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Genç A, Sonel Tur B. Rehabilitation in children with home invasive mechanical ventilation. Pediatr Pulmonol 2024; 59:2203-2209. [PMID: 38265147 DOI: 10.1002/ppul.26872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/25/2024]
Abstract
Children with home invasive mechanical ventilation need special health care and rehabilitation services due to complications caused by both the pulmonary system and physical inactivity. Children who are dependent on invasive mechanical ventilators due to breathing difficulties and lung problems can benefit from rehabilitation programs. Rehabilitation requires a close relationship between the child, parents and/or caregivers, and healthcare professionals. The main goal of rehabilitation is to improve breathing, lung function and overall quality of life. In this review, although full standard approaches have not been determined yet, rehabilitation approaches for children dependent on home-type invasive mechanical ventilator will be discussed.
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Affiliation(s)
- Aysun Genç
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Birkan Sonel Tur
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
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Albarrati A, Aldhahi MI, Almuhaid T, Alnahdi A, Alanazi AS, Alqahtani AS, Nazer RI. A Culture of Early Mobilization in Adult Intensive Care Units: Perspective and Competency of Physicians. Healthcare (Basel) 2024; 12:1300. [PMID: 38998835 PMCID: PMC11241168 DOI: 10.3390/healthcare12131300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Early mobility (EM) is vital in the intensive care unit (ICU) to counteract immobility-related effects. A multidisciplinary approach is key, as it requires precise initiation knowledge. However, physicians' understanding of EM in adult ICU settings remains unexplored. This study was conducted to investigate the knowledge and clinical competency of physicians working in adult ICUs toward EM. METHODS This cross-sectional study enrolled 236 physicians to assess their knowledge of EM. A rigorously designed survey comprising 30 questions across the demographic, theoretical, and clinical domains was employed. The criteria for knowledge and competency were aligned with the minimum passing score (70%) stipulated for physician licensure by the medical regulatory authority in Saudi Arabia. RESULTS Nearly 40% of the respondents had more than 5 years of experience. One-third of the respondents received theoretical knowledge about EM as part of their residency training, and only 4% of the respondents attended formal courses to enhance their knowledge. Almost all the respondents (95%) stated their awareness of EM benefits and its indications and contraindications and considered it safe to mobilize patients on mechanical ventilators. However, 62.3% of the respondents did not support EM for critically ill patients on mechanical ventilators until weaning. In contrast, 51.7% of respondents advised EM for agitated patients with RASS > 2. Only 113 (47.9%) physicians were competent in determining the suitability of ICU patients for EM. For critically ill patients who should be mobilized, nearly 60% of physicians refused to initiate EM. CONCLUSIONS This study underscores insufficient practical knowledge of ICU physicians about EM criteria, which leads to suboptimal decisions, particularly in complex ICU cases. These findings emphasize the need for enhanced training and education of physicians working in adult ICU settings to optimize patient care and outcomes in critical care settings.
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Affiliation(s)
- Ali Albarrati
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
| | - Monira I Aldhahi
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Turki Almuhaid
- Prince Mohammed Bin Abdulaziz Hospital, Ministry of Health, Riyadh 14214, Saudi Arabia
| | - Ali Alnahdi
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
| | - Ahmed S Alanazi
- Department of Physical Therapy, College of Medical Rehabilitation Sciences, Taibah University, Medina 42353, Saudi Arabia
| | - Abdulfattah S Alqahtani
- Rehabilitation Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
| | - Rakan I Nazer
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh 11421, Saudi Arabia
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Cussen J, Mukpradab S, Tobiano G, Cooke C, Pearcy J, Marshall AP. Early mobility and family partnerships in the intensive care unit: A scoping review of reviews. Nurs Crit Care 2024; 29:597-613. [PMID: 37749618 DOI: 10.1111/nicc.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/09/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Critical illness significantly impacts the well-being of patients and families. Previous studies show that family members are willing to participate in patient care. Involving families in early mobility interventions may contribute to improved recovery and positive outcomes for patients and families. AIM In this scoping review, we investigated early mobility interventions for critically ill patients evaluated in randomized controlled trials and the extent to which family engagement in those interventions are reported in the literature. STUDY DESIGN In this scoping review of reviews, EMBASE, CINAHL, PubMed and Cochrane Central databases were searched in October 2019 and updated in February 2022. Systematic reviews were included and assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2. Data were synthesized using a narrative approach. PRISMA-ScR guidelines were adhered to for reporting. RESULTS Thirty-three reviews were included which described a range of early mobility interventions for critically ill patients; none explicitly mentioned family engagement. Almost half of the reviews were of low or critically low quality. Insufficient detail of early mobility interventions prompted information to be extracted from the primary studies. CONCLUSIONS There are a range of early mobility interventions for critically ill patients but few involve families. Given the positive outcomes of family participation, and family willingness to participate in care, there is a need to explore the feasibility and acceptability of family participation in early mobility interventions. RELEVANCE TO CLINICAL PRACTICE Family engagement in early mobility interventions for critically ill patients should be encouraged and supported. How to best support family members and clinicians in enacting family involvement in early mobility requires further investigation.
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Affiliation(s)
| | - Sasithorn Mukpradab
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Nursing, Prince of Songkla University, Thailand
| | - Georgia Tobiano
- Gold Coast Health, Queensland, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
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Maeshige Ph N, Hayashi PhD H, Terashi PhD Md H, Fujii PhD Md M, Iwamoto PhD T, Watanabe MSc Y, Imaoka MSc S, Matsumoto MSc J, Nishikawa BSc M, Takeda BSc N, Mikawa BSc R, Tsuji PhD Md Y, Higashita PhD Md R, Ayabe Md S, Terabe Md Y, Furukawa Md M, Tanaka PhD Md J, Ohura PhD Md T, Kawabe PhD N. Effect of Early Rehabilitation on Gait, Wound and Home Discharge in Lower Extremity Chronic Wound Patients: A Japanese Multicenter Retrospective Study. INT J LOW EXTR WOUND 2023; 22:713-721. [PMID: 34459670 DOI: 10.1177/15347346211039588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study investigated the effect of early rehabilitation on gait restoration, wound healing, and home discharge in patients with lower extremity (LE) chronic wounds. This multicenter, retrospective cohort study included 233 Japanese inpatients who received treatment for LE chronic wounds from April 2012 to March 2015. A multivariate analysis was conducted using outcomes of gait restoration, wound healing, and home discharge as dependent variables. Other survey items were used as independent variables. Early rehabilitation was extracted as an independent factor with gait restoration (hazard ratio [HR] 1.82, P < .01) and home discharge (HR 1.77, P < .001) as dependent factors by the stepwise method in Cox proportional-hazards regression analysis, but it was not extracted as an independent factor with wound healing as the dependent factor by the stepwise method as well as the forced entry method (P = .44). A significant relationship between the presence of gait restoration and home discharge was observed in the chi-square test (P<.001), and the duration from admission to gait restoration was significantly correlated to the duration from admission to home discharge (Pearson's product-moment correlation coefficient; r=.89, P<.0001). Early rehabilitation was a positive factor for gait restoration and home discharge in chronic LE wound patients.
