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Reid JC, Unger J, McCaskell D, Childerhose L, Zorko DJ, Kho ME. Physical rehabilitation interventions in the intensive care unit: a scoping review of 117 studies. J Intensive Care 2018; 6:80. [PMID: 30555705 PMCID: PMC6286501 DOI: 10.1186/s40560-018-0349-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/22/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Physical rehabilitation (PR) interventions in the intensive care unit (ICU) can improve patients' functional outcomes, yet systematic reviews identified discordant effects and poor reporting. We conducted a scoping review to determine the extent of ICU PR interventions and how they were reported and measured. METHODS We searched five databases from inception to December 2016 for prospective studies evaluating adult ICU PR interventions. Two independent reviewers screened titles, abstracts, and full texts for inclusion. We assessed completeness of reporting using the Consolidated Standards of Reporting Trials, Strengthening the Reporting of Observational Studies in Epidemiology, or Standards for Quality Improvement Reporting Excellence guidelines, as appropriate. For planned PR interventions, we evaluated reporting with the Consensus on Exercise Reporting Template (CERT) and assessed intervention and control groups separately. We calculated completeness of reporting scores for each study; scores represented the proportion of reported items. We compared reporting between groups using Kruskal-Wallis with Bonferroni corrections and t tests, α = 0.05. RESULTS We screened 61,774 unique citations, reviewed 1429 full-text publications, and included 117: 39 randomized trials, 30 case series, 9 two-group comparison, 14 before-after, and 25 cohort. Interventions included neuromuscular electrical stimulation (NMES) (14.5%), passive/active exercises (15.4%), cycling (6.8%), progressive mobility (32.5%), and multicomponent (29.9%). The median (first,third quartiles) study reporting score was 75.9% (62.5, 86.7) with no significant differences between reporting guidelines. Of 87 planned intervention studies, the median CERT score was 55.6%(44.7,75.0); cycling had the highest (85.0%(62.2,93.8)), and NMES and multicomponent the lowest (50.0% (39.5, 70.3) and 50.0% (41.5, 58.8), respectively) scores. Authors reported intervention groups better than controls (p < 0.001). CONCLUSIONS We identified important reporting deficiencies in ICU PR interventions, limiting clinical implementation and future trial development.
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Affiliation(s)
- Julie C. Reid
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton, ON L8S 1C7 Canada
| | - Janelle Unger
- Rehabilitation Sciences Institute, University of Toronto, Rehabilitation Sciences Building, 500 University Avenue, Suite 160, Toronto, ON M5G 1V7 Canada
| | - Devin McCaskell
- Department of Physiotherapy, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Laura Childerhose
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton, ON L8S 1C7 Canada
| | - David J. Zorko
- Department of Pediatrics, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Michelle E. Kho
- Faculty of Health Sciences, School of Rehabilitation Science, McMaster University, Institute of Applied Health Sciences, Room 403, 1400 Main Street West, Hamilton, ON L8S 1C7 Canada
- Department of Physiotherapy, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
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102
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Cuello-Garcia CA, Mai SHC, Simpson R, Al-Harbi S, Choong K. Early Mobilization in Critically Ill Children: A Systematic Review. J Pediatr 2018; 203:25-33.e6. [PMID: 30172429 DOI: 10.1016/j.jpeds.2018.07.037] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/18/2018] [Accepted: 07/11/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To characterize how early mobilization is defined in the published literature and describe the evidence on safety and efficacy on early mobilization in critically ill children. STUDY DESIGN Systematic search of randomized and nonrandomized studies assessing early mobilization-based physical therapy in critically ill children under 18 years of age in MEDLINE, Embase, CINAHL, CENTRAL, the National Institutes of Health, Evidence in Pediatric Intensive Care Collaborative, Physiotherapy Evidence Database, and the Mobilization-Network. We extracted data to identify the types of mobility-based interventions and definitions for early, as well as barriers, feasibility, adverse events, and efficacy outcomes (mortality, morbidities, and length of stay). RESULTS Of 1199 titles found, we included 11 studies (2 pilot trials and 9 observational studies) and 1 clinical practice guideline in the analyses. Neurodevelopmentally appropriate increasing mobility levels have been described for critically ill children, and "early" mobilization was defined as either a range (within 48-72 hours) from admission to the pediatric intensive care unit or when clinical safety criteria are met. Current evidence suggests that early mobilization is safe and feasible and institutional practice guidelines significantly increase the frequency of rehabilitation consults, improve the proportion of patients who receive early mobilization, and reduce the time to mobilization. However, there were inconsistencies in populations and interventions across studies, and imprecision and risk of bias in included studies that precluded us from pooling data to evaluate the efficacy outcomes of early mobilization. CONCLUSIONS The definition of early mobilization varies, but seems to be feasible and safe in critically ill children. The efficacy for early mobilization in this population is yet undetermined because of the low certainty of the evidence available.
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Affiliation(s)
- Carlos A Cuello-Garcia
- Department of Pediatrics and Critical Care, Master University, Hamilton, Ontario, Canada.
| | - Safiah Hwai Chuen Mai
- Department of Pediatrics and Critical Care, Master University, Hamilton, Ontario, Canada
| | - Racquel Simpson
- Department of Pediatrics and Critical Care, Master University, Hamilton, Ontario, Canada
| | - Samah Al-Harbi
- Pediatric Department of Medical College at King Abdulaziz University, Jeddah, Saudi Arabia
| | - Karen Choong
- Department of Pediatrics and Critical Care, Master University, Hamilton, Ontario, Canada
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103
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Walker T, Kudchadkar SR. Early Mobility in the Pediatric Intensive Care Unit: Can We Move On? J Pediatr 2018; 203:10-12. [PMID: 30270161 DOI: 10.1016/j.jpeds.2018.08.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Tracie Walker
- Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Charlotte R. Bloomberg Children's Center Baltimore, Maryland
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine Charlotte R. Bloomberg Children's Center Baltimore, Maryland; Department of Pediatrics, Johns Hopkins University School of Medicine Charlotte R. Bloomberg Children's Center Baltimore, Maryland; Department of Physical Medicine and Rehabilitation Johns Hopkins University School of Medicine Charlotte R. Bloomberg Children's Center Baltimore, Maryland.
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104
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Safety and Feasibility of Out-of-Bed Mobilization for Patients With External Ventricular Drains in a Neurosurgical Intensive Care Unit. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2018. [DOI: 10.1097/jat.0000000000000085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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105
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Klein C, Caumo W, Gélinas C, Patines V, Pilger T, Lopes A, Backes FN, Villas-Boas DF, Vieira SRR. Validation of Two Pain Assessment Tools Using a Standardized Nociceptive Stimulation in Critically Ill Adults. J Pain Symptom Manage 2018; 56:594-601. [PMID: 30009967 DOI: 10.1016/j.jpainsymman.2018.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/23/2018] [Accepted: 06/25/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT The Behavioral Pain Scale (BPS) or the Critical-Care Pain Observation Tool (CPOT) are recommended in practice guidelines for pain assessment in critically ill adults unable to self-report. However, their use in another language requires cultural adaptation and validation testing. OBJECTIVES Cross-cultural adaptation of the CPOT and BPS English versions into Brazilian Portuguese, and their validation by comparing behavioral scores during rest, standardized nociceptive stimulation by pressure algometry (SNSPA), and turning were completed. In addition, we explored clinical variables that could predict the CPOT and BPS scores. METHODS A prospective cohort study was conducted with 168 medical-surgical critically ill adults unable to self-report in the intensive care unit. Two nurses were trained to use the CPOT and BPS Brazilian Portuguese versions at the following assessments: 1) baseline at rest, 2) after SNSPA with a pressure of 14 kgf/cm2, 3) during turning, and 4) 15 minutes after turning. RESULTS Inter-rater reliability of nurses' CPOT and BPS scores was supported by high weighted kappa >0.7. Discriminative validation was supported with higher CPOT and BPS scores during SNSPA or turning in comparison to baseline (P < 0.001). The Glasgow Coma Scale score was the only variable that predicted CPOT and BPS scores with explained variance of 44.5% and 55.2%, respectively. CONCLUSION The use of the Brazilian CPOT and BPS versions showed good reliability and validity in critically ill adults unable to self-report. A standardized procedure, the SNSPA, was used for the first time in the validation process of these tools and helped us improve the validation process.
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Affiliation(s)
- Cristini Klein
- Department of Intensive Care Medicine, Clinicas Hospital from Porto Alegre (HCPA), Porto Alegre, Brazil; Post Graduate Program in Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratory of Pain & Neuromodulation, HCPA/UFRGS, Porto Alegre, Brazil.
| | - Wolnei Caumo
- Post Graduate Program in Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Laboratory of Pain & Neuromodulation, HCPA/UFRGS, Porto Alegre, Brazil
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Valéria Patines
- Department of Intensive Care Medicine, Clinicas Hospital from Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Tatiana Pilger
- Department of Intensive Care Medicine, Clinicas Hospital from Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Alexandra Lopes
- Department of Intensive Care Medicine, Clinicas Hospital from Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Fabiane Neiva Backes
- Department of Intensive Care Medicine, Clinicas Hospital from Porto Alegre (HCPA), Porto Alegre, Brazil; Post Graduate Program in Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Débora Feijó Villas-Boas
- Department of Intensive Care Medicine, Clinicas Hospital from Porto Alegre (HCPA), Porto Alegre, Brazil; School of Nursing, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Silvia Regina Rios Vieira
- Department of Intensive Care Medicine, Clinicas Hospital from Porto Alegre (HCPA), Porto Alegre, Brazil; Post Graduate Program in Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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106
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Abstract
Survivors of critical illness often experience multiple morbidities that start in the intensive care unit and impact their quality of life after discharge. Reduced physical function, cognitive decline, feeding disorders, and psychological stress are just a few of the potential complications. Many of these morbidities can lead to a reduced quality of life and lifelong impediments. Early mobilization, an intervention that is intended to maintain or restore musculoskeletal strength in the critically ill, has the potential to also yield positive psychological and cognitive benefits. In adults, early mobilization has been shown to be safe, decrease the incidence of delirium, and decrease length of stay. Early mobilization of the pediatric critically ill patient is still a novel topic with a growing body of research. This article will review the current literature on early mobilization of the pediatric critically ill patient.
