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Girard TD, Alhazzani W, Kress JP, Ouellette DR, Schmidt GA, Truwit JD, Burns SM, Epstein SK, Esteban A, Fan E, Ferrer M, Fraser GL, Gong MN, Hough CL, Mehta S, Nanchal R, Patel S, Pawlik AJ, Schweickert WD, Sessler CN, Strøm T, Wilson KC, Morris PE. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. Am J Respir Crit Care Med 2017; 195:120-133. [DOI: 10.1164/rccm.201610-2075st] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hickmann CE, Castanares-Zapatero D, Bialais E, Dugernier J, Tordeur A, Colmant L, Wittebole X, Tirone G, Roeseler J, Laterre PF. Teamwork enables high level of early mobilization in critically ill patients. Ann Intensive Care 2016; 6:80. [PMID: 27553652 PMCID: PMC4995191 DOI: 10.1186/s13613-016-0184-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/15/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Early mobilization in critically ill patients has been shown to prevent bed-rest-associated morbidity. Reported reasons for not mobilizing patients, thereby excluding or delaying such intervention, are diverse and comprise safety considerations for high-risk critically ill patients with multiple organ support systems. This study sought to demonstrate that early mobilization performed within the first 24 h of ICU admission proves to be feasible and well tolerated in the vast majority of critically ill patients. RESULTS General practice data were collected for 171 consecutive admissions to our ICU over a 2-month period according to a local, standardized, early mobilization protocol. The total period covered 731 patient-days, 22 (3 %) of which met our local exclusion criteria for mobilization. Of the remaining 709 patient-days, early mobilization was achieved on 86 % of them, bed-to-chair transfer on 74 %, and at least one physical therapy session on 59 %. Median time interval from ICU admission to the first early mobilization activity was 19 h (IQR = 15-23). In patients on mechanical ventilation (51 %), accounting for 46 % of patient-days, 35 % were administered vasopressors and 11 % continuous renal replacement therapy. Within this group, bed-to-chair transfer was achieved on 68 % of patient-days and at least one early mobilization activity on 80 %. Limiting factors to start early mobilization included restricted staffing capacities, diagnostic or surgical procedures, patients' refusal, as well as severe hemodynamic instability. Hemodynamic parameters were rarely affected during mobilization, causing interruption in only 0.8 % of all activities, primarily due to reversible hypotension or arrhythmia. In general, all activities were well tolerated, while patients were able to self-regulate their active early mobilization. Patients' subjective perception of physical therapy was reported to be enjoyable. CONCLUSIONS Mobilization within the first 24 h of ICU admission is achievable in the majority of critical ill patients, in spite of mechanical ventilation, vasopressor administration, or renal replacement therapy.
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Affiliation(s)
- Cheryl Elizabeth Hickmann
- Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Diego Castanares-Zapatero
- Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Emilie Bialais
- Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Jonathan Dugernier
- Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Antoine Tordeur
- Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Lise Colmant
- Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Xavier Wittebole
- Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Giuseppe Tirone
- Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Jean Roeseler
- Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium
| | - Pierre-François Laterre
- Intensive Care Unit, Cliniques universitaires Saint-Luc, Université catholique de Louvain (UCL), Avenue Hippocrate 10, 1200 Brussels, Belgium
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153
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Al Mohammedali Z, O'Dwyer TK, Broderick JM. The emerging role of respiratory physiotherapy: A profile of the attitudes of nurses and physicians in Saudi Arabia. Ann Thorac Med 2016; 11:243-248. [PMID: 27803749 PMCID: PMC5070432 DOI: 10.4103/1817-1737.191873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Respiratory physiotherapy plays a key role in the management and treatment of patients with respiratory diseases worldwide, yet this specialty is not well established in Saudi Arabia. AIMS To profile the attitudes among physicians and nurses toward physiotherapists working in respiratory care settings in Saudi Arabia. METHODS A cross-sectional questionnaire-based study was conducted. A questionnaire was developed consisting of 23 items, which was distributed both electronically and in paper form to physicians and nurses working in hospitals and health-care centers in Saudi Arabia. Physicians and nurses working outside of Saudi Arabia, and other health professionals, were excluded from the study. RESULTS A total of 284 questionnaires were returned (nurses: n = 158; physicians: n = 126). The majority believed that physiotherapists have the skills to be involved in respiratory care (79.9%, n = 226) and that physiotherapists are an important member of the Intensive Care Unit team (90.4%, n = 255). Most respondents (n = 232, 82.9%) felt in need of more information regarding the role of physiotherapy within respiratory care; significantly more nurses than physicians believed they needed additional education (P = 0.002). Specialized physicians were more likely than nonspecialized physicians to refer respiratory patients to physiotherapy (P < 0.05). CONCLUSION Physiotherapy in respiratory care settings was positively regarded by nurses and physicians working in hospitals and health-care facilities in Saudi Arabia. The need for further education for physicians and nurses on the role of physiotherapy in respiratory care was highlighted; this would enable physiotherapy to develop and be further integrated into the respiratory care multidisciplinary team.
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Affiliation(s)
- Zainab Al Mohammedali
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, The University of Dublin, Ireland
| | - Tom K O'Dwyer
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, The University of Dublin, Ireland
| | - Julie M Broderick
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, The University of Dublin, Ireland
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154
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Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, Heim M, Houle T, Kurth T, Latronico N, Lee J, Meyer MJ, Peponis T, Talmor D, Velmahos GC, Waak K, Walz JM, Zafonte R, Eikermann M. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 2016; 388:1377-1388. [PMID: 27707496 DOI: 10.1016/s0140-6736(16)31637-3] [Citation(s) in RCA: 413] [Impact Index Per Article: 51.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/13/2016] [Accepted: 07/19/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Immobilisation predicts adverse outcomes in patients in the surgical intensive care unit (SICU). Attempts to mobilise critically ill patients early after surgery are frequently restricted, but we tested whether early mobilisation leads to improved mobility, decreased SICU length of stay, and increased functional independence of patients at hospital discharge. METHODS We did a multicentre, international, parallel-group, assessor-blinded, randomised controlled trial in SICUs of five university hospitals in Austria (n=1), Germany (n=1), and the USA (n=3). Eligible patients (aged 18 years or older, who had been mechanically ventilated for <48 h, and were expected to require mechanical ventilation for ≥24 h) were randomly assigned (1:1) by use of a stratified block randomisation via restricted web platform to standard of care (control) or early, goal-directed mobilisation using an inter-professional approach of closed-loop communication and the SICU optimal mobilisation score (SOMS) algorithm (intervention), which describes patients' mobilisation capacity on a numerical rating scale ranging from 0 (no mobilisation) to 4 (ambulation). We had three main outcomes hierarchically tested in a prespecified order: the mean SOMS level patients achieved during their SICU stay (primary outcome), and patient's length of stay on SICU and the mini-modified functional independence measure score (mmFIM) at hospital discharge (both secondary outcomes). This trial is registered with ClinicalTrials.gov (NCT01363102). FINDINGS Between July 1, 2011, and Nov 4, 2015, we randomly assigned 200 patients to receive standard treatment (control; n=96) or intervention (n=104). Intention-to-treat analysis showed that the intervention improved the mobilisation level (mean achieved SOMS 2·2 [SD 1·0] in intervention group vs 1·5 [0·8] in control group, p<0·0001), decreased SICU length of stay (mean 7 days [SD 5-12] in intervention group vs 10 days [6-15] in control group, p=0·0054), and improved functional mobility at hospital discharge (mmFIM score 8 [4-8] in intervention group vs 5 [2-8] in control group, p=0·0002). More adverse events were reported in the intervention group (25 cases [2·8%]) than in the control group (ten cases [0·8%]); no serious adverse events were observed. Before hospital discharge 25 patients died (17 [16%] in the intervention group, eight [8%] in the control group). 3 months after hospital discharge 36 patients died (21 [22%] in the intervention group, 15 [17%] in the control group). INTERPRETATION Early, goal-directed mobilisation improved patient mobilisation throughout SICU admission, shortened patient length of stay in the SICU, and improved patients' functional mobility at hospital discharge. FUNDING Jeffrey and Judy Buzen.
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Affiliation(s)
- Stefan J Schaller
- Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Matthew Anstey
- Department of Intensive Care, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Manfred Blobner
- Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Thomas Edrich
- Department of Anesthesiology and Critical Care, Klinikum Landkreis Erding, Erding, Germany; Universitätsklinik für Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, Universitätsklinikum Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Stephanie D Grabitz
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ilse Gradwohl-Matis
- Universitätsklinik für Anästhesiologie, perioperative Medizin und allgemeine Intensivmedizin, Universitätsklinikum Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Markus Heim
- Klinik für Anaesthesiologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Timothy Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tobias Kurth
- Institute of Public Health, Charité, Universitätsmedizin Berlin, Berlin, Germany
| | - Nicola Latronico
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy
| | - Jarone Lee
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew J Meyer
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thomas Peponis
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daniel Talmor
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - George C Velmahos
- Department of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Karen Waak
- Department of Physical Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - J Matthias Walz
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham, MA, USA; Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Universität Duisburg-Essen, Klinik für Anaesthesiologie und Intensivmedizin, Essen, Germany.
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155
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Tsuboi N, Nozaki H, Ishida Y, Kanazawa I, Inamoto M, Hayashi K, Nishimura N, Nakagawa S, Kasahara M, Kamikubo T. Early Mobilization after Pediatric Liver Transplantation. J Pediatr Intensive Care 2016; 6:199-205. [PMID: 31073448 DOI: 10.1055/s-0036-1593387] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022] Open
Abstract
Objective This study aims to evaluate the impact of early mobilization (EM) after pediatric liver transplantation in the pediatric intensive care unit (PICU). Design A 14-month prospective before and after study. Setting Multivalent PICU with 20 beds at a tertiary children's hospital. Patients A total of 57 patients aged younger than 16 years who received liver transplantation and were admitted to the PICU after surgery. Interventions EM project, a multifaceted framework for successful EM practice in the PICU focusing on a multidisciplinary team approach. Measurements and Main Results Compared with the period before the implementation of the EM project, there was a significant increase in the proportion of patients who received physical therapy in the PICU (43 vs. 97%, p < 0.001). Also, there were greater median numbers of physical therapy per eligible patient (0 vs. 3, p < 0.001). Moreover, patients achieved higher functional mobility level within a shorter time. Length of intubation, PICU stay, and hospital stay were not significantly different. There were no adverse events or deaths. Conclusion Using an EM project process, the proportion of patients who received physical therapy after liver transplantation increased. However, there was no difference in the length of PICU or hospital stay. Our findings indicated that EM for pediatric patients who received liver transplantation was well tolerated and safe.
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Affiliation(s)
- Norihiko Tsuboi
- Department of Critical Care Medicine, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Hitomi Nozaki
- Department of Rehabilitation, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Yukihiro Ishida
- Department of Rehabilitation, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Ikue Kanazawa
- Department of Rehabilitation, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Miku Inamoto
- Department of Critical Care Medicine, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Kenichiro Hayashi
- Department of Critical Care Medicine, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Nao Nishimura
- Department of Critical Care Medicine, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Satoshi Nakagawa
- Department of Critical Care Medicine, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Takeshi Kamikubo
- Department of Rehabilitation, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
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156
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[Algorithms for early mobilization in intensive care units]. Med Klin Intensivmed Notfmed 2016; 112:156-162. [PMID: 27600938 DOI: 10.1007/s00063-016-0210-8] [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: 05/18/2016] [Revised: 07/09/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one's own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient's awareness, pain, anxiety, stress, delirium and family's presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters.