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Affiliation(s)
| | | | | | - Miki Fujii PhD Md
- Critical Limb Ischemia Center, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Tetsuya Iwamoto PhD
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan
| | - Yu Watanabe MSc
- Kobe University Graduate School of Health Sciences, Kobe, Hyogo, Japan
| | | | | | | | | | | | | | | | - Shinobu Ayabe Md
- Wound Care Center, Yao Tokushukai General Hospital, Yao, Osaka, Japan
| | - Yuta Terabe Md
- Limb Salvage Center, Kasukabe Chuo General Hospital, Kasukabe, Saitama, Japan
| | | | - Junko Tanaka PhD Md
- Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Kho ME, Connolly B. From Strict Bedrest to Early Mobilization. Crit Care Clin 2023; 39:479-502. [DOI: 10.1016/j.ccc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Yeung MT, Tan NK, Lee GZ, Gao Y, Tan CJ, Yan CC. Perceived barriers to mobility in the intensive care units of Singapore: The Patient Mobilisation Attitudes and Beliefs Survey for the intensive care units. J Intensive Care Soc 2023; 24:32-39. [PMID: 36874293 PMCID: PMC9975807 DOI: 10.1177/17511437221099791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Prolonged bed rest and immobility in the intensive care units (ICU) increase the risk of ICU-acquired weakness (ICUAW) and other complications. Mobilisation has been shown to improve patient outcomes but may be limited by the perceived barriers of healthcare professionals to mobilisation. The Patient Mobilisation Attitudes and Beliefs Survey for the ICU (PMABS-ICU) was adapted to assess perceived barriers to mobility in the Singapore context (PMABS-ICU-SG). Methods The 26-item PMABS-ICU-SG was disseminated to doctors, nurses, physiotherapists, and respiratory therapists working in ICU of various hospitals across Singapore. Overall and subscale (knowledge, attitude, and behaviour) scores were obtained and compared with the clinical roles, years of work experience, and type of ICU of the survey respondents. Results A total of 86 responses were received. Of these, 37.2% (32/86) were physiotherapists, 27.9% (24/86) were respiratory therapists, 24.4% (21/86) were nurses and 10.5% (9/86) were doctors. Physiotherapists had significantly lower mean barrier scores in overall and all subscales compared to nurses (p < 0.001), respiratory therapists (p < 0.001), and doctors (p = 0.001). A poor correlation (r = 0.079, p < 0.05) was found between years of experience and the overall barrier score. There was no statistically significant difference in the overall barriers score between types of ICU (χ2(2) = 4.720, p = 0.317). Conclusion In Singapore, physiotherapists had significantly lower perceived barriers to mobilisation compared to the other three professions. Years of experience and type of ICU had no significance in relation to barriers to mobilisation.
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Affiliation(s)
- Meredith T Yeung
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Nicholas K Tan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Gideon Z Lee
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Yuemian Gao
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore
| | - Chun Ju Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Clement C Yan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.,Department of Physiotherapy, Sengkang General Hospital, Singapore
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Barros-Poblete M, Bernardes Neto SC, Benavides-Cordoba V, Vieira RP, Baz M, Martí JD, Spruit MA, Torres-Castro R. Early mobilization in intensive care unit in Latin America: A survey based on clinical practice. Front Med (Lausanne) 2022; 9:1005732. [PMID: 36479097 PMCID: PMC9720404 DOI: 10.3389/fmed.2022.1005732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/28/2022] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The application of early mobilization (EM) in intensive care units (ICUs) has shown to improve the physical and ventilatory status of critically ill patients, even after ICU stay. This study aimed to describe the practices regarding EM in ICUs in Latin America. METHODS We conducted an observational, cross-sectional study of professionals from all countries in Latin America. Over 3 months, professionals working in ICU units in Latin America were invited to answer the survey, which was designed by an expert committee and incorporated preliminary questions based on studies about EM recommendations. RESULTS As many as 174 health professionals from 17 countries completed the survey. The interventions carried out within each ICU were active mobilization (90.5%), passive mobilization (85.0%), manual and instrumental techniques for drainage of mucus secretion (81.8%), and positioning techniques (81%). The professionals who most participated in the rehabilitation process in ICUs were physiotherapists (98.7%), intensive care physicians (61.6%), nurses (56.1%), and respiratory therapists (43.8%). In only 36.1% of the ICUs, protocols were established to determine when a patient should begin EM. In 38.1% of the cases, the onset of EM was established by individual evaluation, and in 25.0% of the cases, it was the medical indication to start rehabilitation and EM. CONCLUSION This report shows us that EM of critically ill patients is an established practice in our ICUs like in other developed countries.
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Affiliation(s)
- Marisol Barros-Poblete
- Programa de Doctorado en Ciencias Médicas, Escuela de Graduados Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Saint-Clair Bernardes Neto
- FACISA—Faculdade de Ciências de Saúde do Trairi, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Rodolfo P. Vieira
- Evangelical University of Goias (Unievangélica), Goiás, Brazil
- Brazil University, São Paulo, Brazil
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São Paulo, Brazil
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Manuel Baz
- Área de Cuidados Intermedios, Departamento Clínico de Medicina, Facultad de Medicina, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Joan-Daniel Martí
- Cardiovascular Surgery Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Martijn A. Spruit
- Department of Research and Development, CIRO, Horn, Netherlands
- Department of Respiratory Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, NUTRIM School, Maastricht University, Maastricht, Netherlands
| | - Rodrigo Torres-Castro
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
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Abstract
The detrimental effects of immobility are well documented in the literature, yet immobility still plagues the hospitalized adult. As the influx of COVID-19 patients began, patient mobility was further compromised. The purpose of this quality improvement project was to assess the impact of COVID mobility teams, composed of deployed coworkers, on COVID-19–positive and person under investigation patient outcomes. Using mobility teams improved mobility in COVID-positive and person under investigation patients. Increasing patient mobility results in improved patient outcomes by preventing hospital-acquired functional decline, preventing intensive care unit transfers, and decreasing length of stay.
