FVC, FEF25, FEF50, FEF75. Moreover, the possible influence of duration of physiotherapy on ventilation activity of lungs was assessed. Material and methods The study considered 91 women after breast cancer therapy qualified for outpatient physiotherapy. All patients underwent radiation therapy, and more than half of the women received concurrent chemotherapy. To assess rates of respiratory disorders, the patients were subjected to spirometric tests. The clinical status of examined subjects was also taken into account. Results Statistical analysis showed that the duration of physiotherapy contributed to increased ventilation index FEV1% – with each treatment day corresponding to an average of 1.8 units. In contrast, the involvement of lymph nodes radically reduced the level of PEF by as much as 64 units. The results of linear modelling provided evidence of statistically significant effects of chemotherapy on spirometric indicators. What is more, a statistically significant impact of time of rehabilitation on FEV1 increase was estimated. Conclusions Physiotherapy leads to improvement of lung functions in patients with breast cancer after oncological treatment; progress is more evident in patients with advanced cancer after radical treatment.
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Degree of implementation of preventive strategies for post-ICU syndrome: Multi-centre, observational study in Spain. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.enfie.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Raurell-Torredà M, Arias-Rivera S, Martí J, Frade-Mera M, Zaragoza-García I, Gallart E, Velasco-Sanz T, San José-Arribas A, Blázquez-Martínez E, Rodríguez Delgado ME, Contreras Rodríguez AM, Oreña Cimiano E, Ortega Guerrero Á, Martínez del Aguila MDC, Rodríguez Monsalve V, Cano Herrera CL, Masegosa Pérez JM, González de la Cuesta DM, Pardo Artero MI, Palacios Laseca M, Cabello Casao AI, Vera Bellostas MBVD, Pérez Martínez C, Escuder González S, Lezcano Cisneros A, Miguel Romeo A, López Alegre I, San Pío ERD, Fernández Alonso H, Rodríguez Villanueva LM, Riaño Suárez R, Sánchez Cerviñio B, Carrasco Santos S, José Arribas AS, González García M, Linares Tavio A, Álvarez García P, Polo Hernández N, Gómez Cosío L, Pérez Loza I, Suárez Pérez Á, Crespo Rebollo S, Muñoz Camargo JC, García García J, Rojo Aguado C, Gómez López J, Sonseca Bartolomé L, José Arribas AS, Olmo Nuñez SD, García Mazo P, Siguero Torres E, Muñoz Díez I, Delgado Hito P, Garrido Martín MO, Marín Vivó G, Eseverri Rovira MDM, Guillen Dobon M, Aran Esteve M, Mirabete Rodríguez M, Mariné Méndez A, Rodríguez Fernández S, Rosselló Sancho J, Zafra Lamas V, Carmona Delgado I, Navarro Arilla À, Zariquiey Esteva G, Bueno Luna ÁL, Lerma Brianso C, Gómez García R, Planas Pascual B, Sabaté López M, Mayer Frutos AI, Roca Escrihuela R, Torrents Albà G, García Flores V, Melis Galmés J, Belmonte Moral S, Grau Pellicer M, Ruiz Eizmendi A, Garriga Moll C, de Jaureguízar EB, Cordovilla Guardia S, López Espuela F, Mateos Hinojal L, Redondo Cantos MI, Villar Redondo MDR, Vila Rey J, Sánchez Méndez S, García Fernández Y, Benítez Canosa MC, Díaz Álvarez M, Cordo Isorna JR, Estébez Penín Á, Güeto Rial G, Bouzas López E, Arias Rivera S, Frade Mera MJ, Luengo Alarcia MJ, Regueiro Díaz N, Carrasco Rodríguez-Rey LF, Hernández García MDR, Sala Gómez G, Vecino Rubio J, García González S, Sánchez Sánchez MDM, Cruzado Franco C, Martín Rivera B, González Blanco R, Sánchez de la Ventana AB, Bravo Arcas ML, Escobar Lavela J, Domingo Moreno MDP, García Arias M, Collado Saiz IC, Acevedo Nuevo M, Barrios Suárez A, Zarza Bejarano FJ, Pérez Muñoz MC, Toribio Rubio V, Martínez Chicharro P, Pascual Martínez A, López Pozo S, Sánchez Infante L, Ocaña García V, Menes Medina D, Vadillo Cortázar A, Lendínez Burgos G, Díaz Juntanez J, Godino Olivares MT, Rodríguez Mondéjar JJ, Martínez Rojo FJ, Ruiz Martínez MV, Linares Celdrán D, Ros Molina A, Sáez Sánchez J, Martínez Oliva JM, Bernal Gilar A, Hernández García MB, Ríos Cortés