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157
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Ramsay P, Huby G, Merriweather J, Salisbury L, Rattray J, Griffith D, Walsh T. Patient and carer experience of hospital-based rehabilitation from intensive care to hospital discharge: mixed methods process evaluation of the RECOVER randomised clinical trial. BMJ Open 2016; 6:e012041. [PMID: 27481624 PMCID: PMC4985782 DOI: 10.1136/bmjopen-2016-012041] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness. DESIGN Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers. SETTING Two university-affiliated hospitals in Scotland. PARTICIPANTS 240 patients discharged from ICU who required ≥48 hours of mechanical ventilation were randomised into the trial (120 per trial arm). Exclusion criteria comprised: primary neurologic diagnosis, palliative care, current/planned home ventilation and age <18 years. 182 patients completed the PEQ at 3 months postrandomisation. 22 participants (14 patients and 8 carers) took part in focus groups (2 per trial group) at >3 months postrandomisation. INTERVENTIONS A complex intervention of post-ICU acute hospital rehabilitation, comprising enhanced physiotherapy, nutritional care and information provision, case-managed by dedicated rehabilitation assistants (RAs) working within existing ward-based clinical teams, delivered between ICU discharge and hospital discharge. Comparator was usual care. OUTCOME MEASURES A novel PEQ capturing patient-reported aspects of quality care. RESULTS The PEQ revealed statistically significant between-group differences across 4 key intervention components: physiotherapy (p=0.039), nutritional care (p=0.038), case management (p=0.045) and information provision (p<0.001), suggesting greater patient satisfaction in the intervention group. Focus group data strongly supported and helped explain these findings. Specifically, case management by dedicated RAs facilitated greater access to physiotherapy, nutritional care and information that cut across disciplinary boundaries and staffing constraints. Patients highly valued its individualisation according to their needs, abilities and preferences. CONCLUSIONS Case management by dedicated RAs improves patients' experiences of post-ICU hospital-based rehabilitation and increases perceived quality of care. TRIAL REGISTRATION NUMBER ISRCTN09412438.
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Affiliation(s)
- Pam Ramsay
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Guro Huby
- Faculty of Health and Social Studies, University College Østfold, Halden, Norway
| | - Judith Merriweather
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Lisa Salisbury
- Department of Nursing, University of Edinburgh, Edinburgh, UK
| | - Janice Rattray
- School of Nursing and Midwifery, University of Dundee, Dundee, UK
| | - David Griffith
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Timothy Walsh
- Department of Anaesthesia and Critical Care, Royal Infirmary of Edinburgh, Edinburgh, UK
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158
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Describing and measuring recovery and rehabilitation after critical illness. Curr Opin Crit Care 2016; 21:445-52. [PMID: 26348422 DOI: 10.1097/mcc.0000000000000233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Rehabilitation is the cornerstone of management of postcritical illness morbidity. Selection of appropriate tools to measure response to rehabilitation therapy is vital to accurately document trajectory of change across the recovery continuum. In the context of physical-based strategies to redress critical illness associated muscle wasting and dysfunction, this review will discuss a framework to guide assessment of physical recovery in the critical illness population, clinimetric measurement properties for instruments and evidence for their implementation, and recent interventional trial data. RECENT FINDINGS The International Classification of Functioning, Disability and Health (ICF) model is a useful framework to guide selection of outcome measures representing physical function at the level of impairment, activity limitation and participation restriction. Clinimetric data are emerging to support a number of physical function outcome measures in the ICU, albeit further research is required to corroborate tools used beyond ICU discharge. Factors associated with outcome measure selection have contributed to interpreting findings from recent interventional trials of physical rehabilitation. SUMMARY Determining the future design, conduct and impact of physical therapy interventions for critically ill patients will rely on further development of clinimetrically robust metrics to capture individual patient response spanning the recovery pathway. This approach should be similarly applied to rehabilitation interventions addressing other postintensive care syndrome domains.
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159
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O'Shea K, Stiller K. Early progressive mobilisation following acute subarachnoid or subdural haemorrhage: An observational pilot study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2016. [DOI: 10.12968/ijtr.2016.23.7.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kristie O'Shea
- Senior physiotherapist, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kathy Stiller
- Allied health research coordinator/facilitator, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
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160
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National Profile of Physical Therapists in Critical Care Units of Sri Lanka: Lower Middle-Income Country. Phys Ther 2016; 96:933-9. [PMID: 26893503 DOI: 10.2522/ptj.20150363] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 01/25/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The availability and role of physical therapists in critical care is variable in resource-poor settings, including lower middle-income countries. OBJECTIVE The aim of this study was to determine: (1) the availability of critical care physical therapist services, (2) the equipment and techniques used and needed, and (3) the training and continuous professional development of physical therapists. METHODS All physical therapists working in critical care units (CCUs) of state hospitals in Sri Lanka were contacted. The study tool used was an interviewer-administered telephone questionnaire. RESULTS The response rate was 100% (N=213). Sixty-one percent of the physical therapists were men. Ninety-four percent of the respondents were at least diploma holders in physical therapy, and 6% had non-physical therapy degrees. Most (n=145, 68%) had engaged in some continuous professional development in the past year. The majority (n=119, 56%) attended to patients after referral from medical staff. Seventy-seven percent, 98%, and 96% worked at nights, on weekends, and on public holidays, respectively. Physical therapists commonly perform manual hyperinflation, breathing exercises, manual airway clearance techniques, limb exercises, mobilization, positioning, and postural drainage in the CCUs. Lack of specialist training, lack of adequate physical therapy staff numbers, a heavy workload, and perceived lack of infection control in CCUs were the main difficulties they identified. LIMITATIONS Details on the proportions of time spent by the physical therapists in the CCUs, wards, or medical departments were not collected. CONCLUSIONS The availability of physical therapist services in CCUs in Sri Lanka, a lower middle-income country, was comparable to that in high-income countries, as per available literature, in terms of service availability and staffing, although the density of physical therapists remained very low, critical care training was limited, and resource limitations to physical therapy practices were evident.
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161
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Skinner EH, Thomas P, Reeve JC, Patman S. Minimum standards of clinical practice for physiotherapists working in critical care settings in Australia and New Zealand: A modified Delphi technique. Physiother Theory Pract 2016; 32:468-482. [PMID: 27259819 DOI: 10.3109/09593985.2016.1145311] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Achieving competency in critical care in entry-level physiotherapy courses across Australia and New Zealand is not essential, and accredited training for qualified physiotherapists working in critical care units is lacking. As a result, practice standards and training may vary. The objective was to establish consensus-based minimum clinical practice standards for physiotherapists working in critical care settings in Australia and New Zealand. DESIGN A modified Delphi technique, which consisted of three rounds of questionnaires, was used to obtain consensus on items. SETTING Australian and New Zealand critical care settings. PARTICIPANTS A panel (n = 61) was invited from a pool of eligible physiotherapists throughout Australia and New Zealand (n = 93). Eligibility criteria were defined a-priori on the basis of possession of expertise and experience in the practice and teaching of critical care physiotherapy clinical skills. MAIN OUTCOME MEASURE Questionnaires were disseminated electronically (either via email, or SurveyMonkey®). Items were designated by participants as being 'Essential/Unsure/Not Essential'. Consensus for inclusion was achieved when items were ranked 'Essential' by more than 70% of participants. RESULTS Fifty physiotherapists consented and participated in the initial Delphi round, of whom 45 (90%) completed all rounds. Consensus was reached on 199 (89%) items. The panel agreed that 132 (58%) items were 'Essential' items for inclusion in the final framework. CONCLUSIONS This is the first study to develop a consensus framework of minimum standards of practice for physiotherapists working in critical care. The clinical utility of this framework now requires assessment.
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Affiliation(s)
- Elizabeth H Skinner
- a Department of Physiotherapy , Western Health , Melbourne , Victoria , Australia
| | - Peter Thomas
- b Royal Brisbane and Women's Hospital , Physiotherapy , Brisbane , Queensland , Australia
| | - Julie C Reeve
- c AUT University , School of Rehabilitation and Occupation Studies , Auckland , New Zealand
| | - Shane Patman
- d University of Notre Dame Australia , Physiotherapy , Fremantle , Western Australia , Australia
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162
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Green M, Marzano V, Leditschke IA, Mitchell I, Bissett B. Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians. J Multidiscip Healthc 2016; 9:247-56. [PMID: 27307746 PMCID: PMC4889100 DOI: 10.2147/jmdh.s99811] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives To describe our experience and the practical tools we have developed to facilitate early mobilization in the intensive care unit (ICU) as a multidisciplinary team. Background Despite the evidence supporting early mobilization for improving outcomes for ICU patients, recent international point-prevalence studies reveal that few patients are mobilized in the ICU. Existing guidelines rarely address the practical issues faced by multidisciplinary ICU teams attempting to translate evidence into practice. We present a comprehensive strategy for safe mobilization utilized in our ICU, incorporating the combined skills of medical, nursing, and physiotherapy staff to achieve safe outcomes and establish a culture which prioritizes this intervention. Methods A raft of tools and strategies are described to facilitate mobilization in ICU by the multidisciplinary team. Patients without safe unsupported sitting balance and without ≥3/5 (Oxford scale) strength in the lower limbs commence phase 1 mobilization, including training of sitting balance and use of the tilt table. Phase 2 mobilization involves supported or active weight-bearing, incorporating gait harnesses if necessary. The Plan B mnemonic guides safe multidisciplinary mobilization of invasively ventilated patients and emphasizes the importance of a clearly articulated plan in delivering this valuable treatment as a team. Discussion These tools have been used over the past 5 years in a tertiary ICU with a very low incidence of adverse outcomes (<2%). The tools and strategies described are useful not only to guide practical implementation of early mobilization, but also in the creation of a unit culture where ICU staff prioritize early mobilization and collaborate daily to provide the best possible care. Conclusion These practical tools allow ICU clinicians to safely and effectively implement early mobilization in critically ill patients. A genuinely multidisciplinary approach to safe mobilization in ICU is key to its success in the long term.
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Affiliation(s)
- Margot Green
- Physiotherapy Department, Canberra Hospital, Canberra, ACT, Australia
| | - Vince Marzano
- Physiotherapy Department, Canberra Hospital, Canberra, ACT, Australia
| | - I Anne Leditschke
- Intensive Care Unit, Canberra Hospital, Canberra, ACT, Australia; School of Medicine, Australian National University, Canberra, ACT, Australia
| | - Imogen Mitchell
- Intensive Care Unit, Canberra Hospital, Canberra, ACT, Australia; School of Medicine, Australian National University, Canberra, ACT, Australia
| | - Bernie Bissett
- Physiotherapy Department, Canberra Hospital, Canberra, ACT, Australia; Discipline of Physiotherapy, University of Canberra, Canberra, ACT, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
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163
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Bein T, Bischoff M, Brückner U, Gebhardt K, Henzler D, Hermes C, Lewandowski K, Max M, Nothacker M, Staudinger T, Tryba M, Weber-Carstens S, Wrigge H. [Short version S2e guidelines: "Positioning therapy and early mobilization for prophylaxis or therapy of pulmonary function disorders"]. Anaesthesist 2016; 64:596-611. [PMID: 26260196 DOI: 10.1007/s00101-015-0060-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The German Society of Anesthesiology and Intensive Care Medicine (DGAI) commissioned a revision of the S2 guidelines on "positioning therapy for prophylaxis or therapy of pulmonary function disorders" from 2008. Because of the increasing clinical and scientific relevance the guidelines were extended to include the issue of "early mobilization" and the following main topics are therefore included: use of positioning therapy and early mobilization for prophylaxis and therapy of pulmonary function disorders, undesired effects and complications of positioning therapy and early mobilization as well as practical aspects of the use of positioning therapy and early mobilization. These guidelines are the result of a systematic literature search and the subsequent critical evaluation of the evidence with scientific methods. The methodological approach for the process of development of the guidelines followed the requirements of evidence-based medicine, as defined as the standard by the Association of the Scientific Medical Societies in Germany. Recently published articles after 2005 were examined with respect to positioning therapy and the recently accepted aspect of early mobilization incorporates all literature published up to June 2014.