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Ou GWM, Ng MJH, Ng CLW, Ong HK, Jayachandran B, Palanichamy V. Physiotherapy Practice Pattern in the Adult Intensive Care Units of Singapore – A Multi-Centre Survey. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058211068589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The roles of physiotherapy in Intensive Care Unit (ICU) have significantly developed from the traditional management of respiratory conditions to early rehabilitation and mobilisation of patients on mechanical ventilation. Surveys of United Kingdom, Australia and regional ICU physiotherapy practice have been published but there are no local data sets. This study aims to report the physiotherapy practices across the adult ICUs of Singapore. Methods Twenty-nine item questionnaire was mailed to 90 physiotherapists working in 15 adult ICUs across restructured and private hospitals in Singapore. Data sets were summarised from the returned questionnaires. This includes identifying common physiotherapy techniques and exercise prescription protocols for both mechanically and non-mechanically ventilated patients in the ICU. Results A total of 63 (70%) questionnaires were returned. The most used physiotherapy interventions were airway secretion clearance, techniques to improve lung ventilation and mobilisation out of bed. Positioning was most used respiratory technique (60/61, 98%). Sitting on the edge of bed is the most preferred physical activity for ICU patients (43/44, 98%). Exercise was routinely prescribed (50/61, 83%) although only a minority (8/50, 16%) have established exercise prescription protocols. For mechanically ventilated patients, active/active assisted exercises were most used (40/44, 91%). 12% of ICU use either Chelsea Critical Care Physical Assessment Tool or the Functional Status Score for the Intensive Care Unit as routine outcome measures. Conclusion Airway clearance was stated as the most used physiotherapy technique. Exercise is routinely prescribed in ICU. Validated outcome measures are only used by few.
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Affiliation(s)
| | - Marcus Jun Hui Ng
- Physiotherapy, Singapore Institute of Technology, Singapore, Singapore
| | | | - Hwee Kuan Ong
- Physiotherapy, Singapore General Hospital, Singapore, Singapore
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Fernald MM, Smyrnios NA, Vitello J. Early Mobility for Critically Ill Patients: Building Staff Commitment Through Appreciative Inquiry. Crit Care Nurse 2021; 40:66-72. [PMID: 32737490 DOI: 10.4037/ccn2020251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Immobility contributes to many adverse effects in critically ill patients. Early progressive mobility can mitigate these negative sequelae but is not widely implemented. Appreciative inquiry is a quality improvement method/change philosophy that builds on what works well in an organization. OBJECTIVES To explore whether appreciative inquiry would reinvigorate an early progressive mobility initiative in a medical intensive care unit and improve and sustain staff commitment to providing regular mobility therapy at the bedside. Secondary goals were to add to the literature about appreciative inquiry in health care and to determine whether it can be adapted to critical care. METHODS Staff participated in appreciative inquiry workshops, which were conducted by a trained facilitator and structured with the appreciative inquiry 4-D cycle. Staff members' attitudes toward and knowledge of early progressive mobility were evaluated before and after the workshops. Performance of early progressive mobility activities was recorded before and 3 and 10 months after the workshops. RESULTS Sixty-seven participants completed the program. They rated the workshops as successfully helping them to understand the importance of early progressive mobility (98%), explain their responsibility to improve patient outcomes (98%), and engender a greater commitment to patients and the organization (96%). Regarding mobility treatments, at 3 months orders had improved from 62% to 88%; documentation, from 52% to 89%; and observation, from 39% to 87%. These improvements were maintained at 10 months. CONCLUSION Participation in the workshops improved the staff's attitude toward and performance of mobility treatments. Appreciative inquiry may provide an adjunct to problem-based quality improvement techniques.
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Affiliation(s)
- Michelle M Fernald
- Michelle M. Fernald is a nurse manager in the medical intensive care unit, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Nicholas A Smyrnios
- Nicholas A. Smyrnios is a professor, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, and Medical Director, medical intensive care unit, Division of Pulmonary, Allergy, and Critical Care Medicine, UMass Memorial Medical Center
| | - Joan Vitello
- Joan Vitello is Dean and a professor, University of Massachusetts Medical School Graduate School of Nursing
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Schallom M, Tymkew H, Vyers K, Prentice D, Sona C, Norris T, Arroyo C. Implementation of an Interdisciplinary AACN Early Mobility Protocol. Crit Care Nurse 2021; 40:e7-e17. [PMID: 32737495 DOI: 10.4037/ccn2020632] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Increasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components. METHODS A staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted. In phase 1, data were collected on patients with intensive care unit stays of 24 hours or more for 2 months before and 2 months after protocol implementation. In phase 2, data were collected on a random sample of 20% of patients with an intensive care unit stay of 3 days or more for 2 months before and 12 months after protocol implementation. RESULTS The study population consisted of 1266 patients before and 1420 patients after implementation in phase 1 and 258 patients before and 1681 patients after implementation in phase 2. In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P < .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases. CONCLUSIONS Implementing the American Association of Critical-Care early mobility protocol in intensive care units with ABCDEF components in place can increase mobility levels, decrease length of stay, and decrease delirium with minimal complications.