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Affiliation(s)
- Tracie C Walker
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Baltimore, MD, USA
| | - Sapna R Kudchadkar
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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107
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Riley C, Maxwell A, Parsons A, Andrist E, Beck AF. Disease prevention & health promotion: what's critical care got to do with it? Transl Pediatr 2018; 7:262-266. [PMID: 30460177 PMCID: PMC6212390 DOI: 10.21037/tp.2018.09.13] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Health systems are increasingly investing in efforts to prevent disease and promote health for populations. By and large, these prevention-related interventions have not been inclusive of critical care and the intensive care unit (ICU). However, we suggest that there is value-to patients, families, health systems, and society at large-in extending this continuum into the ICU setting and including the ICU in disease prevention and health promotion efforts. Including the ICU in this continuum allows the critical care perspective to inform (I) advocacy for prevention; (II) efforts to improve disparities in health and health care; (III) mitigation of the negative effects of critical illness and injury as well as ICU exposure; and (IV) promotion of health and well-being in the community. As disease prevention and health promotion rise as priorities within health systems, critical care can and should join, even help lead, the effort.
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Affiliation(s)
- Carley Riley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrea Maxwell
- Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison Parsons
- Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Erica Andrist
- Division of Critical Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew F Beck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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108
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Wheeler DS, Dewan M, Maxwell A, Riley CL, Stalets EL. Staffing and workforce issues in the pediatric intensive care unit. Transl Pediatr 2018; 7:275-283. [PMID: 30460179 PMCID: PMC6212383 DOI: 10.21037/tp.2018.09.05] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The health care industry is in the midst of incredible change, and unfortunately, change is not easy. The intensive care unit (ICU) plays a critical role in the overall delivery of care to patients in the hospital. Care in the ICU is expensive. One of the best ways of improving the value of care delivered in the ICU is to focus greater attention on the needs of the critical care workforce. Herein, we highlight three major areas of concern-the changing model of care delivery outside of the traditional four walls of the ICU, the need for greater diversity in the pediatric critical care workforce, and the widespread problem of professional burnout and its impact on patient care.
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Affiliation(s)
- Derek S Wheeler
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Maya Dewan
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrea Maxwell
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carley L Riley
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Erika L Stalets
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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109
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Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. Rehabilitation and early mobilization in the critical patient: systematic review. J Phys Ther Sci 2018; 30:1193-1201. [PMID: 30214124 PMCID: PMC6127491 DOI: 10.1589/jpts.30.1193] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/29/2018] [Indexed: 12/23/2022] Open
Abstract
[Purpose] To review the literature that examines rehabilitation and early mobilization
and that involves different practices (effects of interventions) for the critically ill
patient. [Materials and Methods] A PRISMA-Systematic review has been conducted based on
different data sources: Biblioteca Virtual en Salud, CINHAL, Pubmed, Scopus, and Web of
Science were used to identify randomized controlled trials, crossover trials, and
case-control studies. [Results] Eleven studies were included. Early rehabilitation had no
significant effect on the length of stay and number of cases of Intensive Care Unit
Acquired Weaknesses. However, early rehabilitation had a significant effect on the
functional status, muscle strength, mechanical ventilation duration, walking ability at
discharge, and health quality of life. [Conclusion] Rehabilitation and early mobilization
are associated with an increased probability of walking more distance at discharge. Early
rehabilitation is associated with an increase in functional capacity and muscle strength,
an improvement in walking distance and better perception of the health-related quality of
life. Cycloergometer and electrical stimulation can be used to maintain muscle strength.
Further research is needed to establish stronger evidences.
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Affiliation(s)
- Patricia Arias-Fernández
- Health Sciences School, Department of Nursing and Physiotherapy, Intensive Care Unit, University Hospital of León, Spain
| | | | - Juan Gómez-Salgado
- Nursing School, University of Huelva: 21071 Huelva, Spain.,University Espiritu Santo, Ecuador
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110
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Improving Outcomes for Critically Ill Cardiovascular Patients Through Increased Physical Therapy Staffing. Arch Phys Med Rehabil 2018; 100:270-277.e1. [PMID: 30172645 DOI: 10.1016/j.apmr.2018.07.437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine the effect of increasing physical therapy (PT) staff in a cardiovascular intensive care unit (CVICU) on temporal measures of PT interventions and on outcomes important to patients and hospitals. DESIGN Retrospective pre/post subgroup analysis from a quality improvement initiative. SETTING Academic medical center. PARTICIPANTS Cardiovascular patients in either a baseline (N=52) or quality improvement period (N=62) with a CVICU length of stay (LOS) ≥7 days and use of any one of the following: mechanical ventilation, continuous renal replacement therapy, or mechanical circulatory support. INTERVENTIONS The 6-month quality improvement initiative increased CVICU-dedicated PT staff from 2 to 4. MAIN OUTCOME MEASURES Changes in physical therapy delivery were examined using the frequency and daily duration of PT intervention. Post-CVICU LOS was the primary outcome. CVICU LOS, mobility change, and discharge level of care were secondary outcomes. A secondary analysis of hospital survivors was also conducted. RESULTS Compared to those in the baseline period, cardiovascular patients in the quality improvement period participated in PT for an additional 9.6 minutes (95% confidence interval [CI]: 1.9, 17.2) per day for all patients and 15.1 minutes (95% CI: 7.6, 22.6) for survivors. Post-CVICU LOS decreased 2.2 (95% CI: -6.0, 1.0) days for all patients and 2.6 days (95% CI: -5.3, 0.0) for survivors. CVICU LOS decreased 3.6 days (95% CI: -6.4, -0.8) for all patients and 3.1 days (95% CI: -6.4, -0.9) for survivors. Differences in mobility change and discharge level of care were not significant. CONCLUSIONS Additional CVICU-dedicated PT staff was associated with increased PT treatment and reductions in CVICU and post-CVICU LOS. The effects of each were greatest for hospital survivors.
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111
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Pottenger BC, Pronovost PJ, Kreif J, Klein L, Hobson D, Young D, Hoyer EH. Towards improving hospital workflows: An evaluation of resources to mobilize patients. J Nurs Manag 2018; 27:27-34. [PMID: 30117210 DOI: 10.1111/jonm.12644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 01/25/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022]
Abstract
AIM To characterize resources to safely mobilize different types of hospitalized patients. BACKGROUND Current approaches to determine nurse-patient ratios do not always include information regarding the specific demands of patients who require extra resources to mobilize. Workflows must be designed with knowledge of resource requirements to integrate patient mobility into the daily nursing team care plan. METHODS Nurse-led mobility sessions were evaluated on two adult hospital units, which consisted of nurse-patient encounters focused on patient mobility only. The resources assessed for each session were time-to-mobilize patient, time-to-document, need for additional staff support, and the need for assistive devices. Mobility sessions were also categorized by patient ambulation status, level of mobility limitations (low, medium and high) and diagnosis. RESULTS In 212 total mobility sessions, the median time-to-mobilize and time-to-document were 7.75 and 1.27 min, respectively. Additional staff support was required for 87% and 92% of patients with medium and high mobility limitations, respectively. All patients with low mobility limitations ambulated, and only 14% required additional staff. Ambulating patients with high mobility limitations was the most time-intensive (median 12.55 min). Ambulating stroke patients required one additional staff and an assistive device in 92% and 69% of the sessions, respectively. CONCLUSION This study describes the resources associated with mobilizing inpatients with different levels of mobility impairments and diagnoses. IMPLICATIONS FOR NURSING MANAGEMENT These results could assist nursing management with facilitating appropriate daily nurse-patient ratios and justify the need for assistive devices and staff support to safely mobilize patients.