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Affiliation(s)
- T Bein
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland,
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Hoyer EH, Friedman M, Lavezza A, Wagner-Kosmakos K, Lewis-Cherry R, Skolnik JL, Byers SP, Atanelov L, Colantuoni E, Brotman DJ, Needham DM. Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project. J Hosp Med 2016; 11:341-7. [PMID: 26849277 DOI: 10.1002/jhm.2546] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 12/05/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS). PATIENTS AND METHODS Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables. RESULTS Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P < 0.001), and patients with improved JH-HLM mobility scores between admission and discharge increased from 32% to 45% (P < 0.001). For all patients, the QI project was associated with an adjusted median LOS reduction of 0.40 (95% confidence interval [CI]: -0.57 to -0.21, P < 0.001) days compared to 12 months prior. A subgroup of patients expected to have a longer LOS (expected LOS >7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P < 0.001) days. Increased mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73). CONCLUSIONS AND RELEVANCE Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | | | | | - Judy L Skolnik
- Department of Nursing, Johns Hopkins Hospital, Baltimore, Maryland
| | - Sherrie P Byers
- Department of Nursing, Johns Hopkins Hospital, Baltimore, Maryland
| | - Levan Atanelov
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Daniel J Brotman
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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165
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McSparron JI, Hayes MM, Poston JT, Thomson CC, Fessler HE, Stapleton RD, Carlos WG, Hinkle L, Liu K, Shieh S, Ali A, Rogers A, Shah NG, Slack D, Patel B, Wolfe K, Schweickert WD, Bakhru RN, Shin S, Sell RE, Luks AM. ATS Core Curriculum 2016: Part II. Adult Critical Care Medicine. Ann Am Thorac Soc 2016; 13:731-40. [PMID: 27144797 PMCID: PMC5461968 DOI: 10.1513/annalsats.201601-050cme] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/16/2016] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jakob I McSparron
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Margaret M Hayes
- 1 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jason T Poston
- 2 Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Carey C Thomson
- 3 Division of Pulmonary and Critical Care, Mount Auburn Hospital, Harvard Medical School, Boston, Massachusetts
| | - Henry E Fessler
- 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Renee D Stapleton
- 5 Division of Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - W Graham Carlos
- 6 Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Laura Hinkle
- 6 Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Kathleen Liu
- 7 Division of Nephrology, Department of Medicine, and
- 8 Division of Critical Care Medicine, Department of Anesthesia, University of California San Francisco, San Francisco, California
| | - Stephanie Shieh
- 9 Division of Nephrology, Department of Medicine, Saint Louis University, Saint Louis, Missouri
| | - Alyan Ali
- 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Angela Rogers
- 10 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Nirav G Shah
- 11 Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Donald Slack
- 11 Division of Pulmonary and Critical Care Medicine, University of Maryland Medical Center, Baltimore, Maryland
| | - Bhakti Patel
- 2 Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Krysta Wolfe
- 2 Section of Pulmonary and Critical Care Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - William D Schweickert
- 12 Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rita N Bakhru
- 13 Section of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina
| | - Stephanie Shin
- 14 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California; and
| | - Rebecca E Sell
- 14 Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, California; and
| | - Andrew M Luks
- 15 Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
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Knols RH, Vanderhenst T, Verra ML, de Bruin ED. Exergames for Patients in Acute Care Settings: Systematic Review of the Reporting of Methodological Quality, FITT Components, and Program Intervention Details. Games Health J 2016; 5:224-35. [PMID: 27096922 DOI: 10.1089/g4h.2015.0067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study was designed to summarize (1) the evidence from studies investigating the use of exergames in acute care settings, (2) the methodological quality of these studies, (3) the reporting of frequency, intensity, time, and type (FITT) of exergaming components and adherence, and (4) reporting of intervention details enabling study replication. MATERIALS AND METHODS Medline-Ovid, EMBASE, CINAHL, PsychInfo, and the Cochrane Library were consulted. Two authors independently selected and systematically reviewed the included reports. Study quality was scored for each study. RESULTS Of the nine reports representing five randomized clinical trials, one controlled clinical trial, and three single-group studies, the methodological quality was rather low, and the majority of the reports appeared to have a high risk of bias. Altogether, 365 patients were included in the selected articles. Energy expenditure, 6-Minute Walking Test, Timed Up and Go Test, Modified Berg Balance Scale, level of enjoyment, Transitional Dyspnea Index, upper limb activity, cognitive performance, and length of hospital stay favored exergaming. Three studies considered 70 percent or more of methodological quality items. Two studies reported all four FITT components. No studies reported adherence. Three studies each included descriptions of six intervention details. CONCLUSIONS The included studies suggest that patients in acute care settings may benefit from exergaming. The relationship between exergaming and patient outcomes requires, however, further exploration. Future adequately powered studies with low risk of bias and with acute care populations that are followed over extended time periods should be performed to substantiate or refute the advantageous effect of exergaming in acute care settings. Future studies should pay attention to the description of FITT components and adherence to the intervention. Attention to include details of the used exergaming intervention is important for replication purposes.
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Affiliation(s)
- Ruud H Knols
- 1 Directorate of Research and Education, Physiotherapy and Occupational Therapy Research Center, University Hospital Zurich , Zurich, Switzerland
| | - Tom Vanderhenst
- 2 Nursing and Allied Health Professions Office, Physiotherapy Occupational Therapy, University Hospital Zurich , Zurich, Switzerland
| | - Martin L Verra
- 3 Department of Physiotherapy, Berne University Hospital , Berne, Switzerland
| | - Eling D de Bruin
- 4 Institute of Human Movement Sciences and Sport , Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
- 5 Centre for Evidence Based Physiotherapy, Maastricht University , Maastricht, The Netherlands
- 6 Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University , Maastricht, The Netherlands
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167
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Nickels M, Aitken LM, Walsham J, Watson L, McPhail S. Clinicians' perceptions of rationales for rehabilitative exercise in a critical care setting: A cross-sectional study. Aust Crit Care 2016; 30:79-84. [PMID: 27105830 DOI: 10.1016/j.aucc.2016.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Rehabilitative exercise for critically ill patients may have many benefits; however, it is unknown what intensive care unit (ICU) clinicians perceive to be important rationale for the implementation of rehabilitative exercise in critical care settings. OBJECTIVE To identify which rationales for rehabilitative exercise interventions were perceived by ICU clinicians to be important and determine whether perceptions were consistent across nursing, medical and physiotherapy clinicians. METHODS A cross-sectional study was undertaken among clinicians (nursing, medical, physiotherapy) working in a mixed medical surgical ICU in an Australian metropolitan tertiary hospital. Participants completed a customised web-based questionnaire developed by a clinician working-group. The questionnaire consisted of 11 plausible rationales for commencing rehabilitative exercise in ICUs based on prior literature and their own clinical experiences grouped into 4 over-arching categories (musculoskeletal, respiratory, psychological and facilitation of discharge). Participants rated their perceived importance for each potential rationale on a 5-point Likert scale. RESULTS Participants (n=76) with a median (interquartile range) 4.8 (1.5, 15.5) years of experience working in ICUs completed the questionnaire. Responses were consistent across professional disciplines. Clinicians rated rehabilitative exercise as either 'very much' or 'somewhat' important for facilitating discharge (n=76, 100%), reducing muscle atrophy (n=76, 100%), increasing muscle strength (n=76, 100%), prevention of contractures (n=73, 96%), reducing the incidence of ICU acquired weakness (n=62, 82%), increasing oxygenation (n=71, 93%), facilitating weaning (n=72, 97%), reducing anxiety (n=60, 80%), reducing depression (n=64, 84%), reducing delirium (n=53, 70%), and increasing mental alertness (n=65, 87%). CONCLUSIONS Any shortcoming in implementation of rehabilitation exercise is unlikely attributable to a lack of perceived importance by nursing, medical or physiotherapy clinicians who are the most likely clinicians to influence rehabilitation practices in ICUs. It is noteworthy that this study examined self-reported perceptions, not physiological or scientific legitimacy of rationales, or clinician behaviours in practice.
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Affiliation(s)
- Marc Nickels
- Intensive Care Unit and Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia; School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Leanne M Aitken
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia; NHMRC Centre of Research Excellence in Nursing Interventions for Hospitalised Patients, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Health Sciences, City University London, London, United Kingdom
| | - James Walsham
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | - Lisa Watson
- Intensive Care Unit and Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Steven McPhail
- School of Public Health & Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia
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168
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Baidya S, Acharya RS, Coppieters MW. Physiotherapy practice patterns in Intensive Care Units of Nepal: A multicenter survey. Indian J Crit Care Med 2016; 20:84-90. [PMID: 27076708 PMCID: PMC4810938 DOI: 10.4103/0972-5229.175939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Context: As physiotherapy (PT) is a young profession in Nepal, there is a dearth of insight into the common practices of physiotherapists in critical care. Aims: To identify the availability of PT services in Intensive Care Units (ICUs) and articulate the common practices by physiotherapists in ICUs of Nepal. Settings and Design: All tertiary care hospitals across Nepal with ICU facility via an exploratory cross-sectional survey. Subjects and Methods: An existing questionnaire was distributed to all the physiotherapists currently working in ICUs of Nepal with 2 years of experience. The survey was sent via E-mail or given in person to 86 physiotherapists. Statistical Analysis Used: Descriptive and inferential statistics according to nature of data. Results: The response rate was 60% (n = 52). In the majority of hospitals (68%), PT service was provided only after a physician consultation, and few hospitals (13%) had established hospital criteria for PT in ICUs. Private hospitals (57.1%) were providing PT service in weekends compared to government hospitals (32.1%) (P = 0.17). The likelihood of routine PT involvement varied significantly with the clinical scenarios (highest 71.2% status cerebrovascular accident, lowest 3.8% myocardial infarction, P < 0.001). The most preferred PT treatment was chest PT (53.8%) and positioning (21.2%) while least preferred was therapeutic exercise (3.8%) irrespective of clinical scenarios. Conclusions: There is a lack of regular PT service during weekends in ICUs of Nepal. Most of the cases are treated by physiotherapists only after physician's referral. The preferred intervention seems to be limited only to chest PT and physiotherapists are not practicing therapeutic exercise and functional mobility training to a great extent.