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Affiliation(s)
- Marilyn Schallom
- Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Heidi Tymkew
- Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Kara Vyers
- Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Donna Prentice
- Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
| | - Carrie Sona
- Carrie Sona is a clinical nurse specialist, surgical/burn/trauma intensive care unit, Barnes-Jewish Hospital
| | - Traci Norris
- Traci Norris is a clinical specialist, Rehabilitation Department, Barnes-Jewish Hospital
| | - Cassandra Arroyo
- Marilyn Schallom is director, Heidi Tymkew and Donna Prentice are research scientists, Kara Vyers is a research coordinator, and Cassandra Arroyo is lead statistical analyst, Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, Missouri
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Felten-Barentsz KM, van de Wetering-van Dongen VA, Vloet L, Koenders N, Nijhuis-van der Sanden MWG, Hoogeboom TJ. Family participation during physical activity in the intensive care unit: A longitudinal qualitative study. J Crit Care 2021; 65:42-48. [PMID: 34082254 DOI: 10.1016/j.jcrc.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Family-centered care has been implemented in the ICU to meet relatives' needs concerning information, support, participation and shared decision making. This study explores the needs, beliefs, feelings and behaviors of relatives of patients admitted to the ICU regarding participation during physical activity. METHODS Longitudinal qualitative study design following a grounded theory approach. Relatives were interviewed at 4, 8 and 12 days after the patient's ICU-admission. Data were analyzed using constant comparison. RESULTS Twenty-five interviews were conducted in ten relatives. Relatives believed that physical activity in the ICU improves recovery. Participating in physical activity decreased their feelings of powerlessness and uselessness. Relatives mentioned that they would be stimulated to participate if they were invited, guided and informed by healthcare providers. The perceived reticence of healthcare providers, patient's health-changing capacity and the inability to communicate led to a more passive attitude towards participation. CONCLUSIONS The conceptual model shows how family participation during physical activity changes from a passive role, with negative beliefs and feelings of uselessness and powerlessness, to a more proactive participatory role. Relatives felt more useful and like they were part of the team. Providing relatives with additional information might be a viable strategy to help and stimulate participation.
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Affiliation(s)
- Karin M Felten-Barentsz
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, the Netherlands.
| | - Veerle A van de Wetering-van Dongen
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lilian Vloet
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Niek Koenders
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Department of Rehabilitation - Physical Therapy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Daptardar AA. Quest of Knowledge and Perceived Barriers toward Early Mobilization of Critically Ill Patients in Intensive Care Unit: A Continuing Journey! Indian J Crit Care Med 2021; 25:489-490. [PMID: 34177164 PMCID: PMC8196386 DOI: 10.5005/jp-journals-10071-23838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
How to cite this article: Daptardar AA. Quest of Knowledge and Perceived Barriers toward Early Mobilization of Critically Ill Patients in Intensive Care Unit: A Continuing Journey! Indian J Crit Care Med 2021;25(5):489-490.
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Respiratory Support Adjustments and Monitoring of Mechanically Ventilated Patients Performing Early Mobilization: A Scoping Review. Crit Care Explor 2021; 3:e0407. [PMID: 33912837 PMCID: PMC8078339 DOI: 10.1097/cce.0000000000000407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: This scoping review is aimed to summarize current knowledge on respiratory support adjustments and monitoring of metabolic and respiratory variables in mechanically ventilated adult patients performing early mobilization. Data Sources: Eight electronic databases were searched from inception to February 2021, using a predefined search strategy. Study Selection: Two blinded reviewers performed document selection by title, abstract, and full text according to the following criteria: mechanically ventilated adult patients performing any mobilization intervention, respiratory support adjustments, and/or monitoring of metabolic/respiratory real-time variables. Data Extraction: Four physiotherapists extracted relevant information using a prespecified template. Data Synthesis: From 1,208 references screened, 35 documents were selected for analysis, where 20 (57%) were published between 2016 and 2020. Respiratory support settings (ventilatory modes or respiratory variables) were reported in 21 documents (60%). Reported modes were assisted (n = 11) and assist-control (n = 9). Adjustment of variables and modes were identified in only seven documents (20%). The most frequent respiratory variable was the Fio2, and only four studies modified the level of ventilatory support. Mechanical ventilator brand/model used was not specified in 26 documents (74%). Monitoring of respiratory, metabolic, and both variables were reported in 22 documents (63%), four documents (11%) and 10 documents (29%), respectively. These variables were reported to assess the physiologic response (n = 21) or safety (n = 13). Monitored variables were mostly respiratory rate (n = 26), pulse oximetry (n = 22), and oxygen consumption (n = 9). Remarkably, no study assessed the work of breathing or effort during mobilization. Conclusions: Little information on respiratory support adjustments during mobilization of mechanically ventilated patients was identified. Monitoring of metabolic and respiratory variables is also scant. More studies on the effects of adjustments of the level/mode of ventilatory support on exercise performance and respiratory muscle activity monitoring for safe and efficient implementation of early mobilization in mechanically ventilated patients are needed.
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Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit. Crit Care Res Pract 2020; 2020:7840743. [PMID: 33294221 PMCID: PMC7714600 DOI: 10.1155/2020/7840743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Patients admitted to the intensive care unit (ICU) are generally confined to bed leading to limited mobility that may have detrimental effects on different body systems. Early mobilization prevents or reduces these effects and improves outcomes in patients following critical illness. The purpose of this review is to summarize different aspects of early mobilization in intensive care. Methods Electronic databases of PubMed, Google Scholar, ScienceDirect, and Scopus were searched using a combination of keywords. Full-text articles meeting the inclusion criteria were selected. Results Fifty-six studies on various aspects such as the effectiveness of early mobilization in various intensive care units, newer techniques in early mobilization, outcome measures for physical function in the intensive care unit, safety, and practice and barriers to early mobilization were included. Conclusion: Early mobilization is found to have positive effects on various outcomes in patients with or without mechanical ventilation. The newer techniques can be used to facilitate early mobilization. Scoring systems—specific to the ICU—are available and should be used to quantify patients' status at different intervals of time. Early mobilization is not commonly practiced in many countries. Various barriers to early mobilization have been identified, and different strategies can be used to overcome them.
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Gatty A, Samuel SR, Alaparthi GK, Prabhu D, Upadya M, Krishnan S, Amaravadi SK. Effectiveness of structured early mobilization protocol on mobility status of patients in medical intensive care unit. Physiother Theory Pract 2020; 38:1345-1357. [PMID: 33228448 DOI: 10.1080/09593985.2020.1840683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Patients admitted to the intensive care units (ICU) have limited mobility due to their illness and its management and are at a risk for immobility-related complications. Early mobilization has been suggested to prevent or limit physical dysfunction due to these complications. Effectiveness of early mobilization protocols is studied using various outcomes. OBJECTIVE To study the effectiveness of an early mobilization protocol on mobility status of patients in Medical ICU. METHODS Patients admitted to Medical ICU were screened for eligibility and allotted into two groups. Intervention group received mobilization according to a protocol while control group received mobilization as per usual mobilization practices in our ICU. Mobility was assessed using the Perme ICU mobility score on the first day of ICU, first day of rehabilitation and last day of rehabilitation. RESULTS 63 patients were included in the study. The median difference in the Perme ICU mobility score from first day of rehabilitation to last day of rehabilitation was 9 and 2 in the intervention group and control group respectively. Significant improvements in the mobility scores were not present from first day of ICU to first day of rehabilitation in both, the intervention (p = .069) and control group (p = .124). Improvement in the scores from first day of rehabilitation to last day of rehabilitation was significant within and between both the groups (p < .001). CONCLUSION Early Mobilization Protocol was effective in improving mobility status of patients in Medical ICU.