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Affiliation(s)
- Brent C Pottenger
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland
| | - Peter J Pronovost
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University, Baltimore, Maryland.,Departments of Anesthesiology & Critical Care Medicine and Health Policy and Management, Johns Hopkins University, Baltimore, Maryland
| | - Julie Kreif
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Lisa Klein
- Department of Neurosciences, Johns Hopkins University, Baltimore, Maryland.,Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Deborah Hobson
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.,Department of Surgery, Johns Hopkins University, Baltimore, Maryland.,Department of Nursing, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel Young
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland.,Department of Physical Therapy, University of Nevada, Las Vegas, Nevada
| | - Erik H Hoyer
- Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland.,Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
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112
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Chen M, Zeng RX, Liang X, Hu X, Kong L, Wang J, Guo L, Zhang MZ, Zhang X. Seated-Baduanjin as an adjuvant rehabilitation treatment for dysfunctional ventilatory weaning response: A case report. Medicine (Baltimore) 2018; 97:e11854. [PMID: 30142776 PMCID: PMC6112903 DOI: 10.1097/md.0000000000011854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Seated-Baduanjin as adjuvant rehabilitation treatment in a patient with Dysfunctional ventilatory weaning response(DVWR) is extremely rare, and we report a case of a patient's rehabilitation exercise who suffered from DVWR. PATIENT CONCERNS A 62-year-old patient was admitted for dyspnea for more than a month after surgery. DIAGNOSES On arrival, the patient was conscious but anxious, and he had difficulty breathing. When attempting to disconnect the ventilator, the patient's autonomous respiration > 25 times /min, and the heart rate > 120 times /min. He had to rely on the ventilator to survive. According to the characteristics of the patient, we considered the patient with DVWR. INTERVENTIONS We provided the same essential treatment as the last hospital and performed the Seated-Baduanjin for the patient which was a new form of bed exercise, 2 times a day, 30 minutes each time. OUTCOMES The patient showed a gradual improvement in breathing and muscle strength. LESSONS In this case report, the Seated-Baduanjin showed a remarkable therapeutic effect on a patient and might be an adjuvant treatment for DVWR.
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113
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Abstract
Physical activity in acute and critical care has been recognized as a successful method of improving patient outcomes. Challenges lie, however, in mobilizing pediatric critically ill patients and establishing consensus among health care providers about the safety and feasibility. The challenge of mobilizing pediatric patients is balancing developmental level, functional ability, and level of acuity; therefore, a mobility guideline was developed for use in the pediatric intensive care unit (PICU). The unique population and challenges in the PICU led to the development of a PICU-specific set of medical criteria within a PICU mobility guideline. The process of determining the medical criteria, using evidence, is discussed along with stratification of the criteria into phases of mobility. We review the criteria and the implications for mobility guidelines and patient outcomes.
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114
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Tadyanemhandu C, van Aswegen H, Ntsiea V. Early mobilisation practices of patients in intensive care units in Zimbabwean government hospitals - a cross-sectional study. SOUTHERN AFRICAN JOURNAL OF CRITICAL CARE 2018; 34:46-51. [PMID: 35800336 PMCID: PMC9256537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Recent evidence shows that early mobilisation of patients in an intensive care unit (ICU) is feasible, safe and associated with improvement in patients' clinical outcomes. However, its successful implementation is dependent on several factors, which include ICU structure and organisational practices. OBJECTIVES To evaluate the structure and organisational practices of Zimbabwean government hospital ICUs and to describe early mobilisation practices of adult patients in these units. METHODS A cross-sectional survey was conducted in all government hospitals in Zimbabwe. Data collected included hospital and ICU structure, adult patient demographic data and mobilisation activities performed in the ICU during the 24 hours prior to the day of the survey. RESULTS A total of five quaternary level hospitals were surveyed, with each hospital having one adult ICU. Four of the units were open-type ICUs. The majority of the units (n=3; 60%) reported that they had a permanent physiotherapist who covered their unit, but none of the physiotherapists worked solely in the ICU. The nurse-to-patient ratio across all units was 1:1. None of the units utilised a standardised sedation scoring system or a standardised outcome measure to assess patient mobility status. Only one ICU (20%) had a patient eligibility guideline for early mobilisation in place. Across the ICUs, 40 patients were surveyed. The median (interquartile range) age was 33 (23.3 - 38) years and 24 (60%) were mechanically ventilated. Indications for admission into the ICU included acute respiratory failure (n=12; 30%) and postoperative care (n=10; 25%). Mobilisation activities performed in the previous 24 hours included turning the patient in bed (n=39; 97.5%), sitting over the edge of the bed (n=10; 25%) and walking away from the bedside (n=2; 5%). The main reason listed for treatment performed in bed was patients being sedated and unresponsive (n=13; 32.5%). CONCLUSION Out-of-bed mobilisation activities were low and influenced by patient unresponsiveness and sedation, staffing levels and lack of rehabilitation equipment in ICU.
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Affiliation(s)
- C Tadyanemhandu
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - H van Aswegen
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - V Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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115
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Colwell BRL, Williams CN, Kelly SP, Ibsen LM. Mobilization Therapy in the Pediatric Intensive Care Unit: A Multidisciplinary Quality Improvement Initiative. Am J Crit Care 2018; 27:194-203. [PMID: 29716905 DOI: 10.4037/ajcc2018193] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Mobilization is safe and associated with improved outcomes in critically ill adults, but little is known about mobilization of critically ill children. OBJECTIVE To implement a standardized mobilization therapy protocol in a pediatric intensive care unit and improve mobilization of patients. METHODS A goal-directed mobilization protocol was instituted as a quality improvement project in a 20-bed cardiac and medical-surgical pediatric intensive care unit within an academic tertiary care center. The mobilization goal was based on age and severity of illness. Data on severity of illness, ordered activity limitations, baseline functioning, mobilization level, complications of mobilization, and mobilization barriers were collected. Goal mobilization was defined as a ratio of mobilization level to severity of illness of 1 or greater. RESULTS In 9 months, 567 patient encounters were analyzed, 294 (52%) of which achieved goal mobilization. The mean ratio of mobilization level to severity of illness improved slightly but nonsignificantly. Encounters that met mobilization goals were in younger (P = .04) and more ill (P < .001) patients and were less likely to have barriers (P < .001) than encounters not meeting the goals. Complication rate was 2.5%, with no difference between groups (P = .18). No serious adverse events occurred. CONCLUSIONS A multidisciplinary, multiprofessional, goal-directed mobilization protocol achieved goal mobilization in more than 50% of patients in this pediatric intensive care unit. Undermobilized patients were older, less ill, and more likely to have mobilization barriers at the patient and provider level.
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Affiliation(s)
- Blair R. L. Colwell
- Blair R. L. Colwell is a pediatric critical care physician at University of California Davis, Sacramento, California. Cydni N. Williams is an assistant professor of pediatrics at Oregon Health and Science University, Portland, Oregon. Serena P. Kelly is an assistant professor of pediatrics at Oregon Health and Science University. Laura M. Ibsen is a professor of pediatrics and anesthesiology at Oregon Health and Science University
| | - Cydni N. Williams
- Blair R. L. Colwell is a pediatric critical care physician at University of California Davis, Sacramento, California. Cydni N. Williams is an assistant professor of pediatrics at Oregon Health and Science University, Portland, Oregon. Serena P. Kelly is an assistant professor of pediatrics at Oregon Health and Science University. Laura M. Ibsen is a professor of pediatrics and anesthesiology at Oregon Health and Science University
| | - Serena P. Kelly
- Blair R. L. Colwell is a pediatric critical care physician at University of California Davis, Sacramento, California. Cydni N. Williams is an assistant professor of pediatrics at Oregon Health and Science University, Portland, Oregon. Serena P. Kelly is an assistant professor of pediatrics at Oregon Health and Science University. Laura M. Ibsen is a professor of pediatrics and anesthesiology at Oregon Health and Science University
| | - Laura M. Ibsen
- Blair R. L. Colwell is a pediatric critical care physician at University of California Davis, Sacramento, California. Cydni N. Williams is an assistant professor of pediatrics at Oregon Health and Science University, Portland, Oregon. Serena P. Kelly is an assistant professor of pediatrics at Oregon Health and Science University. Laura M. Ibsen is a professor of pediatrics and anesthesiology at Oregon Health and Science University
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Ringdal M, Warren Stomberg M, Egnell K, Wennberg E, Zätterman R, Rylander C. In-bed cycling in the ICU; patient safety and recollections with motivational effects. Acta Anaesthesiol Scand 2018; 62:658-665. [PMID: 29349777 DOI: 10.1111/aas.13070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 12/04/2017] [Accepted: 12/12/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND In-bed cycling (IBC) is gaining interest for implementation in intensive care units. Our main objective was to explore patient recollections and experiences of early mobilization, including IBC. Secondly, we aimed to examine if IBC was safe and feasible. METHODS Eleven participants were interviewed about their experiences during their critical illnesses and active mobilization in the intensive care unit. The interviews were analyzed thematically. Six participants were also monitored for physiological reactions and adverse events during IBC while mechanically ventilated. RESULTS From the interviews, one main theme with three subthemes was identified. The main theme was: Early mobilization gave a direction toward normalization. The three subthemes were: (1) IBC gave a feeling of control over recovery early on during the critical illness (2) Early mobilization, including IBC, with continuous support from health care professionals gave a feeling of safety and hope for recovery for the patient; and (3) Unpleasant experiences and disorientation were felt during the critical illness and IBC. Furthermore, IBC did not induce large physiological changes or major adverse events in the participants who were monitored for feasibility and safety. CONCLUSIONS Patient interviews indicated that the patients' participation in early mobilization with emphasis on IBC motivated them to be active in their recovery to regain a good level of health after their earlier critical illness during their intensive care stay. IBC was, in this small study, safe and feasible in the two participating intensive care units.