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Affiliation(s)
- Sumana Baidya
- Department of Physiotherapy, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Ranjeeta S Acharya
- Department of Physiotherapy, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Michel W Coppieters
- Department of Physiotherapy, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal; Department of Movement Sciences, MOVE Research Institute Amsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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169
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Freynet A, Gobaille G, Joannes-Boyau O, Grandet P, Fleureau C, Ripoche J, Dewitte A, Ouattara A. Effects of chest physiotherapy by expiratory flow increase on secretion removal and lung mechanics in ventilated patients: a randomized crossover study. Intensive Care Med 2016; 42:1090-1. [PMID: 27033885 DOI: 10.1007/s00134-016-4315-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Anne Freynet
- CHU de Bordeaux, Service de Kinésithérapie, 33000, Bordeaux, France
| | | | | | - Pierre Grandet
- CHU de Bordeaux, Service de Kinésithérapie, 33000, Bordeaux, France
| | - Catherine Fleureau
- CHU de Bordeaux, Service d'Anesthésie-Réanimation II, 33000, Bordeaux, France
| | - Jean Ripoche
- University of Bordeaux, Bioingénierie tissulaire, U1026, 33000, Bordeaux, France
| | - Antoine Dewitte
- CHU de Bordeaux, Service d'Anesthésie-Réanimation II, 33000, Bordeaux, France. .,University of Bordeaux, Bioingénierie tissulaire, U1026, 33000, Bordeaux, France.
| | - Alexandre Ouattara
- CHU de Bordeaux, Service d'Anesthésie-Réanimation II, 33000, Bordeaux, France.,University of Bordeaux, Adaptation cardiovasculaire à l'ischémie, U1034, 33600, Pessac, France
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170
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Barbas CSV, Ísola AM, Farias AMDC, Cavalcanti AB, Gama AMC, Duarte ACM, Vianna A, Serpa Neto A, Bravim BDA, Pinheiro BDV, Mazza BF, de Carvalho CRR, Toufen Júnior C, David CMN, Taniguchi C, Mazza DDDS, Dragosavac D, Toledo DO, Costa EL, Caser EB, Silva E, Amorim FF, Saddy F, Galas FRBG, Silva GS, de Matos GFJ, Emmerich JC, Valiatti JLDS, Teles JMM, Victorino JA, Ferreira JC, Prodomo LPDV, Hajjar LA, Martins LC, Malbouisson LMS, Vargas MADO, Reis MAS, Amato MBP, Holanda MA, Park M, Jacomelli M, Tavares M, Damasceno MCP, Assunção MSC, Damasceno MPCD, Youssef NCM, Teixeira PJZ, Caruso P, Duarte PAD, Messeder O, Eid RC, Rodrigues RG, de Jesus RF, Kairalla RA, Justino S, Nemer SN, Romero SB, Amado VM. Brazilian recommendations of mechanical ventilation 2013. Part 2. Rev Bras Ter Intensiva 2016; 26:215-39. [PMID: 25295817 PMCID: PMC4188459 DOI: 10.5935/0103-507x.20140034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 12/13/2022] Open
Abstract
Perspectives on invasive and noninvasive ventilatory support for critically ill
patients are evolving, as much evidence indicates that ventilation may have positive
effects on patient survival and the quality of the care provided in intensive care
units in Brazil. For those reasons, the Brazilian Association of Intensive Care
Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and
the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e
Tisiologia - SBPT), represented by the Mechanical Ventilation Committee
and the Commission of Intensive Therapy, respectively, decided to review the
literature and draft recommendations for mechanical ventilation with the goal of
creating a document for bedside guidance as to the best practices on mechanical
ventilation available to their members. The document was based on the available
evidence regarding 29 subtopics selected as the most relevant for the subject of
interest. The project was developed in several stages, during which the selected
topics were distributed among experts recommended by both societies with recent
publications on the subject of interest and/or significant teaching and research
activity in the field of mechanical ventilation in Brazil. The experts were divided
into pairs that were charged with performing a thorough review of the international
literature on each topic. All the experts met at the Forum on Mechanical Ventilation,
which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to
collaboratively draft the final text corresponding to each sub-topic, which was
presented to, appraised, discussed and approved in a plenary session that included
all 58 participants and aimed to create the final document.
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Affiliation(s)
- Carmen Sílvia Valente Barbas
- Corresponding author: Carmen Silvia Valente Barbas, Disicplina de
Pneumologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São
Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, Zip code - 05403-900 - São Paulo
(SP), Brazil, E-mail:
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Lima NP, Silva GMCD, Park M, Pires-Neto RC. Mobility therapy and central or peripheral catheter-related adverse events in an ICU in Brazil. J Bras Pneumol 2016; 41:225-30. [PMID: 26176520 PMCID: PMC4541757 DOI: 10.1590/s1806-37132015000004338] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 02/10/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To determine whether mobility therapy is associated with central or peripheral catheter-related adverse events in critically ill patients in an ICU in Brazil. METHODS: A retrospective analysis of the daily medical records of patients admitted to the Clinical Emergency ICU of the University of São Paulo School of Medicine Hospital das Clínicas Central Institute between December of 2009 and April of 2011. In addition to the demographic and clinical characteristics of the patients, we collected data related to central venous catheters (CVCs), hemodialysis (HD) catheters and indwelling arterial catheters (IACs): insertion site; number of catheter days; and types of adverse events. We also characterized the mobility therapy provided. RESULTS: Among the 275 patients evaluated, CVCs were used in 49%, HD catheters were used in 26%, and IACs were used in 29%. A total of 1,268 mobility therapy sessions were provided to patients while they had a catheter in place. Catheter-related adverse events occurred in 20 patients (a total of 22 adverse events): 32%, infection; 32%, obstruction; and 32%, accidental dislodgement. We found that mobility therapy was not significantly associated with any catheter-related adverse event, regardless of the type of catheter employed: CVC-OR = 0.8; 95% CI: 0.7-1.0; p = 0.14; HD catheter-OR = 1.04; 95% CI: 0.89-1.21; p = 0.56; or IAC-OR = 1.74; 95% CI: 0.94-3.23; p = 0.07. CONCLUSIONS: In critically ill patients, mobility therapy is not associated with the incidence of adverse events involving CVCs, HD catheters, or IACs.
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Affiliation(s)
| | | | - Marcelo Park
- School of Medicine, University of São Paulo, São Paulo, Brazil
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Rocha ÂRM, da Costa CHV. To: Changes in respiratory mechanics during respiratory physiotherapy in mechanically ventilated patients. Rev Bras Ter Intensiva 2016; 27:422-3. [PMID: 26761485 PMCID: PMC4738833 DOI: 10.5935/0103-507x.20150072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Dafoe S, Chapman MJ, Edwards S, Stiller K. Overcoming barriers to the mobilisation of patients in an intensive care unit. Anaesth Intensive Care 2016; 43:719-27. [PMID: 26603796 DOI: 10.1177/0310057x1504300609] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We conducted a quality improvement project aimed at increasing the frequency of mobilisation in our ICU. We designed a four-part quality improvement project comprising: an audit documenting the baseline frequency of mobilisation; a staff survey evaluating perceptions of the barriers to mobilisation; identification of barriers that were amenable to change and implementation of strategies to address these; and a follow-up audit to determine their effectiveness. The setting was a tertiary care, urban, public hospital ICU in South Australia. All patients admitted to the ICU during the two audit periods were included in the audits, while all permanent/semi-permanent ICU staff were eligible for inclusion in the staff survey. We found that patient- and institution-related factors had the greatest impact on the mobilisation of patients in our ICU. Barriers identified as being amenable to change included insufficient staff education about the benefits of mobilisation, poor interdisciplinary communication and lack of leadership regarding mobilisation. Various strategies were implemented to address these barriers over a three-month period. Multivariable analyses showed that three out of four mobility outcomes did not significantly change between the baseline and follow-up audits, with a significant difference in favour of the baseline audit found for the fourth mobility outcome (maximum level of mobility). We concluded that implementing relatively simple measures to improve staff education, interdisciplinary communication and leadership regarding early progressive mobilisation was ineffective at improving mobility outcomes for patients in a large tertiary-level Australian ICU. Other strategies, such as changing sedation practices and/or increasing staffing, may be required to improve mobility outcomes of these patients.
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Affiliation(s)
- S Dafoe
- Acute Care and surgery, Physiotherapy Department, Royal Adelaide Hospital, Adelaide, South Australia
| | - M J Chapman
- Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia
| | - S Edwards
- Data Management and Analysis Centre, University of Adelaide, Adelaide, South Australia
| | - K Stiller
- Physiotherapy Department, Royal Adelaide Hospital, Adelaide, South Australia
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175
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Hauffe T, Krüger B, Bettex D, Rudiger A. Shock Management for Cardio-surgical Intensive Care Unit Patient: The Silver Days. Card Fail Rev 2016; 2:56-62. [PMID: 28785454 DOI: 10.15420/cfr.2015:27:2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Shock in cardio-surgical intensive care unit (ICU) patients requires prompt identification of the underlying condition and timely therapeutic interventions. Management during the first 6 hours, also referred to as "the golden hours", is of paramount importance to reverse the shock state and improve the patient's outcome. The authors have previously described a state-of-the-art diagnostic work-up and discussed how to optimise preload, vascular tone, contractility, heart rate and oxygen delivery during this phase. Ideally, shock can be reversed during this initial period. However, some patients might have developed multiple organ dysfunction, which persists beyond the first 6 hours despite the early haemodynamic treatment goals having been accomplished. This period, also referred to as "the silver days", is the focus of this review. The authors discuss how to reduce vasopressor load and how to minimise adrenergic stress by using alternative inotropes, extracorporeal life-support and short acting beta-blockers. The review incorporates data on fluid weaning, safe ventilation, daily interruption of sedation, delirium management and early rehabilitation. It includes practical recommendations in areas where the evidence is scarce or controversial. Although the focus is on cardio-surgery ICU patients, most of the considerations apply to critical ill patients in general.
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Affiliation(s)
- Till Hauffe
- Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich, Switzerland
| | - Bernard Krüger
- Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich, Switzerland
| | - Dominique Bettex
- Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich, Switzerland
| | - Alain Rudiger
- Cardiosurgical Intensive Care Unit, Institute of Anaesthesiology, University Hospital Zurich, Switzerland
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176
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Schaller SJ, Stäuble CG, Suemasa M, Heim M, Duarte IM, Mensch O, Bogdanski R, Lewald H, Eikermann M, Blobner M. The German Validation Study of the Surgical Intensive Care Unit Optimal Mobility Score. J Crit Care 2015; 32:201-6. [PMID: 26857328 DOI: 10.1016/j.jcrc.2015.12.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/03/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Immobilization of critically ill patients leads to muscle weakness, which translates to increased costs of care and long-term functional disability. We tested the validity of a German Surgical Intensive Care Unit (ICU) Optimal Mobilization Score (SOMS) in 2 different cohorts (neurocritical and nonneurocritical care patients). MATERIALS AND METHODS Physical therapists estimated the patients' mobilization capacity by using the German version of the SOMS the morning after admission. We tested the prognostic value of the prediction for ICU and hospital length of stay (LOS) as well as for mortality, and built a model to account for other known predictors of these outcomes in the 2 cohorts. RESULTS A total of 128 patients were included in the analysis, 48 of these were neurocritical care patients. The SOMS predicted mortality and ICU and hospital LOS. Neurocritical care patients stayed significantly longer in the ICU (median 12 vs 4 days, P < .001) and in the hospital (25 vs 17 days, P = .02). The SOMS predicted ICU and hospital LOS. It predicted mortality only in nonneurocritical patients. CONCLUSIONS The German SOMS assessed by physical therapists on the day after ICU admission predicts ICU and hospital LOS, and mortality. Our data suggest that the association between early mobilization and mortality is more complex in neurocritical care patients.