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Affiliation(s)
- Aishwarya Gatty
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangaluru, India
| | - Stephen Rajan Samuel
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangaluru, India
| | - Gopala Krishna Alaparthi
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Dattatray Prabhu
- Department of Anaesthesiology, Consultant Critical Care, Kasturba Medical College, Manipal Academy of Higher Education, Mangaluru, India
| | - Madhusudan Upadya
- Department of Anaesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Mangaluru, India
| | - Shyam Krishnan
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangaluru, India
| | - Sampath Kumar Amaravadi
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
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Merino-Osorio C, Velásquez M, Reveco R, Marmolejo JI, Fu C. 24/7 Physical Therapy Intervention With Adult Patients in a Chilean Intensive Care Unit: A Cost-Benefit Analysis in a Developing Country. Value Health Reg Issues 2020; 23:99-104. [PMID: 33171360 DOI: 10.1016/j.vhri.2020.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 03/22/2020] [Accepted: 04/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Physiotherapy in an adult intensive care unit (ICU) affects health outcome. To justify the investment in ICU physical therapy, the cost savings associated with its benefits need to be established. The main objective of this study is to evaluate the potential cost savings of implementing 24-hour, 7-days-per-week physiotherapist (24/7-PT) in a Chilean public high-complex specialized ICU. METHODS Using clinical data from a literature review and a micro-costing technique, we conducted a cost-benefit analysis in the National Institute of Thorax in Chile. Our example scenario involves 697 theoretical admissions of adult patients with cardiovascular or respiratory diseases, and the costs and benefits by reduction of length of stay in ICU, days of mechanical ventilation, and days with respiratory infections during the first year and 5 years of admissions. A sensitivity analysis was considered according to the variability in total costs, production income, and clinical benefits. RESULTS Net cost savings generated in our example scenario demonstrate that the implementation of 24/7-PT produces a minimum saving for the institution of $16 242 during the first year and $69 351 over a 5-year interval considering individual income production. Out of the 30 scenarios included in the sensitivity analyses, 26 (87%) demonstrated net savings. CONCLUSIONS A financial model, based on literature review and actual cost data, projects that 24/7-PT intervention is a cost-benefit alternative in adult ICU patients with cardiovascular or respiratory diseases in Chile. It is necessary a scenario of at least 3 sessions per day with insurance payment for individual treatments to support the long-term implementation of a 24/7-PT program.
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Affiliation(s)
- Catalina Merino-Osorio
- School of Physical Therapy, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
| | - Mónica Velásquez
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile; Department of Medical Specialties Faculty of Medicine Universidad de La Frontera, Temuco, Chile
| | - Roberto Reveco
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile; Department of Administration and Economy, Universidad de La Frontera, Temuco, Chile
| | - José Ignacio Marmolejo
- School of Physical Therapy, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Instituto Nacional del Tórax, Santiago, Chile
| | - Carolina Fu
- Department of Physical Therapy, Speech, and Occupational Therapy, Universidade São Paulo, São Paulo, Brazil
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Neifert SN, Chapman EK, Martini ML, Shuman WH, Schupper AJ, Oermann EK, Mocco J, Macdonald RL. Aneurysmal Subarachnoid Hemorrhage: the Last Decade. Transl Stroke Res 2020; 12:428-446. [PMID: 33078345 DOI: 10.1007/s12975-020-00867-0] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) affects six to nine people per 100,000 per year, has a 35% mortality, and leaves many with lasting disabilities, often related to cognitive dysfunction. Clinical decision rules and more sensitive computed tomography (CT) have made the diagnosis of SAH easier, but physicians must maintain a high index of suspicion. The management of these patients is based on a limited number of randomized clinical trials (RCTs). Early repair of the ruptured aneurysm by endovascular coiling or neurosurgical clipping is essential, and coiling is superior to clipping in cases amenable to both treatments. Aneurysm repair prevents rebleeding, leaving the most important prognostic factors for outcome early brain injury from the hemorrhage, which is reflected in the neurologic condition of the patient, and delayed cerebral ischemia (DCI). Observational studies suggest outcomes are better when patients are managed in specialized neurologic intensive care units with inter- or multidisciplinary clinical groups. Medical management aims to minimize early brain injury, cerebral edema, hydrocephalus, increased intracranial pressure (ICP), and medical complications. Management then focuses on preventing, detecting, and treating DCI. Nimodipine is the only pharmacologic treatment that is approved for SAH in most countries, as no other intervention has demonstrated efficacy. In fact, much of SAH management is derived from studies in other patient populations. Therefore, further study of complications, including DCI and other medical complications, is needed to optimize outcomes for this fragile patient population.
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Affiliation(s)
- Sean N Neifert
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, 10029, USA
| | - Emily K Chapman
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, 10029, USA
| | - Michael L Martini
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, 10029, USA
| | - William H Shuman
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, 10029, USA
| | | | - Eric K Oermann
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, 10029, USA
| | - J Mocco
- Department of Neurosurgery, Mount Sinai Health System, New York, NY, 10029, USA
| | - R Loch Macdonald
- University Neurosciences Institutes, University of California San Francisco, Fresno Campus, Fresno, CA, 93701-2302, USA.