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Affiliation(s)
- M. Ringdal
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Department of Anaesthetics and Intensive Care; Kungälv Hospital; Kungälv Sweden
| | - M. Warren Stomberg
- Institute of Health and Care Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - K. Egnell
- Department of Anaesthetics and Intensive Care; Kungälv Hospital; Kungälv Sweden
| | - E. Wennberg
- Department of Anaesthetics and Intensive Care; Kungälv Hospital; Kungälv Sweden
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - R. Zätterman
- Department of Anaesthetics and Intensive Care; Kungälv Hospital; Kungälv Sweden
| | - C. Rylander
- Department of Anaesthesiology and Intensive Care Medicine; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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Williams L. Adults in the Pediatric Intensive Care Unit: A Pediatric Nurse's Perspective. AACN Adv Crit Care 2018; 28:107-110. [PMID: 28592466 DOI: 10.4037/aacnacc2017492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Lori Williams
- Lori Williams is Clinical Nurse Specialist, Universal Care Unit, American Family Children's Hospital, University of Wisconsin Hospital and Clinics, Mail Code C850, 1675 Highland Avenue, Room 8317, Madison, WI 53792
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Sustainability of a nurse-driven early progressive mobility protocol and patient clinical and psychological health outcomes in a neurological intensive care unit. Intensive Crit Care Nurs 2018; 45:11-17. [DOI: 10.1016/j.iccn.2018.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/23/2017] [Accepted: 01/15/2018] [Indexed: 10/18/2022]
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119
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Evaluation of a Progressive Mobility Protocol in Postoperative Cardiothoracic Surgical Patients. Dimens Crit Care Nurs 2018; 35:277-82. [PMID: 27487753 DOI: 10.1097/dcc.0000000000000197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cardiothoracic surgical patients are at high risk for complications related to immobility, such as increased intensive care and hospital length of stay, intensive care unit readmission, pressure ulcer development, and deep vein thrombosis/pulmonary embolus. A progressive mobility protocol was started in the thoracic cardiovascular intensive care unit in a rural academic medical center. The purpose of the progressive mobility protocol was to increase mobilization of postoperative patients and decrease complications related to immobility in this unique patient population. A matched-pairs design was used to compare a randomly selected sample of the preintervention group (n = 30) to a matched postintervention group (n = 30). The analysis compared outcomes including intensive care unit and hospital length of stay, intensive care unit readmission occurrence, pressure ulcer prevalence, and deep vein thrombosis/pulmonary embolism prevalence between the 2 groups. Although this comparison does not achieve statistical significance (P < .05) for any of the outcomes measured, it does show clinical significance in a reduction in hospital length of stay, intensive care unit days, in intensive care unit readmission rate, and a decline in pressure ulcer prevalence, which is the overall goal of progressive mobility. This study has implications for nursing, hospital administration, and therapy services with regard to staffing and cost savings related to fewer complications of immobility. Future studies with a larger sample size and other populations are warranted.
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Liu K, Ogura T, Takahashi K, Nakamura M, Ohtake H, Fujiduka K, Abe E, Oosaki H, Miyazaki D, Suzuki H, Nishikimi M, Lefor AK, Mato T. The safety of a novel early mobilization protocol conducted by ICU physicians: a prospective observational study. J Intensive Care 2018; 6:10. [PMID: 29484188 PMCID: PMC5819168 DOI: 10.1186/s40560-018-0281-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/12/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There are numerous barriers to early mobilization (EM) in a resource-limited intensive care unit (ICU) without a specialized team or an EM culture, regarding patient stability while critically ill or in the presence of medical devices. We hypothesized that ICU physicians can overcome these barriers. The aim of this study was to investigate the safety of EM according to the Maebashi EM protocol conducted by ICU physicians. METHODS This was a single-center prospective observational study. All consecutive patients with an unplanned emergency admission were included in this study, according to the exclusion criteria. The observation period was from June 2015 to June 2016. Data regarding adverse events, medical devices in place during rehabilitation, protocol adherence, and rehabilitation outcomes were collected. The primary outcome was safety. RESULTS A total of 232 consecutively enrolled patients underwent 587 rehabilitation sessions. Thirteen adverse events occurred (2.2%; 95% confidence interval, 1.2-3.8%) and no specific treatment was needed. There were no instances of dislodgement or obstruction of medical devices, tubes, or lines. The incidence of adverse events associated with mechanical ventilation or extracorporeal membrane oxygenation (ECMO) was 2.4 and 3.6%, respectively. Of 587 sessions, 387 (66%) sessions were performed at the active rehabilitation level, including sitting out of the bed, active transfer to a chair, standing, marching, and ambulating. ICU physicians attended over 95% of these active rehabilitation sessions. Of all patients, 143 (62%) got out of bed within 2 days (median 1.2 days; interquartile range 0.1-2.0). CONCLUSIONS EM according to the Maebashi EM protocol conducted by ICU physicians, without a specialized team or EM culture, was performed at a level of safety similar to previous studies performed by specialized teams, even with medical devices in place, including mechanical ventilation or ECMO. Protocolized EM led by ICU physicians can be initiated in the acute phase of critical illness without serious adverse events requiring additional treatment.
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Affiliation(s)
- Keibun Liu
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma 371-0014 Japan
| | - Takayuki Ogura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma 371-0014 Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Tsurumai-cho 64, Syowa-ku, Nagoya, Aichi 466-8560 Japan
| | - Mitsunobu Nakamura
- Department of Biostatistics, Nagoya University Graduate School of Medicine, Tsurumai-cho 64, Syowa-ku, Nagoya, Aichi 466-8560 Japan
| | - Hiroaki Ohtake
- Department of Rehabilitation Medicine, Japan Red Cross Maebashi Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma 371-0014 Japan
| | - Kenji Fujiduka
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma 371-0014 Japan
| | - Emi Abe
- Department of Nursing, Intensive Care Unit, Japan Red Cross Maebashi Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma 371-0014 Japan
| | - Hitoshi Oosaki
- Department of Rehabilitation Medicine, Japan Red Cross Maebashi Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma 371-0014 Japan
| | - Dai Miyazaki
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma 371-0014 Japan
| | - Hiroyuki Suzuki
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma 371-0014 Japan
| | - Mitsuaki Nishikimi
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, 3-21-36 Asahi-cho, Maebashi, Gunma 371-0014 Japan
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsukeshi, Tochigi, 329-0498 Japan
| | - Takashi Mato
- Department of Emergency Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsukeshi, Tochigi, 329-0498 Japan
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Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program. Clin Nutr ESPEN 2018; 23:184-193. [DOI: 10.1016/j.clnesp.2017.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/28/2017] [Accepted: 10/17/2017] [Indexed: 12/14/2022]
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Miura S, Wieczorek B, Lenker H, Kudchadkar SR. Normal Baseline Function Is Associated With Delayed Rehabilitation in Critically Ill Children. J Intensive Care Med 2018; 35:405-410. [PMID: 29357778 DOI: 10.1177/0885066618754507] [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: 12/28/2022]
Abstract
BACKGROUND Early mobilization of patients in the adult intensive care unit (ICU) is associated with improved functional outcomes and shorter ICU stay. Although emerging evidence suggests that early mobilization in pediatric ICUs (PICUs) is safe and feasible, physical therapist (PT) consultation may be delayed because of perceptions that patient acuity precludes mobilization activities. Factors that influence timely involvement of PTs to facilitate acute rehabilitation in critically ill children have not been characterized. The aim of this study was to identify patient-level factors for early PT consultation in a tertiary care PICU before large-scale implementation of a multicomponent early mobilization program. METHODS We conducted a retrospective analysis of data from the PICU Up! Quality Improvement Initiative. The primary outcome was early rehabilitation, defined as PT consultation within the first 3 days of PICU admission. Patients (n = 100) were divided into 2 groups by outcome, and predictive factors for early rehabilitation were analyzed with logistic regression. RESULTS Of 100 children, 54% received early rehabilitation. In univariate analyses, higher pediatric risk of mortality (PRISM) score (P < .001), baseline motor impairment (P < .01), developmental delay (P = .04), mechanical ventilation (P = .1), and number of devices (P = .01) were associated with early rehabilitation. In a logistic regression model, predictive factors for early rehabilitation included baseline motor impairment (adjusted odds ratio = 5.36, 95% confidence interval [CI] = 1.3-22.0) and higher PRISM score (adjusted odds ratio = 1.17, 95% CI = 1.02-1.34). CONCLUSIONS Critically ill children with normal baseline function or lower acuity of illness are less likely to have initiation of early rehabilitation with PT prior to implementation of a unit-wide early mobilization program. Baseline motor impairment and higher PRISM scores were independently associated with early rehabilitation. These findings highlight the need for streamlined criteria for PT consultation to meet the rehabilitation needs of all critically ill patients.