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Affiliation(s)
- Stefan J Schaller
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Christiane G Stäuble
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Mika Suemasa
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Markus Heim
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ingrid Moreno Duarte
- Department of Anesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Oliver Mensch
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ralph Bogdanski
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Heidrun Lewald
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care, Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Manfred Blobner
- Klinik für Anaesthesiologie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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177
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Vincent JL, Creteur J. Paradigm shifts in critical care medicine: the progress we have made. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19 Suppl 3:S10. [PMID: 26728199 PMCID: PMC4698770 DOI: 10.1186/cc14728] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
There have really been no single, major, advances in critical care medicine since the specialty came into existence. There has, however, been a gradual, continuous improvement in the process of care over the years, which has resulted in improved patient outcomes. Here, we will highlight just a few of the paradigm shifts we have seen in processes of critical care, including the move from small, closed units to larger, more open ICUs; from a paternal "dictatorship" to more "democratic" team-work; from intermittent to continuous, invasive to less-invasive monitoring; from "more" interventions to "less" thus reducing iatrogenicity; from consideration of critical illness as a single event to realization that it is just one part of a trajectory; and from "four walls" to "no walls" as we take intensive care outside the physical ICU. These and other paradigm shifts have resulted in improvements in the whole approach to patient management, leading to more holistic, humane care for patients and their families. As critical care medicine continues to develop, further paradigm shifts in processes of care are inevitable and must be embraced if we are to continue to provide the best possible care for all critically ill patients.
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178
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Laurent H, Aubreton S, Richard R, Gorce Y, Caron E, Vallat A, Davin AM, Constantin JM, Coudeyre E. Systematic review of early exercise in intensive care: A qualitative approach. Anaesth Crit Care Pain Med 2015; 35:133-49. [PMID: 26655865 DOI: 10.1016/j.accpm.2015.06.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/27/2015] [Accepted: 06/29/2015] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Practice guidelines recommend early physical therapy in intensive care units (ICU). Feasibility, safety and efficacy are confirmed by growing evidence-based data. PURPOSE To perform a qualitative systematic literature review on early exercise in ICUs, focused on the subject areas of "how to do", "for which patients" and "for what benefits". METHODS Articles were obtained from the PubMed, Google Scholar, Physiotherapy Evidence Database (PEDro), Embase, CINAHL, CENTRAL, Cochrane and ReeDOC databases. The full texts of references selected according to title and abstract were read. Data extraction and PEDro scoring were performed. Consort recommendations were used for the drafting of the systematic review, which was declared on the Prospero website. RESULTS We confirm the feasibility and safety of early exercise in the ICU. Convergent evidence-based data are in favour of the efficacy of early exercise programs in ICUs. But the potential benefit of earlier program initiation has not been clearly demonstrated. Our analysis reveals tools and practical modalities that could serve to standardize these programs. The scientific literature mainly emphasizes the heterogeneity of targeted populations and lack of precision concerning multiple criteria for early exercise programs. CONCLUSION Changes in the professional culture of multidisciplinary-ICU teams are necessary as concerns early exercise. Physical therapists must be involved and their essential role in the ICU is clearly justified. Although technical difficulties and questions remain, the results of the present qualitative review should encourage the early and progressive implementation of exercise programs in the ICU.
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Affiliation(s)
- Hélène Laurent
- Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France
| | - Sylvie Aubreton
- Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France
| | - Ruddy Richard
- Department of Sport Medicine and Functional Explorations, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France; Inra UMR 1019, CRNH-Auvergne, 63000 Clermont-Ferrand, France
| | - Yannael Gorce
- Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France
| | - Emilie Caron
- Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France
| | - Aurélie Vallat
- Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France
| | - Anne-Marie Davin
- Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France
| | - Jean-Michel Constantin
- Perioperative Medicine Department, University Hospital of Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, Clermont-Ferrand cedex 1, France.
| | - Emmanuel Coudeyre
- Physical Medicine and Rehabilitation Department, Clermont-Ferrand University Hospital, 58, rue Montalembert BP 69, 63003 Clermont-Ferrand cedex 1, France
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179
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Bein T, Bischoff M, Brückner U, Gebhardt K, Henzler D, Hermes C, Lewandowski K, Max M, Nothacker M, Staudinger T, Tryba M, Weber-Carstens S, Wrigge H. S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders : Revision 2015: S2e guideline of the German Society of Anaesthesiology and Intensive Care Medicine (DGAI). Anaesthesist 2015; 64 Suppl 1:1-26. [PMID: 26335630 PMCID: PMC4712230 DOI: 10.1007/s00101-015-0071-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The German Society of Anesthesiology and Intensive Care Medicine (DGAI) commissioneda revision of the S2 guidelines on "positioning therapy for prophylaxis or therapy of pulmonary function disorders" from 2008. Because of the increasing clinical and scientificrelevance the guidelines were extended to include the issue of "early mobilization"and the following main topics are therefore included: use of positioning therapy and earlymobilization for prophylaxis and therapy of pulmonary function disorders, undesired effects and complications of positioning therapy and early mobilization as well as practical aspects of the use of positioning therapy and early mobilization. These guidelines are the result of a systematic literature search and the subsequent critical evaluation of the evidence with scientific methods. The methodological approach for the process of development of the guidelines followed the requirements of evidence-based medicine, as defined as the standard by the Association of the Scientific Medical Societies in Germany. Recently published articles after 2005 were examined with respect to positioning therapy and the recently accepted aspect of early mobilization incorporates all literature published up to June 2014.
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Affiliation(s)
- Th Bein
- Clinic for Anaesthesiology, University Hospital Regensburg, 93042, Regensburg, Germany.
| | - M Bischoff
- Clinic for Anaesthesiology, University Hospital Regensburg, 93042, Regensburg, Germany
| | - U Brückner
- Physiotherapy Department, Clinic Donaustauf, Centre for Pneumology, 93093, Donaustauf, Germany
| | - K Gebhardt
- Clinic for Anaesthesiology, University Hospital Regensburg, 93042, Regensburg, Germany
| | - D Henzler
- Clinic for Anaesthesiology, Surgical Intensive Care Medicine, Emergency Care Medicine, Pain Management, Klinikum Herford, 32049, Herford, Germany
| | - C Hermes
- HELIOS Clinic Siegburg, 53721, Siegburg, Germany
| | - K Lewandowski
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Management, Elisabeth Hospital Essen, 45138, Essen, Germany
| | - M Max
- Centre Hospitalier, Soins Intensifs Polyvalents, 1210, Luxembourg, Luxemburg
| | - M Nothacker
- Association of Scientific Medical Societies (AWMF), 35043, Marburg, Germany
| | - Th Staudinger
- University Hospital for Internal Medicine I, Medical University of Wien, General Hospital of Vienna, 1090, Vienna, Austria
| | - M Tryba
- Clinic for Anaesthesiology, Intensive Care Medicine and Pain Management, Klinikum Kassel, 34125, Kassel, Germany
| | - S Weber-Carstens
- Clinic for Anaesthesiology and Surgical Intensive Care Medicine, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, 13353, Berlin, Germany
| | - H Wrigge
- Clinic and Policlinic for Anaesthesiology and Intensive Care Medicine, University Hospital Leipzig, 04103, Leipzig, Germany
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180
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Hopkins RO, Choong K, Zebuhr CA, Kudchadkar SR. Transforming PICU Culture to Facilitate Early Rehabilitation. J Pediatr Intensive Care 2015; 4:204-211. [PMID: 27134761 PMCID: PMC4849412 DOI: 10.1055/s-0035-1563547] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 06/24/2015] [Indexed: 12/16/2022] Open
Abstract
Children who survive a critical illness are at risk of developing significant, long-lasting morbidities that may include neuromuscular weakness, cognitive impairments, and new mental health disorders. These morbidities, collectively known as post-intensive care syndrome (PICS), may lead to functional impairments, difficulty in school and social settings, and reduced quality of life. Interventions aimed at rehabilitation such as early mobilization, sedation minimization and prevention of ICU-acquired weakness, delirium, and posttraumatic stress disorder may lead to improved clinical outcomes and functional recovery in critically ill children. Acute rehabilitation is challenging to implement in a pediatric intensive care unit (PICU), and a culture change is needed to effect widespread transformation in this setting. Our objectives in this article are to review the evidence on PICS in children and strategies for affecting culture change to facilitate early rehabilitation in the PICU.
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Affiliation(s)
- Ramona O. Hopkins
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, United States
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah, United States
- Center for Humanizing Critical Care, Intermountain Health Care, Murray, Utah, United States
| | - Karen Choong
- Department of Pediatrics and Critical Care Medicine, Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Carleen A. Zebuhr
- Department of Pediatrics, Section of Critical Care, Children's Hospital Colorado, Aurora, Colorado, United States
| | - Sapna R. Kudchadkar
- Department of Anesthesiology and Critical Care Medicine and Pediatrics, Johns Hopkins University School of Medicine, The Charlotte R. Bloomberg Children's Center, Baltimore, Maryland, United States
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181
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Haines KJ, Skinner EH, Pastva A, Berney S, Denehy L. How Can Clinicians Use Outcome Measures in Routine Care? Knowledge Translation Strategies. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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182
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Choong K. Acute Rehabilitation in Critically Ill Children. J Pediatr Intensive Care 2015; 4:171-173. [PMID: 31110869 PMCID: PMC6513168 DOI: 10.1055/s-0035-1563384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Karen Choong
- Division of Pediatric Critical Care, Departments of Pediatrics, Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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183
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Sommers J, Engelbert RHH, Dettling-Ihnenfeldt D, Gosselink R, Spronk PE, Nollet F, van der Schaaf M. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clin Rehabil 2015; 29:1051-63. [PMID: 25681407 PMCID: PMC4607892 DOI: 10.1177/0269215514567156] [Citation(s) in RCA: 129] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/14/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To develop evidence-based recommendations for effective and safe diagnostic assessment and intervention strategies for the physiotherapy treatment of patients in intensive care units. METHODS We used the EBRO method, as recommended by the 'Dutch Evidence Based Guideline Development Platform' to develop an 'evidence statement for physiotherapy in the intensive care unit'. This method consists of the identification of clinically relevant questions, followed by a systematic literature search, and summary of the evidence with final recommendations being moderated by feedback from experts. RESULTS Three relevant clinical domains were identified by experts: criteria to initiate treatment; measures to assess patients; evidence for effectiveness of treatments. In a systematic literature search, 129 relevant studies were identified and assessed for methodological quality and classified according to the level of evidence. The final evidence statement consisted of recommendations on eight absolute and four relative contra-indications to mobilization; a core set of nine specific instruments to assess impairments and activity restrictions; and six passive and four active effective interventions, with advice on (a) physiological measures to observe during treatment (with stopping criteria) and (b) what to record after the treatment. CONCLUSIONS These recommendations form a protocol for treating people in an intensive care unit, based on best available evidence in mid-2014.
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Affiliation(s)
- Juultje Sommers
- Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands Education of Physiotherapy, University of Applied Sciences, Amsterdam, The Netherlands
| | | | - Rik Gosselink
- Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Peter E Spronk
- Department of Intensive Care, University of Amsterdam, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation, University of Amsterdam, Amsterdam, The Netherlands
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185
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Le Neindre A, Mongodi S, Philippart F, Bouhemad B. Thoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review. J Crit Care 2015; 31:101-9. [PMID: 26613650 DOI: 10.1016/j.jcrc.2015.10.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 01/15/2023]
Abstract
The use of diagnostic ultrasound by physiotherapists is not a new concept; it is frequently performed in musculoskeletal physiotherapy. Physiotherapists currently lack accurate, reliable, sensitive, and valid measurements for the assessment of the indications and effectiveness of chest physiotherapy. Thoracic ultrasound may be a promising tool for the physiotherapist and could be routinely performed at patients' bedsides to provide real-time and accurate information on the status of pleura, lungs, and diaphragm; this would allow for assessment of lung aeration from interstitial syndrome to lung consolidation with much better accuracy than chest x-rays or auscultation. Diaphragm excursion and contractility may also be assessed by ultrasound. This narrative review refers to lung and diaphragm ultrasound semiology and describes how physiotherapists could use this tool in their clinical decision-making processes in various cases of respiratory disorders. The use of thoracic ultrasound semiology alongside typical examinations may allow for the guiding, monitoring, and evaluating of chest physiotherapy treatments. Thoracic ultrasound is a potential new tool for physiotherapists.