AT, Navarro Méndez R, Gil García S, Sánchez Garre J, Barrio Linares MD, Goñi Viguria R, Aguirre Santano R, García Díez MR, Aparicio Cilla L, Delicado Domingo M, Rodríguez Núñez C, Arrasate López A, Romero Morán Á, Paños Melgoso R, Yañez Cerón M, Mercado Martínez A, Martínez Llopis B, Vayá Albelda MJ, Inat Carbonell J, Alcayne Senent MR, Giménez García F, Fernández Gonzaga EC, Febrer Puchol L, Berenguer Ortuño S, Pastor Martínez M, Valera Talavera D, Segrera Rovira MJ, Langa Revert Y, Espí Pozuelo M, Diego Miravet MÁD, Garijo Aspas B, Asensio García MDR, Sánchez Muñoz JR, Martínez Sánchez Q, López Mateu R. Grado de implementación de las estrategias preventivas del síndrome post-UCI: estudio observacional multicéntrico en España. ENFERMERIA INTENSIVA 2019; 30:59-71. [DOI: 10.1016/j.enfi.2018.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 04/05/2018] [Accepted: 04/12/2018] [Indexed: 01/28/2023]
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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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Çakmak A, İnce Dİ, Sağlam M, Savcı S, Yağlı NV, Kütükcü EÇ, Özel CB, Ulu HS, Arıkan H. Physiotherapy and Rehabilitation Implementation in Intensive Care Units: A Survey Study. Turk Thorac J 2019; 20:114-119. [PMID: 30958983 DOI: 10.5152/turkthoracj.2018.18107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/17/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Physiotherapy in the intensive care unit (ICU) improves patient outcomes. We aimed to determine the characteristics of physiotherapy practice and critical barriers toward applying physiotherapy in ICUs. MATERIALS AND METHODS A 54-item survey for determining the characteristics of physiotherapists and physiotherapy applications in the ICU was developed. The survey was electronically sent to potential participants through Turkish Physiotherapy Association network. Sixty-five physiotherapists (47F and 18M; 23-52 years; ICU experience: 6.0±6.2 years) completed the survey. The data were analyzed using quantitative and qualitative methods. RESULTS The duration of ICU practice was 3.51±2.10 h/day. Positioning (90.8%), active exercises (90.8%), breathing exercises (89.2%), passive exercises (87.7%), and percussion (87.7%) were the most commonly used applications. The barriers were related to physiotherapist (low level of employment and practice, lack of shift); patient (unwillingness, instability, participation restriction); teamwork (lack of awareness and communication); equipment (inadequacy, non-priority to purchase); and legal (reimbursement, lack of direct physiotherapy access, non-recognition of autonomy) procedures. CONCLUSION The most common interventions were positioning, active, passive, and breathing exercises and percussion. Critical barriers toward physiotherapy are multifactorial and related to physiotherapists, patients, team, equipment, and legal procedures. Physiotherapist employment, service maintenance, and multidisciplinary teamwork should be considered for physiotherapy effectiveness in ICUs.
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Affiliation(s)
- Aslıhan Çakmak
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
| | - Deniz İnal İnce
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
| | - Melda Sağlam
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
| | - Sema Savcı
- Dokuz Eylül University, School of Physical Therapy and Rehabilitation, İzmir, Turkey
| | - Naciye Vardar Yağlı
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
| | - Ebru Çalık Kütükcü
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
| | - Cemile Bozdemir Özel
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
| | - Hazal Sonbahar Ulu
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
| | - Hülya Arıkan
- Department of Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
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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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