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Affiliation(s)
- Shinya Miura
- Department of Pediatric Intensive Care, Saitama Children's Medical Center, Saitama, Japan
| | - Beth Wieczorek
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hallie Lenker
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sapna R Kudchadkar
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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123
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Joyce CL, Taipe C, Sobin B, Spadaro M, Gutwirth B, Elgin L, Silver G, Greenwald BM, Traube C. Provider Beliefs Regarding Early Mobilization in the Pediatric Intensive Care Unit. J Pediatr Nurs 2018; 38:15-19. [PMID: 29167075 DOI: 10.1016/j.pedn.2017.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 01/22/2023]
Abstract
PURPOSE Critically ill patients are at risk for short and long term morbidity. Early mobilization (EM) of critically ill adults is safe and feasible, with improvement in outcomes. There are limited studies evaluating EM in pediatric critical care patients. Provider beliefs and concerns must be evaluated prior to EM implementation in the pediatric intensive care unit (PICU). DESIGN AND METHODS A survey was distributed to PICU providers assessing beliefs and concerns with regards to EM of PICU patients. RESULTS Seventy-one providers responded. Most staff believed EM would be beneficial. The largest perceived benefits were decreased length of both stay and mechanical ventilation. The largest perceived concerns were risk of both endotracheal tube and central venous catheter dislodgement. Surveyed clinicians felt significantly more comfortable mobilizing the oldest as compared to the youngest patients (p<0.0001). Clinicians also felt significantly more comfortable mobilizing patients receiving invasive mechanical ventilation in the oldest as compared to the youngest patients (p<0.0001). CONCLUSION There is clear benefit to the EM of adult ICU patients, with evidence supporting its safety and feasibility. As pediatric patients pose different challenges, it is imperative to understand provider concerns prior to the implementation of EM. Our research demonstrates similar concerns between adult and pediatric programs, with the addition of significant concern surrounding EM in very young children. PRACTICE IMPLICATIONS Understanding pediatric specific concerns with regards to EM will allow for the proper development and implementation of pediatric EM programs, allowing us to assess safety, feasibility, and ultimately outcomes.
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Affiliation(s)
| | - Cosme Taipe
- Department of Nursing, New York-Presbyterian Hospital, USA
| | - Brittany Sobin
- Department of Pediatrics, NewYork-Presbyterian Hospital, USA
| | - Marissa Spadaro
- Department of Pediatrics, NewYork-Presbyterian Hospital, USA
| | | | - Larissa Elgin
- Department of Pediatrics, NewYork-Presbyterian Hospital, USA
| | | | | | - Chani Traube
- Department of Pediatrics, Weill Cornell Medical College, USA
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Magalhães PA, Camillo CA, Langer D, Andrade LB, Duarte MDCM, Gosselink R. Weaning failure and respiratory muscle function: What has been done and what can be improved? Respir Med 2018; 134:54-61. [DOI: 10.1016/j.rmed.2017.11.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/18/2017] [Accepted: 11/28/2017] [Indexed: 02/03/2023]
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125
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Physical Therapists' Clinical Reasoning and Decision-Making Processes When Mobilizing Patients Who Are Critically Ill: A Qualitative Study. Cardiopulm Phys Ther J 2018. [DOI: 10.1097/cpt.0000000000000066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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126
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Nepomuceno BRV, Barreto MDS, Almeida NC, Guerreiro CF, Xavier-Souza E, Neto MG. Safety and efficacy of inspiratory muscle training for preventing adverse outcomes in patients at risk of prolonged hospitalisation. Trials 2017; 18:626. [PMID: 29282152 PMCID: PMC5745884 DOI: 10.1186/s13063-017-2372-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background The early institution of inspiratory muscle training on hospitalised patients with no established respiratory deficits could prevent in-hospital adverse outcomes that are directly or indirectly associated to the loss of respiratory muscle mass inherent to a prolonged hospital stay. The objective of the clinical trial is to assess the impact of inspiratory muscle training on hospital inpatient complications. Methods This is a double-blind randomised controlled trial. Subjects in the intervention group underwent an inspiratory muscle training loaded with 50% maximum inspiratory pressure twice daily for 4 weeks from study enrolment. Patients were randomly assigned to an inspiratory muscle training group or a sham inspiratory muscle training group. All patients received conventional physiotherapy interventions. Baseline and post-intervention respiratory and peripheral muscle strength, functionality (performance of activities of daily living), length of hospital stay, and death were evaluated. Clinical outcomes were assessed until hospital discharge. This study was approved by the Institutional Hospital Ethics Committee (03/2014). Results Thirty-one patients assigned to the inspiratory muscle training group and 34 to the sham inspiratory muscle training group were analysed. Patients in the inspiratory muscle training group had a shorter mean length of hospital stay (35.3 ± 2.7 vs. 41.8 ± 3.5 days, p < 0.01) and a lower risk of endotracheal intubation (relative risk (RR) = 0.36; 95% confidence interval (CI) 0.27–0.97; p = 0.03) as well as muscle weakness (RR = 0.36; 95% CI 0.19–0.98; p = 0.02) and mortality (RR = 0.23; 95% CI 0.2–0.94; p = 0.04). The risk of adverse events did not differ significantly between groups. Conclusion Inspiratory muscle training was a protective factor against endotracheal intubation, muscle weakness, and mortality. Trial registration ClinicalTrials.gov, ID: NCT02459444. Registered on 19 May 2015.
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Affiliation(s)
- Balbino Rivail Ventura Nepomuceno
- Medicine and Health, Federal University of Bahia - UFBA, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil. .,Department of Biofunção, Institute of Health Sciences - ICS, UFBA, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil. .,Reative Physiotherapy Specialist, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil. .,Metropolitan Union for Education and Culture, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil.
| | - Mayana de Sá Barreto
- Metropolitan Union for Education and Culture, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil
| | - Naniane Cidreira Almeida
- Metropolitan Union for Education and Culture, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil
| | | | | | - Mansueto Gomes Neto
- Medicine and Health, Federal University of Bahia - UFBA, Av. Tancredo Neves, n 1283, Sala 902 - Edf. Ômega - Caminho das Árvores, Salvador, Bahia, ZIP 41820-021, Brazil.,Department of Physiotherapy, Institute of Health Sciences-ICS, UFBA, Salvador, BA, Brazil
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Johnson AM, Henning AN, Morris PE, Tezanos AGV, Dupont-Versteegden EE. Timing and Amount of Physical Therapy Treatment are Associated with Length of Stay in the Cardiothoracic ICU. Sci Rep 2017; 7:17591. [PMID: 29242519 PMCID: PMC5730602 DOI: 10.1038/s41598-017-17624-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/15/2017] [Indexed: 01/06/2023] Open
Abstract
Significant variability exists in physical therapy early mobilization practice. The frequency of physical therapy or early mobilization of patients in the cardiothoracic intensive care unit and its effect on length of stay has not been investigated. The goal of our research was to examine variables that influence physical therapy evaluation and treatment in the intensive care unit using a retrospective chart review. Patients (n = 2568) were categorized and compared based on the most common diagnoses or surgical procedures. Multivariate semi-logarithmic regression analyses were used to determine correlations. Differences among patient subgroups for all independent variables other than age and for length of stay were found. The regression model determined that time to first physical therapy evaluation, Charlson Comorbidity Index score, mean days of physical therapy treatment and mechanical ventilation were associated with increased hospital length of stay. Time to first physical therapy evaluation in the intensive care unit and the hospital, and mean days of physical therapy treatment associated with hospital length of stay. Further prospective study is required to determine whether shortening time to physical therapy evaluation and treatment in a cardiothoracic intensive care unit could influence length of stay.
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Affiliation(s)
- Audrey M Johnson
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky, United States of America.
| | - Angela N Henning
- Rehabilitation Department, UK HealthCare, Lexington, Kentucky, United States of America
| | - Peter E Morris
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Lexington, Kentucky, United States of America
| | - Alejandro G Villasante Tezanos
- Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, Kentucky, United States of America
| | - Esther E Dupont-Versteegden
- Department of Rehabilitation Sciences, College of Health Sciences, University of Kentucky, Lexington, Kentucky, United States of America
- Center for Muscle Biology, College of Health Sciences, University of Kentucky, Lexington, Kentucky, United States of America
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Abstract
Early mobilization of patients in the intensive care unit (ICU) is safe, feasible, and beneficial. However, implementation of early mobility as part of routine clinical care can be challenging. The objective of this review is to identify barriers to early mobilization and discuss strategies to overcome such barriers. Based on a literature search, we synthesize data from 40 studies reporting 28 unique barriers to early mobility, of which 14 (50%) were patient-related, 5 (18%) structural, 5 (18%) ICU cultural, and 4 (14%) process-related barriers. These barriers varied across ICUs and within disciplines, depending on the ICU patient population, setting, attitude, and ICU culture. To overcome the identified barriers, over 70 strategies were reported and are synthesized in this review, including: implementation of safety guidelines; use of mobility protocols; interprofessional training, education, and rounds; and involvement of physician champions. Systematic efforts to change ICU culture to prioritize early mobilization using an interprofessional approach and multiple targeted strategies are important components of successfully implementing early mobility in clinical practice.
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Neuburger PJ, Patel PA. Anesthetic Techniques in Transcatheter Aortic Valve Replacement and the Evolving Role of the Anesthesiologist. J Cardiothorac Vasc Anesth 2017; 31:2175-2182. [DOI: 10.1053/j.jvca.2017.03.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Indexed: 11/11/2022]
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130
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Noll DR. The Potential of Osteopathic Manipulative Treatment in Antimicrobial Stewardship: A Narrative Review. J Osteopath Med 2017; 116:600-8. [PMID: 27571297 DOI: 10.7556/jaoa.2016.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The contemporary management of infectious diseases is built around antimicrobial therapy. However, the development of antimicrobial resistance threatens to create a post-antibiotic era. Antimicrobial stewardship attempts to reduce the development of antimicrobial resistance by improving their appropriate use. Osteopathic manipulative treatment as an adjunctive treatment has the potential for enhancing antimicrobial stewardship by enhancing the human immune system, shortening the duration of antimicrobial therapy, reducing complications, and improving treatment outcomes. The present article reviews the evidence published in the literature since this unique treatment approach was first developed more than 100 years ago. The evidence suggests that adjunctive osteopathic manipulative treatment has great potential for enhancing antimicrobial stewardship and should be further investigated.