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Affiliation(s)
- Aymeric Le Neindre
- Intensive Care Unit and Department of Critical Care Medicine, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - Silvia Mongodi
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Department of Anesthesia and Intensive Care, Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
| | - François Philippart
- Intensive Care Unit and Department of Critical Care Medicine, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Bélaïd Bouhemad
- Department of Anesthesia and Surgical Intensive Care Unit, C.H.U. de Dijon, Dijon, France; Faculty of Medicine, University of Burgundy, Dijon, France
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186
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Connolly B, O'Neill B, Salisbury L, McDowell K, Blackwood B. Physical rehabilitation interventions for adult patients with critical illness across the continuum of recovery: an overview of systematic reviews protocol. Syst Rev 2015; 4:130. [PMID: 26419458 PMCID: PMC4588271 DOI: 10.1186/s13643-015-0119-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/16/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Patients admitted to the intensive care unit with critical illness often experience significant physical impairments, which typically persist for many years following resolution of the original illness. Physical rehabilitation interventions that enhance restoration of physical function have been evaluated across the continuum of recovery following critical illness including within the intensive care unit, following discharge to the ward and beyond hospital discharge. Multiple systematic reviews have been published appraising the expanding evidence investigating these physical rehabilitation interventions, although there appears to be variability in review methodology and quality. We aim to conduct an overview of existing systematic reviews of physical rehabilitation interventions for adult intensive care patients across the continuum of recovery. METHODS/DESIGN This protocol has been developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. We will search the Cochrane Systematic Review Database, Database of Abstracts of Reviews of Effectiveness, Cochrane Central Register of Controlled Trials, MEDLINE, Excerpta Medica Database and Cumulative Index to Nursing and Allied Health Literature databases. We will include systematic reviews of randomised controlled trials of adult patients, admitted to the intensive care unit and who have received physical rehabilitation interventions at any time point during their recovery. Data extraction will include systematic review aims and rationale, study types, populations, interventions, comparators, outcomes and quality appraisal method. Primary outcomes of interest will focus on findings reflecting recovery of physical function. Quality of reporting and methodological quality will be appraised using the PRISMA checklist and the Assessment of Multiple Systematic Reviews tool. DISCUSSION We anticipate the findings from this novel overview of systematic reviews will contribute to the synthesis and interpretation of existing evidence regarding physical rehabilitation interventions and physical recovery in post-critical illness patients across the continuum of recovery. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015001068.
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Affiliation(s)
- Bronwen Connolly
- Lane Fox Clinical Respiratory Physiology Research Unit, Guy's and St. Thomas' NHS Foundation Trust, London, UK. .,Centre of Human and Aerospace Physiological Sciences, King's College London, London, UK. .,Guy's & St Thomas' NHS Foundation Trust and King's College London, National Institute of Health Research Biomedical Research Centre, London, UK.
| | - Brenda O'Neill
- School of Health Sciences, Institute of Nursing and Health Research, Ulster University, Ulster, UK.
| | - Lisa Salisbury
- School of Health in Social Science, The University of Edinburgh, Edinburgh, UK.
| | - Kathryn McDowell
- School of Health Sciences, Institute of Nursing and Health Research, Ulster University, Ulster, UK.
| | - Bronagh Blackwood
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
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Pan C, Qiu H. Improve survival from prolonged mechanical ventilation: beginning with first step. J Thorac Dis 2015; 7:1076-9. [PMID: 26380717 DOI: 10.3978/j.issn.2072-1439.2015.07.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/06/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Chun Pan
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Haibo Qiu
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
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188
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Harrold ME, Salisbury LG, Webb SA, Allison GT. Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:336. [PMID: 26370550 PMCID: PMC4570617 DOI: 10.1186/s13054-015-1033-3] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/14/2015] [Indexed: 01/07/2023]
Abstract
Introduction Mobilisation of patients in the intensive care unit (ICU) is an area of growing research. Currently, there is little data on baseline mobilisation practises and the barriers to them for patients of all admission diagnoses. Methods The objectives of the study were to (1) quantify and benchmark baseline levels of mobilisation in Australian and Scottish ICUs, (2) compare mobilisation practises between Australian and Scottish ICUs and (3) identify barriers to mobilisation in Australian and Scottish ICUs. We conducted a prospective, observational, cohort study with a 4-week inception period. Patients were censored for follow-up upon ICU discharge or after 28 days, whichever occurred first. Patients were included if they were >18 years of age, admitted to an ICU and received mechanical ventilation in the ICU. Results Ten tertiary ICUs in Australia and nine in Scotland participated in the study. The Australian cohort had a large proportion of patients admitted for cardiothoracic surgery (43.3 %), whereas the Scottish cohort had none. Therefore, comparison analysis was done after exclusion of patients admitted for cardiothoracic surgery. In total, 60.2 % of the 347 patients across 10 Australian ICUs and 40.1 % of the 167 patients across 9 Scottish ICUs mobilised during their ICU stay (p < 0.001). Patients in the Australian cohort were more likely to mobilise than patients in the Scottish cohort (hazard ratio 1.83, 95 % confidence interval 1.38–2.42). However, the percentage of episodes of mobilisation where patients were receiving mechanical ventilation was higher in the Scottish cohort (41.1 % vs 16.3 %, p < 0.001). Sedation was the most commonly reported barrier to mobilisation in both the Australian and Scottish cohorts. Physiological instability and the presence of an endotracheal tube were also frequently reported barriers. Conclusions This is the first study to benchmark baseline practise of early mobilisation internationally, and it demonstrates variation in early mobilisation practises between Australia and Scotland.
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Affiliation(s)
- Meg E Harrold
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, 6845, Australia. .,Intensive Care Unit and Physiotherapy Department, Royal Perth Hospital, Perth, Australia.
| | - Lisa G Salisbury
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
| | - Steve A Webb
- Intensive Care Unit and Physiotherapy Department, Royal Perth Hospital, Perth, Australia. .,Department of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
| | - Garry T Allison
- School of Physiotherapy and Exercise Science, Faculty of Health Science, Curtin University, GPO Box U1987, Perth, 6845, Australia. .,Intensive Care Unit and Physiotherapy Department, Royal Perth Hospital, Perth, Australia.
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Choong K, Chacon MDP, Walker RG, Al-Harbi S, Clark H, Al-Mahr G, Timmons BW, Thabane L. In-Bed Mobilization in Critically Ill Children: A Safety and Feasibility Trial. J Pediatr Intensive Care 2015; 4:225-234. [PMID: 31110874 DOI: 10.1055/s-0035-1563545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 10/23/2022] Open
Abstract
The objective of this study was to evaluate the feasibility and safety of implementing two methods of in-bed mobilization in critically ill children. This prospective cohort trial was conducted at McMaster Children's Hospital, Pediatric Critical Care Unit (PCCU). Hemodynamically stable patients aged 3 to 17 years with a longer than 24-hour PCCU stay were eligible to participate in the study. Children with cardiorespiratory instability, already mobilizing well or at their baseline mobility, anticipated death during this PCCU admission, and those with contraindications to mobilization were excluded. Two methods of mobilization were applied for a maximum of 2 days, respectively, depending on the level of consciousness and cognitive ability of the participant. In-bed cycling was used for passive mobilization and interactive video games (VG) were used for active mobilization. The primary outcomes were safety and feasibility. Secondary outcomes were physical activity during the study period, as reflected by accelerometer measurements. A total of 406 patients were screened over 1 year, 35 of who were eligible and 31 (89%) consented to participate. Median age of participants was 11 years (quartile 1 is 6 years and quartile 3 is 14 years), and 15 (48%) were male. Twenty-five (81%) participants received the study intervention, 22 (88%) of who received the intervention within 24 hours of consent. Twenty-one (84%) participants received in-bed cycling, five (20%) received VG, and only one received both. Fifteen (60%) completed the prescribed 2-day intervention, while in 11 (44%) the intervention was interrupted or not applied, most commonly because the patient was transferred out of the PCCU. Physical activity was greater during the intervention compared with nonintervention times with in-bed cycling, but not with VG. There were no adverse events attributable to the intervention. This pilot reveals that in-bed cycling can enhance physical activity, and appears to be safe and feasible in this group of critically ill children. VG was feasible only in a minority of patients who were cooperative and age appropriate. Further research is necessary to evaluate the efficacy and most appropriate methods of enhancing mobility and rehabilitation in this population.
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Affiliation(s)
- Karen Choong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Department of Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Maria D P Chacon
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Rachel G Walker
- Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Samah Al-Harbi
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Heather Clark
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Ghadah Al-Mahr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Brian W Timmons
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Child Health and Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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190
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Discordance Between Distance Ambulated as Part of Usual Care and Functional Exercise Capacity in Survivors of Critical Illness Upon Intensive Care Discharge: Observational Study. Phys Ther 2015; 95:1254-63. [PMID: 25838336 DOI: 10.2522/ptj.20140282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 03/23/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND People who have had a prolonged admission to an intensive care unit (ICU) commonly have profound debilitation and weakness. For the delivery of effective exercise training, an accurate assessment of exercise capacity is essential. OBJECTIVE The study objectives were to investigate how much ground-based walking is undertaken by inpatients recovering from critical illness within 1 week of discharge from an ICU and to evaluate the feasibility and safety of the Six-Minute Walk Test (6MWT) for this population. DESIGN This was an observational study. METHODS Within 1 week of discharge from the ICU, functional exercise capacity was measured with the 6MWT. The maximum distance ambulated on the ward in a single session as part of usual clinical management was extracted from the medical notes. The distance achieved during the 6MWT and the maximum distance ambulated on the ward were compared. RESULTS The participants (N=23) were survivors of a critical illness; their mean age was 57 years (SD=11). The median length of ICU stay was 11 days (interquartile range [IQR]=7). The mean 6-minute walk distance (6MWD) was 179 m (SD=101), and the maximum distance ambulated on the ward was 30 m (IQR=65). There was a moderate association between the distance participants ambulated on the ward and the 6MWD (r=.54). The maximum distance ambulated on the ward, expressed as a percentage of the 6MWD, was 29% (IQR=34%). Five participants (22%) experienced oxygen desaturation (oxygen saturation of <85%) and recovered within 1 minute of resting. LIMITATIONS The maximum distance ambulated on the ward was estimated with premeasured distances. CONCLUSIONS Most participants ambulated at a low percentage of their measured exercise capacity. The 6MWT appears to be a safe and useful test for inpatients recently discharged from the ICU.