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Aquim EE, Bernardo WM, Buzzini RF, Azeredo NSGD, Cunha LSD, Damasceno MCP, Deucher RADO, Duarte ACM, Librelato JT, Melo-Silva CA, Nemer SN, Silva SDFD, Verona C. Brazilian Guidelines for Early Mobilization in Intensive Care Unit. Rev Bras Ter Intensiva 2020; 31:434-443. [PMID: 31967216 PMCID: PMC7008992 DOI: 10.5935/0103-507x.20190084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/17/2019] [Indexed: 12/27/2022] Open
Abstract
Immobility can cause several complications, including skeletal muscle atrophy and weakness, that influence the recovery of critically ill patients. This effect can be mitigated by early mobilization. Six key questions guided this research: Is early mobilization safe? Which patients are candidates for early mobilization? What are the contraindications? What is the appropriate dose, and how should it be defined? What results are obtained? What are the prognostic indicators for the use of early mobilization? The objective of this guideline was to produce a document that would provide evidence-based recommendations and suggestions regarding the early mobilization of critically ill adult patients, with the aim of improving understanding of the topic and making a positive impact on patient care. This guideline was based on a systematic review of articles conducted using the PICO search strategy, as recommended by the Guidelines Project of the Associação Médica Brasileira. Randomized clinical trials, prognostic cohort studies, and systematic reviews with or without meta-analysis were selected, and the evidence was classified according to the Oxford Center for Evidence-based Medicine Levels of Evidence. For all the questions addressed, enough evidence was found to support safe and well-defined early mobilization, with prognostic indicators that support and recommend the technique. Early mobilization is associated with better functional outcomes and should be performed whenever indicated. Early mobilization is safe and should be the goal of the entire multidisciplinary team.
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Affiliation(s)
| | - Wanderley Marques Bernardo
- Associação Médica Brasileira - São Paulo (SP), Brasil.,Universidade de São Paulo - São Paulo (SP), Brasil
| | | | | | | | | | | | | | | | | | | | | | - Cleber Verona
- Associação de Medicina Intensiva Brasileira - São Paulo (SP), Brasil
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Laurent H, Aubreton S, Vallat A, Pereira B, Souweine B, Constantin JM, Coudeyre E. Very early exercise tailored by decisional algorithm helps relieve discomfort in ICU patients: an open-label pilot study. Eur J Phys Rehabil Med 2020; 56:756-763. [PMID: 32667148 DOI: 10.23736/s1973-9087.20.06274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Existing algorithms do not allow for setting up finely tuned progression or intensity for exercise training in intensive care units (ICUs). AIM We aimed to assess the feasibility and tolerance of a very early exercise program tailored by using decisional algorithm that integrated both progression and intensity. DESIGN Open-label pilot study. SETTING ICU. POPULATION Thirty adults hospitalized in ICU. METHODS Once a day, patients performed manual range of motion, cycloergometry, and functional training exercises. The progression and intensity of training were standardized by using the constructed algorithm. The main outcome, discomfort on a 0-100 Visual Analog Scale, was assessed before and after each exercise session. Secondary outcomes were muscle strength, ICU length of stay and adverse events related to exercise. RESULTS Overall, 125 exercise sessions were performed. Discomfort during exercise sessions decreased significantly by the fifth session (P=0.049). Early exercise sessions were feasible and did not produce major adverse events. CONCLUSIONS We confirmed the safety and feasibility of very early exercise programs in ICUs. Early exercise tailored by using a decisional algorithm helps relieve the discomfort of ICU patients. CLINICAL REHABILITATION IMPACT In everyday practice, the use of decisional algorithms should be encouraged to initiate and standardize early exercise in ICUs.
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Affiliation(s)
- Hélène Laurent
- Unit of Human Nutrition (UNH), University of Clermont Auvergne, National Institute for Research on Agriculture (INRAE), Clermont-Ferrand, France - .,Service of Physical and Rehabilitation Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France -
| | - Sylvie Aubreton
- Service of Physical and Rehabilitation Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Aurélie Vallat
- Service of Physical and Rehabilitation Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Bruno Pereira
- Center for Clinical Research and Innovation (DRCI), Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Bertrand Souweine
- Service of Medical Resuscitation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Service of Surgical Resuscitation, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Unit of Human Nutrition (UNH), University of Clermont Auvergne, National Institute for Research on Agriculture (INRAE), Clermont-Ferrand, France.,Service of Physical and Rehabilitation Medicine, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
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21
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Wang J, Ren D, Liu Y, Wang Y, Zhang B, Xiao Q. Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis. Int J Nurs Stud 2020; 110:103708. [PMID: 32736250 DOI: 10.1016/j.ijnurstu.2020.103708] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/22/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early mobilization is considered a safe and effective therapeutic strategy for accelerating the rehabilitation of patients admitted to the intensive care unit, with a proven benefit for critically ill patients. OBJECTIVES To evaluate the effects of early mobilization on the prognosis of critically ill patients through a meta-analysis of data pooled from studies meeting the inclusion criteria. DESIGN Systematic review and meta-analysis. DATA SOURCE Electronic databases including PubMed, EMBASE, the Cochrane Library, CINAHL, ProQuest, Web of Science, ProQuest Dissertations and Theses, Chinese BioMedical Literature Service System, WANFANG database, CNKI database, and Clinical Trial Register Platform were systematically searched from inception up to December 31, 2019. REVIEW METHODS Study eligibility was independently evaluated by two researchers. The title and abstract of the studies were first screened, and full-text articles of the remaining studies were screened for verification. Methodologic quality and risk of bias of the included studies were evaluated, and data were extracted from eligible studies. The meta-analysis was conducted using Review Manager v5.3 software. Key outcomes are presented as pooled risk ratio, weighted mean difference, and the corresponding 95% confidential interval . RESULTS A total of 39 articles were included in the meta-analysis. The results showed that early mobilization improved ventilator-associated pneumonia patients' Medical Research Council score; reduced the incidence of intensive care unit-acquired weakness and intensive care unit-related complications such as ventilator-associated pneumonia, deep vein thrombosis, and pressure sores; and shortened the duration of mechanical ventilation, length of intensive care unit stay and hospital stay. However, there were no statistically significant differences in handgrip strength, delirium rate, intensive care unit mortality, hospital mortality, and physical function- and mental health-related quality of life at 2-3 months and 6 months post-hospital discharge. CONCLUSIONS Early mobilization was effective in enhancing the recovery of critically ill patients, but more large-scale, multicenter randomized controlled trials are required to further confirm these findings.
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Affiliation(s)
- Jiani Wang
- School of Nursing, Capital Medical University, Beijing 100069, China.
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, PA 15261, United States.
| | - Yue Liu
- School of Nursing, Capital Medical University, Beijing 100069, China.
| | - Yanling Wang
- School of Nursing, Capital Medical University, Beijing 100069, China.
| | - Bohan Zhang
- School of Nursing, Capital Medical University, Beijing 100069, China.