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131
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Early Rehabilitation: A Path Toward Optimizing Function While Treating Critical Illness in Children. Pediatr Crit Care Med 2017; 18:1080-1081. [PMID: 29099454 DOI: 10.1097/pcc.0000000000001345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moradian ST, Najafloo M, Mahmoudi H, Ghiasi MS. Early mobilization reduces the atelectasis and pleural effusion in patients undergoing coronary artery bypass graft surgery: A randomized clinical trial. JOURNAL OF VASCULAR NURSING 2017; 35:141-145. [PMID: 28838589 DOI: 10.1016/j.jvn.2017.02.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 12/18/2022]
Abstract
Atelectasis and pleural effusion are common after coronary artery bypass graft surgery (CABG). Longer stay in the bed is one of the most important contributing factors in pulmonary complications. Some studies confirm the benefits of early mobilization (EM) in critically ill patients, but the efficacy of EM on pulmonary complications after CABG is not clear. This study was designed to examine the effect of EM on the incidence of atelectasis and pleural effusion in patients undergoing CABG. In a single-blinded randomized clinical trial, 100 patients who were undergoing coronary artery bypass graft surgery were randomly assigned into two groups each consisted of 50 patients. Patients in the experimental group were enrolled in a mobilization protocol consisting of the mobilization from the bed in the first 3 days after surgery in the morning and evening. Patients in the control group were mobilized from bed in third postoperation day, according to the hospital routine. Arterial blood gases, pleural effusion, and atelectasis were compared between groups. Atelectasis and pleural effusion was reduced in experimental group. The partial pressure of oxygen in arterial blood in third postoperative day and the percentage of arterial oxygen saturation in the fourth postoperative day were higher in the intervention group (P value < .05). EM from bed could be an effective intervention in reducing atelectasis and pleural effusion in patients undergoing CABG.
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Affiliation(s)
| | - Mohammad Najafloo
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hosein Mahmoudi
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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133
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Hyde-Wyatt J. Prevention, recognition and management of delirium in patients who are critically ill. Nurs Stand 2017; 32:41-52. [PMID: 29094525 DOI: 10.7748/ns.2017.e10667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2016] [Indexed: 11/09/2022]
Abstract
Delirium is common in patients who are critically ill, often resulting in extended hospital stays and increased mortality and morbidity. There are several subtypes of delirium, which are often undiagnosed and untreated, resulting in suboptimal patient outcomes. This article examines delirium in patients in the intensive care unit, including its signs and symptoms, incidence, causes and subtypes. It outlines the assessment of delirium and the pharmacological and non-pharmacological interventions that can be used to manage the condition, as well as describing the optimal prevention measures.
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Affiliation(s)
- Jaime Hyde-Wyatt
- Northern Lincolnshire and Goole NHS Foundation Trust, Scunthorpe, England
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134
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Outcomes of Patient- and Family-Centered Care Interventions in the ICU: A Systematic Review and Meta-Analysis. Crit Care Med 2017; 45:1751-1761. [PMID: 28749855 DOI: 10.1097/ccm.0000000000002624] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine whether patient- and family-centered care interventions in the ICU improve outcomes. DATA SOURCES We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library databases from inception until December 1, 2016. STUDY SELECTION We included articles involving patient- and family-centered care interventions and quantitative, patient- and family-important outcomes in adult ICUs. DATA EXTRACTION We extracted the author, year of publication, study design, population, setting, primary domain investigated, intervention, and outcomes. DATA SYNTHESIS There were 46 studies (35 observational pre/post, 11 randomized) included in the analysis. Seventy-eight percent of studies (n = 36) reported one or more positive outcome measures, whereas 22% of studies (n = 10) reported no significant changes in outcome measures. Random-effects meta-analysis of the highest quality randomized studies showed no significant difference in mortality (n = 5 studies; odds ratio = 1.07; 95% CI, 0.95-1.21; p = 0.27; I = 0%), but there was a mean decrease in ICU length of stay by 1.21 days (n = 3 studies; 95% CI, -2.25 to -0.16; p = 0.02; I = 26%). Improvements in ICU costs, family satisfaction, patient experience, medical goal achievement, and patient and family mental health outcomes were also observed with intervention; however, reported outcomes were heterogeneous precluding formal meta-analysis. CONCLUSIONS Patient- and family-centered care-focused interventions resulted in decreased ICU length of stay but not mortality. A wide range of interventions were also associated with improvements in many patient- and family-important outcomes. Additional high-quality interventional studies are needed to further evaluate the effectiveness of patient- and family-centered care in the intensive care setting.
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135
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Can Early Rehabilitation on the General Ward After an Intensive Care Unit Stay Reduce Hospital Length of Stay in Survivors of Critical Illness? Am J Phys Med Rehabil 2017; 96:607-615. [DOI: 10.1097/phm.0000000000000718] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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136
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Sibilla A, Nydahl P, Greco N, Mungo G, Ott N, Unger I, Rezek S, Gemperle S, Needham DM, Kudchadkar SR. Mobilization of Mechanically Ventilated Patients in Switzerland. J Intensive Care Med 2017; 35:55-62. [DOI: 10.1177/0885066617728486] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose: Growing evidence suggests that early mobilization benefits intensive care unit (ICU) patients. However, national practices and the culture of individual ICUs influence mobilization activities. Materials and Methods: In a 1-day, Swiss point prevalence study conducted in 35 ICUs (representing 45% of all ICUs), the highest level of mobilization for mechanically ventilated patients was characterized using the validated ICU Mobility Scale, along with data collection for potential safety events and mobilization barriers. Results: Among 161 mechanically ventilated patients, a total of 33% (n = 53) had active mobilization, with walking achieved by only 2% (n = 4). More severe organ failure was associated with lower mobilization (respiratory Sequential Organ Failure Assessment score: P = .037, cardiac: P = .008, neurology: P < .001). Barriers to mobilization were reported in 71% (n = 115), with deep sedation significantly higher among patients receiving passive versus active mobilization (14% vs 0%, P = .005). Potential safety events occurred in 20% (n = 33) of patients without significant differences between passive and active mobilization. Availability of physiotherapists and appropriate equipment were not reported barriers. Conclusion: Mobilization during mechanical ventilation occurred infrequently with greater organ failure associated with lower mobilization. Addressing the identified modifiable barriers via structured efforts to achieve multidisciplinary culture change is essential to decrease the common use of bed rest in Swiss ICUs.
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Affiliation(s)
- Alberto Sibilla
- Kantonsspital Winterthur, Institute for Physiotherapy, Winterthur, Switzerland
| | - Peter Nydahl
- Nursing Research, University Hospital of Schleswig-Holstein, Schleswig-Holstein, Germany
| | - Nicola Greco
- Kantonsspital Winterthur, Institute for Physiotherapy, Winterthur, Switzerland
| | - Giuseppe Mungo
- Kantonsspital Winterthur, Institute for Physiotherapy, Winterthur, Switzerland
| | - Natalie Ott
- Kantonsspital Winterthur, Institute for Physiotherapy, Winterthur, Switzerland
| | - Ines Unger
- Kantonsspital Winterthur, Institute for Physiotherapy, Winterthur, Switzerland
| | - Spencer Rezek
- Kantonsspital Winterthur, Institute for Physiotherapy, Winterthur, Switzerland
| | - Sarah Gemperle
- Intensive Care Unit, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Dale M. Needham
- Outcomes after Critical Illness and Surgery (OACIS) Group, Pulmonary and Critical Care Medicine, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sapna R. Kudchadkar
- Outcomes after Critical Illness and Surgery (OACIS) Group, Anesthesiology and Critical Care Medicine, Pediatrics and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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137
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Bargellesi S, Cavasin L, Scarponi F, De Tanti A, Bonaiuti D, Bartolo M, Boldrini P, Estraneo A. Occurrence and predictive factors of heterotopic ossification in severe acquired brain injured patients during rehabilitation stay: cross-sectional survey. Clin Rehabil 2017; 32:255-262. [PMID: 28805078 DOI: 10.1177/0269215517723161] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres. DESIGN Multicentre cross-sectional survey. SETTING A total of 48 severe acquired brain injury rehabilitation institutes. PARTICIPANTS Traumatic and non-traumatic severe brain-injured patients ( N = 689) in rehabilitation centres on 28 May 2016. MAIN OUTCOME MEASURE Occurrence of heterotopic ossifications diagnosed by standard radiological and/or sonographic evaluation on the basis of clinical suspicion. RESULTS Heterotopic ossification occurred around one or more joints in 94/689 patients (13.6%) with a significantly higher prevalence in young males. Occurrence did not significantly differ in relation to aetiology (16.3% traumatic, 19.2% anoxic, 11.7% vascular and 11.5% other). Prevalence was significantly higher in patients with diffuse (23.3%) rather than focal brain lesions (12.4%) or unspecified lesions (11.2%; chi-square = 7.81, df = 2, P = 0.020); longer duration of coma ( P = 0.0016) and ventilation support ( P = 0.0145); paroxysmal sympathetic hyperactivity (22.6% versus 11.6%; chi-square = 10.81, df = 1, P = 0.001); and spasticity (22.7% versus 10.1%; chi-square = 18.63, df = 1, P < 0.0001). A longer interval between acute brain injury and admission to rehabilitation centre was significantly associated with higher frequency of heterotopic ossifications. CONCLUSION Occurrence of heterotopic ossifications is frequent in patients with severe traumatic and non-traumatic brain-injury in rehabilitation centres. Our study confirms male gender, young age, paroxysmal sympathetic hyperactivity, spasticity, longer duration of coma and ventilation and longer interval between brain injury onset and admission to rehabilitation centre as possible risk factors. Further studies are necessary to investigate the role of early appropriate rehabilitation pathways to reduce occurrence of heterotopic ossifications.