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191
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Early Rehabilitation in the Intensive Care Unit. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015. [DOI: 10.1007/s40141-015-0094-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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192
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dos Santos LJ, de Aguiar Lemos F, Bianchi T, Sachetti A, Dall' Acqua AM, da Silva Naue W, Dias AS, Vieira SRR. Early rehabilitation using a passive cycle ergometer on muscle morphology in mechanically ventilated critically ill patients in the Intensive Care Unit (MoVe-ICU study): study protocol for a randomized controlled trial. Trials 2015; 16:383. [PMID: 26314881 PMCID: PMC4552342 DOI: 10.1186/s13063-015-0914-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 08/17/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients in Intensive Care Units (ICU) are often exposed to prolonged immobilization which, in turn, plays an important role in neuromuscular complications. Exercise with a cycle ergometer is a treatment option that can be used to improve the rehabilitation of patients on mechanical ventilation (MV) in order to minimize the harmful effects of immobility. METHODS/DESIGN A single-blind randomized controlled trial (the MoVe ICU study) will be conducted to evaluate and compare the effects of early rehabilitation using a bedside cycle ergometer with conventional physical therapy on the muscle morphology of the knee extensors and diaphragm in critical ill patients receiving MV. A total of 28 adult patients will be recruited for this study from among those admitted to the intensive care department at the Hospital de Clínicas de Porto Alegre. Eligible patients will be treated with MV from a period of 24 to 48 h, will have spent maximum of 1 week in hospital and will not exhibit any characteristics restricting lower extremity mobility. These subjects will be randomized to receive either conventional physiotherapy or conventional physiotherapy with an additional cycle ergometer intervention. The intervention will be administered passively for 20 min, at 20 revolutions per minute (rpm), once per day, 7 days a week, throughout the time the patients remain on MV. Outcomes will be cross-sectional quadriceps thickness, length of fascicle, pennation angle of fascicles, thickness of vastus lateralis muscle, diaphragm thickness and excursion of critical ICU patients on MV measured with ultrasound. DISCUSSION The MoVe-ICU study will be the first randomized controlled trial to test the hypothesis that early rehabilitation with a passive cycle ergometer can preserve the morphology of knee extensors and diaphragm in critical patients on MV in ICUs. TRIAL REGISTRATION NCT02300662 (25 November 2014).
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Affiliation(s)
- Laura Jurema dos Santos
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Dr Pereira Neto, 725 torre 1 ap 902, Tristeza-Porto Alegre, RS, CEP 91920530, Brazil. .,Department of Physical Therapy, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil.
| | - Fernando de Aguiar Lemos
- Graduate Program in Human Movement Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Tanara Bianchi
- Graduate Program in Respiratory Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Amanda Sachetti
- Graduate Program in Respiratory Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Ana Maria Dall' Acqua
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Dr Pereira Neto, 725 torre 1 ap 902, Tristeza-Porto Alegre, RS, CEP 91920530, Brazil.
| | - Wagner da Silva Naue
- Physical Therapy Service-Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Alexandre Simões Dias
- Graduate Program in Human Movement Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. .,Graduate Program in Respiratory Science, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. .,Department of Physical Therapy, Universidade Federal do Rio Grande do Sul (UFRGS); Physical Therapy Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
| | - Silvia Regina Rios Vieira
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Science, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Dr Pereira Neto, 725 torre 1 ap 902, Tristeza-Porto Alegre, RS, CEP 91920530, Brazil. .,School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS); Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil.
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Mobilization of ventilated patients in the intensive care unit: An elicitation study using the theory of planned behavior. J Crit Care 2015; 30:1243-50. [PMID: 26365000 DOI: 10.1016/j.jcrc.2015.08.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/27/2015] [Accepted: 08/11/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE Early mobilization in intensive care unit (ICU) is safe, feasible, and beneficial. However, mobilization frequently does not occur in practice. The study objective was to elicit attitudinal, normative, and control beliefs (barriers and enablers) toward the mobilization of ventilated patients, to inform development of targeted implementation interventions. MATERIALS AND METHODS A 9-item elicitation questionnaire was administered electronically to a convenience sample of multidisciplinary staff in a tertiary ICU. A snowball recruitment approach was used to target a sample size of 20 to 25. Two investigators performed word count and thematic analyses independently. Themes were cross-checked by a third investigator. RESULTS Twenty-two questionnaires were completed. Respondents wrote the most text about disadvantages. Positive attitudinal beliefs included better respiratory function, reduced functional decline, and reduced muscle wasting/weakness. The main negative attitudinal beliefs were that mobilization is perceived as time consuming and poses a risk of line dislodgement/disconnection. Positive control beliefs (enablers) included increased staff availability, positive staff attitudes, engagement, and teamwork. Negative control beliefs (barriers) included unstable patient physiology and negative workplace culture. CONCLUSIONS Intensive care unit staff expressed positive and negative attitudinal, normative, and control beliefs across the spectrum, and disadvantages were most frequently reported. Identified beliefs can be used to inform development of future interventions.
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194
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Suzuki S, Eastwood GM, Goodwin MD, Noë GD, Smith PE, Glassford N, Schneider AG, Bellomo R. Atelectasis and mechanical ventilation mode during conservative oxygen therapy: A before-and-after study. J Crit Care 2015; 30:1232-7. [PMID: 26346814 DOI: 10.1016/j.jcrc.2015.07.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of the study is to assess the effect of a conservative oxygen therapy (COT) (target SpO2 of 90%-92%) on radiological atelectasis and mechanical ventilation modes. MATERIALS AND METHODS We conducted a secondary analysis of 105 intensive care unit patients from a pilot before-and-after study. The primary outcomes of this study were changes in atelectasis score (AS) of 555 chest radiographs assessed by radiologists blinded to treatment allocation and time to weaning from mandatory ventilation and first spontaneous ventilation trial (SVT). RESULTS There was a significant difference in overall AS between groups, and COT was associated with lower time-weighted average AS. In addition, in COT patients, change from mandatory to spontaneous ventilation or time to first SVT was shortened. After adjustment for baseline characteristics and interactions between oxygen therapy, radiological atelectasis, and mechanical ventilation management, patients in the COT group had significantly lower "best" AS (adjusted odds ratio, 0.28 [95% confidence interval {CI}, 0.12-0.66]; P=.003) and greater improvement in AS in the first 7 days (adjusted odds ratio, 0.42 [95% CI, 0.17-0.99]; P=.049). Moreover, COT was associated with significantly earlier successful weaning from a mandatory ventilation mode (adjusted hazard ratio, 2.96 [95% CI, 1.73-5.04]; P<.001) and with shorter time to first SVT (adjusted hazard ratio, 1.77 [95% CI, 1.13-2.78]; P=.013). CONCLUSIONS In mechanically ventilated intensive care unit patients, COT might be associated with decreased radiological evidence of atelectasis, earlier weaning from mandatory ventilation modes, and earlier first trial of spontaneous ventilation.
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Affiliation(s)
- Satoshi Suzuki
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Glenn M Eastwood
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Mark D Goodwin
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Geertje D Noë
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Paul E Smith
- Department of Radiology, Austin Hospital, Heidelberg, Melbourne, VIC, Australia
| | - Neil Glassford
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Antoine G Schneider
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, Melbourne VIC, Australia; Australian and New Zealand Intensive Care Research Centre, Melbourne, VIC, Australia.
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Shindo Y, Ito R, Kobayashi D, Ando M, Ichikawa M, Goto Y, Fukui Y, Iwaki M, Okumura J, Yamaguchi I, Yagi T, Tanikawa Y, Sugino Y, Shindoh J, Ogasawara T, Nomura F, Saka H, Yamamoto M, Taniguchi H, Suzuki R, Saito H, Kawamura T, Hasegawa Y. Risk factors for 30-day mortality in patients with pneumonia who receive appropriate initial antibiotics: an observational cohort study. THE LANCET. INFECTIOUS DISEASES 2015; 15:1055-1065. [PMID: 26145194 DOI: 10.1016/s1473-3099(15)00151-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 03/04/2015] [Accepted: 03/25/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Appropriate initial antibiotics are essential for the treatment of infectious diseases. However, some patients with pneumonia might develop adverse outcomes, despite receiving appropriate initial antibiotics. We aimed to clarify the risk factors for 30-day mortality in patients who received appropriate initial antibiotics and to identify potential candidates who would benefit from adjunctive therapy. METHODS From March 15, to Dec 22, 2010, we did a prospective, observational study at ten medical institutions in hospitalised patients (aged ≥20 years) with pneumonia. We did a multivariable logistic regression analysis to calculate odds ratios (ORs) and 95% CI to assess the risk factors for 30-day mortality. This study was registered with the University Medical Information Network in Japan, number UMIN000003306. FINDINGS The 30-day mortality was 11% (61 of 579 patients) in the appropriate initial antibiotic treatment group and 17% (29 of 168) in the inappropriate initial antibiotic treatment group. Albumin concentration of less than 30 mg/L (adjusted OR 3·39, 95% CI 1·83-6·28), non-ambulatory status (3·34, 1·84-6·05), pH of less than 7·35 (3·13, 1·52-6·42), respiration rate of at least 30 breaths per min (2·33, 1·28-4·24), and blood urea nitrogen of at least 7·14 mmol/L (2·20, 1·13-4·30) were independent risk factors in patients given appropriate initial antibiotic treatment. The 30-day mortality was 1% (one of 126 patients), 1% (two of 168), 17% (23 of 137), 22% (20 of 89), and 44% (14 of 32) for patients with no, one, two, three, and four or five risk factors, respectively. INTERPRETATION Patients with two or more risk factors were at a higher risk of death during the 30 days assessed than were individuals with no or one risk factor, despite appropriate initial antibiotic treatment. Therefore, adjunctive therapy might be important for improving outcomes in patients with two or more risk factors. FUNDING Central Japan Lung Study Group.
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Affiliation(s)
- Yuichiro Shindo
- Institute for Advanced Research, Nagoya University, Nagoya, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Ryota Ito
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Respiratory Medicine, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Daisuke Kobayashi
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Motoshi Ichikawa
- Department of Respiratory Medicine and Allergy, Toyota Kosei Hospital, Toyota, Japan; Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Nagoya Ekisaikai Hospital, Nagoya, Japan; Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Yasutaka Fukui
- Department of Respiratory Medicine, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Mai Iwaki
- Department of Respiratory Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Junya Okumura
- Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan
| | - Ikuo Yamaguchi
- Department of Central Laboratory, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan
| | - Yoshimasa Tanikawa
- Department of Respiratory Medicine and Allergy, Toyota Kosei Hospital, Toyota, Japan
| | - Yasuteru Sugino
- Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan
| | - Joe Shindoh
- Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan
| | - Tomohiko Ogasawara
- Department of Respiratory Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Fumio Nomura
- Department of Respiratory Medicine, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - Hideo Saka
- Department of Respiratory Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Masashi Yamamoto
- Department of Respiratory Medicine, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Ryujiro Suzuki
- Department of Respiratory Medicine, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Hiroshi Saito
- Department of Respiratory Medicine, Aichi Cancer Center Aichi Hospital, Okazaki, Japan
| | | | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Castro-Avila AC, Serón P, Fan E, Gaete M, Mickan S. Effect of Early Rehabilitation during Intensive Care Unit Stay on Functional Status: Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0130722. [PMID: 26132803 PMCID: PMC4488896 DOI: 10.1371/journal.pone.0130722] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 05/24/2015] [Indexed: 12/27/2022] Open
Abstract
Background and Aim Critically ill survivors may have functional impairments even five years after hospital discharge. To date there are four systematic reviews suggesting a beneficial impact for mobilisation in mechanically ventilated and intensive care unit (ICU) patients, however there is limited information about the influence of timing, frequency and duration of sessions. Earlier mobilisation during ICU stay may lead to greater benefits. This study aims to determine the effect of early rehabilitation for functional status in ICU/high-dependency unit (HDU) patients. Design Systematic review and meta-analysis. MEDLINE, EMBASE, CINALH, PEDro, Cochrane Library, AMED, ISI web of science, Scielo, LILACS and several clinical trial registries were searched for randomised and non-randomised clinical trials of rehabilitation compared to usual care in adult patients admitted to an ICU/HDU. Results were screened by two independent reviewers. Primary outcome was functional status. Secondary outcomes were walking ability, muscle strength, quality of life, and healthcare utilisation. Data extraction and methodological quality assessment using the PEDro scale was performed by primary reviewer and checked by two other reviewers. The authors of relevant studies were contacted to obtain missing data. Results 5733 records were screened. Seven articles were included in the narrative synthesis and six in the meta-analysis. Early rehabilitation had no significant effect on functional status, muscle strength, quality of life, or healthcare utilisation. However, early rehabilitation led to significantly more patients walking without assistance at hospital discharge (risk ratio 1.42; 95% CI 1.17-1.72). There was a non-significant effect favouring intervention for walking distance and incidence of ICU-acquired weakness. Conclusions Early rehabilitation during ICU stay was not associated with improvements in functional status, muscle strength, quality of life or healthcare utilisation outcomes, although it seems to improve walking ability compared to usual care. Results from ongoing studies may provide more data on the potential benefits of early rehabilitation in critically ill patients.