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing 100069, China.
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Effect of Early Mobilization on Respiratory and Limb Muscle Strength and Functionality of Nonintubated Patients in Critical Care: A Feasibility Trial. Crit Care Res Pract 2020. [DOI: 10.1155/2020/3526730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose. To assess the potential effectiveness or efficacy of early mobilization on respiratory and peripheral muscle strengths and functionality in nonintubated patients. Methods. For 40 nonintubated patients over 18 years of age with over 24-hour intensive care unit (ICU) stay allocated to a single intervention, an incremental mobilization protocol was initiated. Maximal inspiratory and expiratory pressures (MIP and MEP), peripheral muscle strength (handgrip strength (HGS) and Medical Research Council scale (MRC-s)), and functionality (FIM, ICF-BMS, PFIT-s, and FSS-ICU scales) were evaluated at ICU admission and discharge. Results. All outcomes were significantly improved (pre vs. post values): MIP (43.93 ± 21.95 vs. 54.12 ± 21.68 cmH2O; P<0.001), MEP (50.32 ± 28.65 vs. 60.30 ± 21.23; P=0.002), HGS (25.5 (9.58) vs. 27.5 (9.48); P=0.046), MRC-s (58.52 ± 2.84 vs. 59.47 ± 1.81; P=0.023), FIM (54.4 ± 22.79 vs. 69.48 ± 12.74), ICF-BMS (28.63 ± 16.19 vs. 14.03 ± 11.15), PFIT-s (9.55 ± 2.34 vs. 11.18 ± 1.32) (P<0.001), and FSS-ICU (28.7 ± 9.1 vs. 32.6 ± 5.0; P=0.001). The ceiling effect at admission/discharge was in MRC-s (60/82.5%), FSS-ICU (50/70%), and FIM (35/62.5%). The floor effect occurred at discharge in ICF-BMS (7.5/52.5%). Conclusions. The early mobilization protocol seemed effective at maintaining/increasing the respiratory muscle strength and functionality of nonintubated patients in critical care. Ceiling effect was high for MRC-s, FSS-ICU, and FIM scales.
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Abstract
To develop and implement a protocol to increase patient mobility in three adult ICUs using an interdisciplinary approach and existing resources.
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24
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Early Mobilization of Patients Receiving Vasoactive Drugs in Critical Care Units: A Systematic Review. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tran DH, Maheshwari P, Nagaria Z, Patel HY, Verceles AC. Ambulatory Status Is Associated With Successful Discharge Home in Survivors of Critical Illness. Respir Care 2020; 65:1168-1173. [PMID: 32234767 DOI: 10.4187/respcare.07437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Survivors of prolonged ICU admissions are bedridden and immobilized for an extended period of time. These patients often are discharged to long-term acute care hospitals (LTACHs) for continued medical care and rehabilitation. Early ambulation has been associated with improved functional outcomes and lower readmission rates in hospitalized patients. The aim of this study was to determine the association between ambulatory status and discharge disposition in survivors of prolonged ICU stays who were admitted to an LTACH. METHODS We performed a retrospective cohort study of 285 survivors of prolonged ICU stays who were admitted to a university-affiliated LTACH facility from 2010 to 2013. Outcomes of interest included comparing the relationship between ambulatory status and disposition status (ie, home vs acute rehabilitation facility, nursing home, readmission to an ICU, or death). RESULTS The mean age of our cohort was 59.0 ± 15.3 y, with 129 (45%) males, 148 (52%) African-American, 123 (43%) white, and 14 (5%) of subjects other races. Most of these subjects were transferred from a medical ICU (68%). The median ICU and LTACH lengths of stay were 25.5 (13-38.8) d and 34.0 (14-64) d, respectively. Thirty-eight (13.3%) subjects were discharged home, 25 (8.7%) to an acute rehabilitation facility, 70 (24.6%) to a nursing home, 139 (48.8%) were readmitted to an ICU, and 13 (4.6%) died. Of 285 total subjects, 74 (26%) ambulated during physical therapy, while 211 (74%) subjects never ambulated. Of those who ambulated, 24 (32.4%) went home, whereas 14 of 211 (6.6%) subjects who did not ambulate went home (P < .001). CONCLUSIONS The ability to ambulate was associated with a greater likelihood of being discharged home in survivors of prolonged ICU stays who were admitted to an LTACH. These results suggest that mobility training for survivors of prolonged ICU stays in LTACH facilities should be strongly emphasized to improve their likelihood of being discharged home.
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Affiliation(s)
- Dena H Tran
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland. .,Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland
| | - Parth Maheshwari
- Department of Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Zain Nagaria
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Harsh Y Patel
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland
| | - Avelino C Verceles
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland
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Schwab M, Brindl N, Studier-Fischer A, Tu T, Gsenger J, Pilgrim M, Friedrich M, Frey PE, Achilles C, Leuck A, Bürgel T, Feisst M, Klose C, Tenckhoff S, Dörr-Harim C, Mihaljevic AL. Postoperative complications and mobilisation following major abdominal surgery with vs. without fitness tracker-based feedback (EXPELLIARMUS): study protocol for a student-led multicentre randomised controlled trial (CHIR-Net SIGMA study group). Trials 2020; 21:293. [PMID: 32293519 PMCID: PMC7092422 DOI: 10.1186/s13063-020-4220-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 03/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Postoperative complications following major abdominal surgery are frequent despite progress in surgical technique and perioperative care. Early and enhanced postoperative mobilisation has been advocated to reduce postoperative complications, but it is still unknown whether it can independently improve outcomes after major surgery. Fitness trackers (FTs) are a promising tool to improve postoperative mobilisation, but their effect on postoperative complications and recovery has not been investigated in clinical trials. METHODS This is a multicentre randomised controlled trial with two parallel study groups evaluating the efficacy of an enhanced and early mobilisation protocol in combination with FT-based feedback in patients undergoing elective major abdominal surgery. Participants are randomly assigned (1:1) to either the experimental group, which receives daily step goals and a FT giving feedback about daily steps, or the control group, which is mobilised according to hospital standards. The control group also receives a FT, however with a blackened screen; thus no FT-based feedback is possible. Randomisation will be stratified by type of surgery (laparoscopic vs. open). The primary endpoint of the study is postoperative morbidity within 30 days measured via the Comprehensive Complication Index. Secondary endpoints include number of steps as well as a set of functional, morbidity and safety parameters. A total of 348 patients will be recruited in 15 German centres. The study will be conducted and organised by the student-led German Clinical Trial Network SIGMA. DISCUSSION Our study aims at investigating whether the implementation of a simple mobilisation protocol in combination with FT-based feedback can reduce postoperative morbidity in patients undergoing major abdominal surgery. If so, FTs would offer a cost-effective intervention to enhance postoperative mobilisation and improve patient outcomes. TRIAL REGISTRATION Deutsches Register Klinischer Studien (DRKS, German Clinical Trials Register): DRKS00016755, UTN U1111-1228-3320. Registered on 06.03.2019.