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Affiliation(s)
- Stefano Bargellesi
- 1 Physical Medicine and Rehabilitation-Severe Brain Injuries Rehabilitation Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Luisa Cavasin
- 2 School of Physical Medicine and Rehabilitation, University of Padova, Padova, Italy
| | - Federico Scarponi
- 3 Severe Brain Injuries Rehabilitation Unit, San Giovanni Battista Hospital, Foligno, Italy
| | - Antonio De Tanti
- 4 Severe Brain Injuries Rehabilitation Unit, Cardinal Ferrari Rehabilitation Centre, Santo Stefano Rehabilitation Institute, Fontanellato, Italy
| | - Donatella Bonaiuti
- 5 Physical Medicine and Rehabilitation Unit, San Gerardo Hospital, Monza, Italy
| | - Michelangelo Bartolo
- 6 Rehabilitation Department, Severe Brain Injuries Rehabilitation Unit, Habilita Institute, Bergamo, Italy
| | - Paolo Boldrini
- 7 Rehabilitation Department, Azienda ULSS 2 and President of Italian Society of Physical Medicine & Rehabilitation (SIMFER), Treviso, Italy
| | - Anna Estraneo
- 8 Neurorehabilitation Unit and Research Laboratory for Disorder of Consciousness, ICS Maugeri, Telese Terme, Italy
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138
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Johnson K, Petti J, Olson A, Custer T. Identifying barriers to early mobilisation among mechanically ventilated patients in a trauma intensive care unit. Intensive Crit Care Nurs 2017; 42:51-54. [PMID: 28743548 DOI: 10.1016/j.iccn.2017.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 06/09/2017] [Accepted: 06/12/2017] [Indexed: 11/30/2022]
Abstract
Mechanically ventilated patients can be at risk for functional decline (Cameron et al., 2015). Early mobilisation of mechanically ventilated patients can improve outcomes after critical illness to prevent this decline. Although registered nurses understand the importance of early mobilisation there are nurses who are unwilling to mobilise patients. AIM The aim of this study is to examine whether nurses' attitudes and beliefs are barriers for early mobilisation and evaluate whether an education intervention can improve early mobilisation. METHOD Pre-test, post-test intervention with registered nurses and charge nurses in a 22 bed trauma intensive care setting. PROCEDURE Pre-test, post-test survey assessed perceived barriers in knowledge, attitudes, and behaviours followed by targeted education. RESULTS Dependent Sample T-test revealed a statistically significant increase in post-test responses for the subscales knowledge, attitudes, and behaviours with early mobilisation. This over-all increase in post-test results support that understanding barriers can improve patient outcomes. CONCLUSION Use of structured surveys to identify barriers for early mobilisation among nursing can assist in providing targeted education that address nurse's perception. The education intervention appeared to have a positive impact on attitudes but it is unknown if the difference was sustained over time or affected participants practice or patient outcomes.
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Affiliation(s)
- Kari Johnson
- Honor Health Thompson Peak Medical Center, 7400 E. Thompson Peak Parkway, Scottsdale, AZ, 85255, United States.
| | - Jamie Petti
- Trauma Intensive Care Unit, Honor Health John C Lincoln Medical Center, 250 East Dunlap Avenue, Phoenix, AZ, 85020, United States.
| | - Amy Olson
- Trauma Intensive Care Unit, Honor Health John C Lincoln Medical Center, 250 East Dunlap Avenue, Phoenix, AZ, 85020, United States.
| | - Tina Custer
- Trauma Intensive Care Unit, Honor Health John C Lincoln Medical Center, 250 East Dunlap Avenue, Phoenix, AZ, 85020, United States.
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139
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Jacobson K, Fletchall S, Dodd H, Starnes C. Current Concepts Burn Rehabilitation, Part I: Care During Hospitalization. Clin Plast Surg 2017; 44:703-712. [PMID: 28888296 DOI: 10.1016/j.cps.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This article summarizes current interventions for several of the most common challenges faced by patients during their rehabilitation from burn injury. These include preservation of range of motion through scar contracture management, and achieving maximal independence through exercise, and training in activities of daily living.
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Affiliation(s)
- Keith Jacobson
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA.
| | - Sandra Fletchall
- Burn Rehabilitation, Firefighters Burn Center, 890 Madison Avenue, TG 043, Memphis, TN 380103, USA
| | - Heather Dodd
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA
| | - Carrie Starnes
- Rehabilitation Therapy Services, NC Jaycee Burn Center, 101 Manning Drive, CB #7600, Chapel Hill, NC 27599, USA
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140
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Implementation of an ICU Bundle: An Interprofessional Quality Improvement Project to Enhance Delirium Management and Monitor Delirium Prevalence in a Single PICU. Pediatr Crit Care Med 2017; 18:531-540. [PMID: 28410275 DOI: 10.1097/pcc.0000000000001127] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the impact of an ICU bundle on delirium screening and prevalence and describe characteristics of delirium cases. DESIGN Quality improvement project with prospective observational analysis. SETTING Nineteen-bed PICU in an urban academic medical center. PATIENTS All consecutive patients admitted from December 1, 2013, to September 30, 2015. INTERVENTIONS A multidisciplinary team implemented an ICU bundle consisting of three clinical protocols: delirium, sedation, and early mobilization using the Plan-Do-Study-Act cycles as part of a quality improvement project. The delirium protocol implemented in December 2013 consisted of universal screening with the Cornell Assessment of Pediatric Delirium revised instrument, prevention and treatment strategies, and case conferences. The sedation protocol and early mobilization protocol were implemented in October 2014 and June 2015, respectively. MEASUREMENTS AND MAIN RESULTS One thousand eight hundred seventy-five patients were screened using the Cornell Assessment of Pediatric Delirium revised tool. One hundred forty patients (17%) had delirium (having Cornell Assessment of Pediatric Delirium revised scores ≥ 9 for 48 hr or longer). Seventy-four percent of delirium positive patients were mechanically ventilated of which 46% were younger than 12 months and 59% had baseline developmental delays. Forty-one patients had emerging delirium (having one Cornell Assessment of Pediatric Delirium revised score ≥ 9). Statistical process control was used to evaluate the impact of three ICU bundle process changes on monthly delirium rates over a 22-month period. The delirium rate decreased with the implementation of each phase of the ICU bundle. Ten months after the delirium protocol was implemented, the mean delirium rate was 19.3%; after the sedation protocol and early mobilization protocols were implemented, the mean delirium rate was 11.84%. CONCLUSIONS Implementation of an ICU bundle along with staff education and case conferences is effective for improving delirium screening, detection, and treatment and is associated with decreased delirium prevalence.
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141
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Hurt RT, McClave SA, Martindale RG, Ochoa Gautier JB, Coss-Bu JA, Dickerson RN, Heyland DK, Hoffer LJ, Moore FA, Morris CR, Paddon-Jones D, Patel JJ, Phillips SM, Rugeles SJ, Sarav, MD M, Weijs PJM, Wernerman J, Hamilton-Reeves J, McClain CJ, Taylor B. Summary Points and Consensus Recommendations From the International Protein Summit. Nutr Clin Pract 2017; 32:142S-151S. [DOI: 10.1177/0884533617693610] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Ryan T. Hurt
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Stephen A. McClave
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Robert G. Martindale
- Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Juan B. Ochoa Gautier
- Nestlé HealthCare Nutrition, Inc, Florham Park, New Jersey, USA, and the Department of Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Jorge A. Coss-Bu
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Roland N. Dickerson
- Department of Clinical Pharmacology, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Daren K. Heyland
- Department of Critical Care Medicine, Queens University, Kingston, Ontario, Canada
| | - L. John Hoffer
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Claudia R. Morris
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Douglas Paddon-Jones
- School of Health Professions, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jayshil J. Patel
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Stuart M. Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Saúl J. Rugeles
- Department of Surgery, Pontificia Universidad Javeriana Medical School, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Menaka Sarav, MD
- Department of Medicine, Northshore University Health System, Evanston, Illinois, USA
| | - Peter J. M. Weijs
- Department of Medicine, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Jan Wernerman
- Department of Clinical Science, Karolinska University, Stockholm, Sweden
| | - Jill Hamilton-Reeves
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Craig J. McClain
- Department of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Beth Taylor
- Department of Food and Nutrition, Barnes-Jewish Hospital, St Louis, Missouri, USA
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142
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Alugubelli NR, Al-Ani A, Needham DM, Parker AM. Understanding early goal-directed mobilization in the surgical intensive care unit. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:176. [PMID: 28480212 DOI: 10.21037/atm.2017.03.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Navya Reddy Alugubelli
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Awsse Al-Ani
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dale M Needham
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ann M Parker
- Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA.,Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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143
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Barbaro RP, Boonstra PS, Moler FW, Davis MM, Prosser LA. Hospital-level variation in inpatient cost among children receiving extracorporeal membrane oxygenation. Perfusion 2017; 32:538-546. [PMID: 28466677 DOI: 10.1177/0267659117702709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Pediatric extracorporeal membrane oxygenation (ECMO) varies in the way care is provided from hospital to hospital. This variability in hospital ECMO care can be represented by the variation in ECMO costs. We hypothesized that hospitals will demonstrate large variations in case-mix-adjusted ECMO inpatient costs for children requiring ECMO and higher volume hospitals will have lower associated costs. METHODS We retrospectively analyzed the inpatient cost of children receiving ECMO in 2006, 2009 and 2012, using the Healthcare Cost and Utilization Project Kids' Inpatient Database. We used a hierarchical linear regression model and the intraclass correlation coefficient to quantify how much of the difference in ECMO inpatient costs was associated with the hospital where a child received care. To do this, we adjusted for patient factors, hospital factors and potentially modifiable factors such as complications, procedures and length of stay. RESULTS The median inflation-adjusted inpatient costs for children requiring ECMO were $183,000, $240,000 and $241,000 in years 2006, 2009 and 2012, respectively. The largest median cost for ECMO cases in a given hospital in a given year ($690,000) was more than 11 times that of the smallest median cost ($60,000). After case-mix adjustment, 27% of the variation in inpatient costs was associated with the hospital where ECMO care was provided. Average hospital costs were not associated with hospital ECMO volume. CONCLUSIONS The large variation in ECMO inpatient costs between hospitals suggests great variation in care between hospitals, which is important because hospitals have a co-existing variation in ECMO survival rates.