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Affiliation(s)
- Ana Cristina Castro-Avila
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- * E-mail:
| | - Pamela Serón
- Internal Medicine Department, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Mónica Gaete
- Internal Medicine Department, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Sharon Mickan
- Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Freynet A, Gobaille G, Dewilde C, Truchi T, Sarreau P, Grandet P. Rôle du kinésithérapeute dans le succès de l’extubation : une revue de la littérature. MEDECINE INTENSIVE REANIMATION 2015. [DOI: 10.1007/s13546-015-1082-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Connolly B, Salisbury L, O'Neill B, Geneen LJ, Douiri A, Grocott MPW, Hart N, Walsh TS, Blackwood B. Exercise rehabilitation following intensive care unit discharge for recovery from critical illness. Cochrane Database Syst Rev 2015; 2015:CD008632. [PMID: 26098746 PMCID: PMC6517154 DOI: 10.1002/14651858.cd008632.pub2] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Skeletal muscle wasting and weakness are significant complications of critical illness, associated with degree of illness severity and periods of reduced mobility during mechanical ventilation. They contribute to the profound physical and functional deficits observed in survivors. These impairments may persist for many years following discharge from the intensive care unit (ICU) and can markedly influence health-related quality of life. Rehabilitation is a key strategy in the recovery of patients after critical illness. Exercise-based interventions are aimed at targeting this muscle wasting and weakness. Physical rehabilitation delivered during ICU admission has been systematically evaluated and shown to be beneficial. However, its effectiveness when initiated after ICU discharge has yet to be established. OBJECTIVES To assess the effectiveness of exercise rehabilitation programmes, initiated after ICU discharge, for functional exercise capacity and health-related quality of life in adult ICU survivors who have been mechanically ventilated longer than 24 hours. SEARCH METHODS We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid SP MEDLINE, Ovid SP EMBASE and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host to 15 May 2014. We used a specific search strategy for each database. This included synonyms for ICU and critical illness, exercise training and rehabilitation. We searched the reference lists of included studies and contacted primary authors to obtain further information regarding potentially eligible studies. We also searched major clinical trials registries (Clinical Trials and Current Controlled Trials) and the personal libraries of the review authors. We applied no language or publication restriction. We reran the search in February 2015 and will deal with the three studies of interest when we update the review. SELECTION CRITERIA We included randomized controlled trials (RCTs), quasi-RCTs and controlled clinical trials (CCTs) that compared an exercise intervention initiated after ICU discharge versus any other intervention or a control or 'usual care' programme in adult (≥ 18 years) survivors of critical illness. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by the Cochrane Collaboration. MAIN RESULTS We included six trials (483 adult ICU participants). Exercise-based interventions were delivered on the ward in two studies; both on the ward and in the community in one study; and in the community in three studies. The duration of the intervention varied according to length of hospital stay following ICU discharge (up to a fixed duration of 12 weeks).Risk of bias was variable for all domains across all trials. High risk of bias was evident in all studies for performance bias, although blinding of participants and personnel in therapeutic rehabilitation trials can be pragmatically challenging. For other domains, at least half of the studies were at low risk of bias. One study was at high risk of selection bias, attrition bias and other sources of bias. Risk of bias was unclear for the remaining studies across domains. We decided not to undertake a meta-analysis because of variation in study design, types of interventions and outcome measurements. We present a narrative description of individual studies for each outcome.All six studies assessed functional exercise capacity, although we noted wide variability in the nature of interventions, outcome measures and associated metrics and data reporting. Overall quality of the evidence was very low. Individually, three studies reported positive results in favour of the intervention. One study found a small short-term benefit in anaerobic threshold (mean difference (MD) 1.8 mL O2/kg/min, 95% confidence interval (CI) 0.4 to 3.2; P value = 0.02). In a second study, both incremental (MD 4.7, 95% CI 1.69 to 7.75 watts; P value = 0.003) and endurance (MD 4.12, 95% CI 0.68 to 7.56 minutes; P value = 0.021) exercise testing results were improved with intervention. Finally self reported physical function increased significantly following use of a rehabilitation manual (P value = 0.006). Remaining studies found no effect of the intervention.Similar variability was evident with regard to findings for the primary outcome of health-related quality of life. Only two studies evaluated this outcome. Individually, neither study reported differences between intervention and control groups for health-related quality of life due to the intervention. Overall quality of the evidence was very low.Four studies reported rates of withdrawal, which ranged from 0% to 26.5% in control groups, and from 8.2% to 27.6% in intervention groups. The quality of evidence for the effect of the intervention on withdrawal was low. Very low-quality evidence showed rates of adherence with the intervention. Mortality ranging from 0% to 18.8% was reported by all studies. The quality of evidence for the effect of the intervention on mortality was low. Loss to follow-up, as reported in all studies, ranged from 0% to 14% in control groups, and from 0% to 12.5% in intervention groups, with low quality of evidence. Only one non-mortality adverse event was reported across all participants in all studies (a minor musculoskeletal injury), and the quality of the evidence was low. AUTHORS' CONCLUSIONS At this time, we are unable to determine an overall effect on functional exercise capacity, or on health-related quality of life, of an exercise-based intervention initiated after ICU discharge for survivors of critical illness. Meta-analysis of findings was not appropriate because the number of studies and the quantity of data were insufficient. Individual study findings were inconsistent. Some studies reported a beneficial effect of the intervention on functional exercise capacity, and others did not. No effect on health-related quality of life was reported. Methodological rigour was lacking across several domains, influencing the quality of the evidence. Wide variability was noted in the characteristics of interventions, outcome measures and associated metrics and data reporting.If further trials are identified, we may be able to determine the effects of exercise-based intervention following ICU discharge on functional exercise capacity and health-related quality of life among survivors of critical illness.
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Affiliation(s)
- Bronwen Connolly
- Guy's and St Thomas' NHS Foundation TrustLane Fox Clinical Respiratory Physiology Research UnitLondonUK
- King’s College LondonDivision of Asthma, Allergy and Lung BiologyLondonUK
- Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, National Institute of Health Research Biomedical Research CentreLondonUK
| | - Lisa Salisbury
- University of EdinburghEdinburgh Critical Care Research Group MRC Centre for Inflammation ResearchEdinburghUK
| | - Brenda O'Neill
- Ulster UniversityCentre for Health and Rehabilitation Technologies (CHaRT), Institute of Nursing and Health ResearchNewtownabbeyNorthern IrelandUK
| | | | - Abdel Douiri
- Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, National Institute of Health Research Biomedical Research CentreLondonUK
- King's College LondonDepartment of Public Health Sciences, Division of Health and Social Care Research42 Weston StreetLondonUKSE1 3QD
| | - Michael PW Grocott
- University of SouthamptonIntegrative Physiology and Critical Illness Group, Clinical and Experimental SciencesSouthamptonUK
- Southampton NIHR Respiratory Biomedical Research UnitCritical Care Research AreaSouthamptonUK
- University Hospital Southampton NHS Foundation TrustAnaesthesia and Critical Care Research UnitSouthamptonUK
| | - Nicholas Hart
- Guy's and St Thomas' NHS Foundation TrustLane Fox Clinical Respiratory Physiology Research UnitLondonUK
- King’s College LondonDivision of Asthma, Allergy and Lung BiologyLondonUK
- Guy’s & St Thomas’ NHS Foundation Trust and King’s College London, National Institute of Health Research Biomedical Research CentreLondonUK
| | - Timothy S Walsh
- Edinburgh Royal InfirmaryLittle France CrescentEdinburghUKEH16 2SA
| | - Bronagh Blackwood
- Queen’s University BelfastHealth Sciences, School of Medicine, Dentistry and Biomedical Sciences, Centre for Infection and ImmunityBelfastUK
| | - for the ERACIP Group
- The Intensive Care FoundationThe Intensive Care Society, Churchill House35 Red Lion SquareLondonUKWC1R 4SG
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Barriers to early mobility of hospitalized general medicine patients: survey development and results. Am J Phys Med Rehabil 2015; 94:304-12. [PMID: 25133615 DOI: 10.1097/phm.0000000000000185] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Functional status decline commonly accompanies hospitalization making patients vulnerable to complications. Such decline can be mitigated through hospital-based early mobility programs. Success in implementing patient mobility quality improvement processes requires evaluating providers' knowledge, attitudes, and behaviors. DESIGN A cross-sectional, self-administered survey in two different hospital settings was completed by 120 nurses and physical and occupational therapists (rehabilitation therapists, 38; nurses, 82) from six general medicine units. The survey was developed using published guidelines, literature review, and provider meetings and refined through pilot testing. Psychometric properties were assessed, and regression analyses were conducted to examine barriers to early mobility by hospital site, provider discipline, and years of experience. RESULTS Internal consistency reliability, item consistency, and discriminant validity psychometric characteristics were acceptable. In multivariable regression analysis, overall perceived barriers were similar between the two hospitals (P = 0.25) and significantly higher for staff with less experience (P = 0.02) and for nurses vs. rehabilitation therapists (P < 0.001).The survey identified specific barriers common to both nurses and rehabilitation therapists and other barriers that were discipline specific. CONCLUSIONS This novel survey identified important barriers to mobilizing medical inpatients that were similar across two hospital settings. These results can assist with the implementation of quality improvement projects for increasing early hospital-based patient mobility.
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Abstract
PURPOSE OF REVIEW Survivors of a critical illness may experience poor physical function and quality of life as a result of reduced skeletal muscle mass and strength during their acute illness. Patients diagnosed with sepsis are particularly at risk, and mechanical ventilation may result in diaphragm dysfunction. Interest in the interaction of these conditions is both growing and important to understand for individualized patient care. RECENT FINDINGS This review describes developments in the presentation of both diaphragm and limb myopathy in critical illness, as measured from muscle biopsy and at the bedside with various imaging and strength-testing modalities. The influence of unloading of the diaphragm with mechanical ventilation and peripheral muscles with immobilization in septic patients has been recently questioned. Systemic inflammation appears to primarily accelerate and accentuate dysfunction, which may be remedied by early mobilization and augmented with developing muscle and/or nerve stimulation techniques. SUMMARY Many acute muscle changes in septic patients are likely to stem from pre-existing impairments, which should provide context for clinical evaluations of strength. During illness, sarcolemmal injury promotes a cascade of intra-cellular abnormalities. As unique characteristics of ICU-acquired weakness and differential effects on muscle groups are understood, early diagnosis and management should be facilitated.
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Affiliation(s)
- Claire E Baldwin
- aInternational Centre for Allied Health Evidence and School of Health Sciences, University of South Australia, Adelaide bPhysiotherapy Department, Flinders Medical Centre, Bedford Park cDepartment of Critical Care Medicine, School of Medicine, Faculty of Health Sciences, Flinders University, Bedford Park dIntensive and Critical Care Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
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