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Affiliation(s)
- Ryan P Barbaro
- 1 Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.,2 Child Health Evaluation and Research (CHEAR) Unit, University of Michigan, Ann Arbor, Michigan, USA
| | - Philip S Boonstra
- 3 Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank W Moler
- 1 Department of Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew M Davis
- 4 Department of Pediatrics, Northwestern University, Chicago, Illinois, USA
| | - Lisa A Prosser
- 5 Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA.,6 School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
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144
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Phillips SM, Dickerson RN, Moore FA, Paddon-Jones D, Weijs PJM. Protein Turnover and Metabolism in the Elderly Intensive Care Unit Patient. Nutr Clin Pract 2017; 32:112S-120S. [PMID: 28388378 DOI: 10.1177/0884533616686719] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences. It is likely that the older patient is already experiencing muscle loss due to sarcopenia; however, the period of stay in the ICU represents a greatly accelerated period of muscle loss. Thus, on discharge, the older ICU patient is now on a steeper downward trajectory of muscle loss, more likely to have ICU-acquired muscle weakness, and at risk of becoming sarcopenic and/or frail. One practice that has been shown to have benefit during ICU stays is early ambulation and physical therapy (PT), and it is likely that both are potent stimuli to induce a sensitivity of protein anabolism. Thus, recommendations for the older ICU patient would be provision of at least 1.2-1.5 g protein/kg usual body weight/d, regular and early utilization of ambulation (if possible) and/or PT, and follow-up rehabilitation for the older discharged ICU patient that includes rehabilitation, physical activity, and higher habitual dietary protein to change the trajectory of ICU-mediated muscle mass loss and weakness.
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Affiliation(s)
- Stuart M Phillips
- 1 McMaster University, Department of Kinesiology, Hamilton, Ontario, Canada
| | - Roland N Dickerson
- 2 Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Frederick A Moore
- 3 Department of Surgery, Division of Acute Care Surgery, and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Douglas Paddon-Jones
- 4 Nutrition and Metabolism, University of Texas Medical Branch, Galveston, Texas, USA
| | - Peter J M Weijs
- 5 Nutrition and Dietetics, Department of Internal Medicine, Department of Intensive Care Medicine, and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,6 Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
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145
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Evidence based expert consensus for early rehabilitation in the intensive care unit. ACTA ACUST UNITED AC 2017. [DOI: 10.3918/jsicm.24_255] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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146
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Physical Therapy Intervention During a Red Blood Cell Transfusion in an Oncologic Population: A Preliminary Study. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2017. [DOI: 10.1097/jat.0000000000000046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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147
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Liebl ME, Elmer N, Schroeder I, Schwedtke C, Baack A, Reisshauer A. Introduction of the Charité Mobility Index (CHARMI) - A Novel Clinical Mobility Assessment for Acute Care Rehabilitation. PLoS One 2016; 11:e0169010. [PMID: 28006023 PMCID: PMC5179242 DOI: 10.1371/journal.pone.0169010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 12/09/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Mobility is an essential part of a person’s functioning and independence. It encompasses locomotive functions, but also the more basic functions of positioning and transferring. Despite the availability of several mobility-related assessment instruments to date, there is a need for assessment instruments with the specific capability to display the full range of mobilisation. Our aim was to develop and validate a scoring instrument with hierarchical composition where every score value stands for a defined mobility level. Participants and Methods A previously developed and validated pilot instrument was applied to assess patients (n = 113) admitted to an acute rehabilitation programme. Mobility was assessed during admission, subsequently at weekly intervals and at discharge to acquire a detailed status of mobility at multiple time points and individual mobilisation profiles over time. The scoring instrument was then remodelled based on clinical criteria to establish an easy-to-use scoring system with hierarchical composition. Psychometric properties were calculated using an independent sample of 87 consecutive patients. Results Content validity could be affirmed. The psychometric tests demonstrated excellent convergent validity with the three mobility items of the Barthel Index (r = 0.93), despite an adequately lower correlation with the whole Barthel Index (r = 0.63). Adequate floor and ceiling effects (20%) and a large responsiveness to change (ǀdǀ = 1.7, p < 0.001) between admission and discharge values were demonstrated. Inter-rater reliability was excellent (κ = 0.88). Conclusions The Charité Mobility Index (CHARMI) is a promising, easy-to-use hierarchical scoring instrument assessing the full individual spectrum from immobility to unlimited mobility, including positioning, transfer and locomotion items. It allows for monitoring of mobilisation.
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Affiliation(s)
- Max E. Liebl
- Department of Physical Medicine and Rehabilitation, Charité University Hospital, Berlin, Germany
- * E-mail:
| | - Nancy Elmer
- Department of Physical Medicine and Rehabilitation, Charité University Hospital, Berlin, Germany
| | - Isabelle Schroeder
- Department of Physical Medicine and Rehabilitation, Charité University Hospital, Berlin, Germany
| | - Christine Schwedtke
- Department of Physical Medicine and Rehabilitation, Charité University Hospital, Berlin, Germany
| | - Angelika Baack
- Department of Physical Medicine and Rehabilitation, Charité University Hospital, Berlin, Germany
- Charité Physiotherapy and Prevention Centre, Charité University Hospital, Berlin, Germany
| | - Anett Reisshauer
- Department of Physical Medicine and Rehabilitation, Charité University Hospital, Berlin, Germany
- Charité Physiotherapy and Prevention Centre, Charité University Hospital, Berlin, Germany
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Prise en charge ventilatoire et mobilisation précoce du patient obèse en réanimation. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1251-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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149
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Sutton LJ, Jarden RJ. Improving the quality of nurse-influenced patient care in the intensive care unit. Nurs Crit Care 2016; 22:339-347. [PMID: 27976489 DOI: 10.1111/nicc.12266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/10/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Quality of care is a major focus in the intensive care unit (ICU). AIM To describe a nurse-initiated quality improvement (QI) project that improved the care of critically ill patients in a New Zealand tertiary ICU. DESIGN A framework for QI was developed and implemented as part of a practice change initiative. METHODS Audit data were collected, analysed and reported across seven nurse-influenced patient care standards. The seven standards were enteral nutrition delivered within 24 h of admission, timely administration of antibiotics, sedation holds for eligible patients, early mobilization and three pressure ulcer prevention strategies. RESULTS Comparison of audit data collected in 2014 and 2015 demonstrated improvements in five of the seven standards. Those standards with the largest practice improvements were related to the following standards: all eligible patients have enteral nutrition commenced within the first 24 h of ICU admission (3% increase); all eligible patients receive antibiotics within 30 min of prescription time (6% increase); all eligible patients have a daily sedation interruption (DSI; 24% increase); and all eligible patients are mobilized daily in their ICU stay (11% increase in percentage of patients mobilized daily). CONCLUSIONS The nursing-initiated QI project demonstrated improved ICU patient care in relation to early enteral nutrition commencement, DSIs and early and daily mobilizing. RELEVANCE TO CLINICAL PRACTICE The use of a nursing QI framework incorporating audit and feedback is one method of evaluating and enhancing the quality of care and improving patient outcomes. This initiative demonstrated the improved quality of nursing care for ICU patients, particularly in relation to early enteral nutrition commencement, timely antibiotics, DSIs and daily mobilizing. It is thus highly relevant to critical care nursing teams, particularly those working to create a culture where change is safe, achievable and valued.
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Affiliation(s)
- Lynsey J Sutton
- Wellington Regional Hospital, Intensive Care Unit, Intensive Care Services, Wellington Regional Hospital, Wellington, New Zealand.,Graduate School of Nursing Midwifery & Health (GSNMH), Victoria University of Wellington, New Zealand
| | - Rebecca J Jarden
- Department of Nursing, School of Clinical Sciences, Auckland University of Technology (AUT), Auckland, New Zealand
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