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Affiliation(s)
- Marius Schwab
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Niall Brindl
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | | | - Thomas Tu
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Julia Gsenger
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Max Pilgrim
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Mirco Friedrich
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Pia-Elena Frey
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Christina Achilles
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Alexander Leuck
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 346, 69120, Heidelberg, Germany
| | - Thore Bürgel
- Health Data Science Unit, University Hospital Heidelberg, BioQuant, Im Neuenheimer Feld 267, 69120, Heidelberg, Germany
| | - Manuel Feisst
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry and Informatics, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Solveig Tenckhoff
- CHIR-Net Coordination Centre at the Study Centre of the German Surgical Society (SDGC), University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Colette Dörr-Harim
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Pelekhaty SL, Pajoumand M, Omanwa KS, Galvagno SM, Lantry JH, Deatrick KB, Cornachione CR, Menaker J. Oxandrolone in Patients on Venovenous Extracorporeal Membrane Oxygenation: A Case Series. Nutr Clin Pract 2020; 35:514-521. [PMID: 32083363 DOI: 10.1002/ncp.10468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Venovenous extracorporeal membrane oxygenation (VV ECMO) induces a systemic inflammatory response, which may progress to persistent inflammation, immunosuppression, and catabolism syndrome (PICS). The anabolic steroid oxandrolone may improve the metabolic aberrations of PICS. We report our experience with 3 patients on VV ECMO who received oxandrolone after demonstrating refractory catabolism on serial nitrogen balance (NB) studies or persistent weakness. Patients in cases 1 and 3 were started on oxandrolone on VV ECMO days 45 and 29, respectively, for negative NB despite nutrition optimization. The case 2 patient started oxandrolone for persistent weakness 68 days after cannulation. All patients demonstrated improvements in NB results. One patient developed mild transaminitis while on oxandrolone, which did not alter his medication course and resolved after the medication was discontinued. The impact of oxandrolone on functional capacity varied between patients. Oxandrolone may be beneficial in persistently catabolic VV ECMO patients to improve NB results. In some patients, this may support functional recovery. Additional research is needed to identify optimal patients for therapy and to investigate the impact of oxandrolone in this population.
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Affiliation(s)
- Stacy L Pelekhaty
- University of Maryland Medical Center, Baltimore, Maryland, USA.,R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA
| | | | | | - Samuel M Galvagno
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.,University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - James H Lantry
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.,University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Jay Menaker
- R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA.,University of Maryland School of Medicine, Baltimore, Maryland, USA
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Chen B, You X, Lin Y, Dong D, Xie X, Zheng X, Li D, Lin W. A systematic review and meta-analysis of the effects of early mobilization therapy in patients after cardiac surgery: A protocol for systematic review. Medicine (Baltimore) 2020; 99:e18843. [PMID: 31977881 PMCID: PMC7004682 DOI: 10.1097/md.0000000000018843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prolonged hospitalization and immobility of critical care patients elevates the risk of long-term physical and cognitive impairments. However, the therapeutic effects of early mobilization have been difficult to interpret due to variations in study populations, interventions, and outcome measures. This systematic review and meta-analysis aims to assess the effects of early mobilization therapy for non-emergency cardiac surgery patients in the intensive care unit (ICU). METHODS The following databases will be used to search for relevant keywords: PubMed, Embase, CINAHL, PEDro, and the Cochrane Library from inception to September 2018 by 2 researchers independently. Randomized controlled trials (RCTs), will be included if patients are adults (≥18 years) admitted to any ICU for cardiac surgery due to cardiovascular disease and who are treated with experimental physiotherapy initiated in the ICU (pre, post, or perioperative). The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous outcomes will be presented as the weighted mean difference (WMD) or standardized mean difference (SMD) with 95% confidence interval (CI), while dichotomous data will be expressed as relative risk (RR) with 95% CI. If the included studies have existing heterogeneity (P < 0.1), a random-effects model will be used. Otherwise, we will calculate using a fixed effects model. RESULTS This review will evaluate the effects of early mobilization on length of ICU and hospital stay, physical function and adverse events in patients with cardiac surgery patients in the ICU. CONCLUSION This systematic review will comprehensively provide conclusive evidence of the therapeutic effect of early mobilization on cardiac surgery patients in the ICU.PROSPERO Research registration identifying number: CRD42019135338.
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Anekwe DE, Biswas S, Bussières A, Spahija J. Early rehabilitation reduces the likelihood of developing intensive care unit-acquired weakness: a systematic review and meta-analysis. Physiotherapy 2019; 107:1-10. [PMID: 32135387 DOI: 10.1016/j.physio.2019.12.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intensive care unit-acquired weakness (ICUAW) is associated with significant impairments in body structure and function, activity limitation, and participation restriction. The etiology and management of ICUAW remain uncertain. OBJECTIVE To estimate the extent to which early rehabilitation interventions (early mobilization [EM] and/or neuromuscular electrical stimulation [NMES]) compared to usual care reduce the incidence of ICUAW in critically ill patients. DATA SOURCES We searched MEDLINE, EMBASE, CINAHL, Cochrane Central and Physiotherapy Evidence Database databases from inception to May 1st, 2017. ELIGIBILITY CRITERIA Randomized controlled trials of EM and/or NMES interventions in critically ill adults. DATA EXTRACTION AND DATA SYNTHESIS Data on the incidence of ICUAW and secondary outcomes were extracted. Both odds and risk ratios for ICUAW were pooled using the random-effects model. RESULTS We identified 1421 reports after duplicate removal. Nine studies including 841 patients (419 intervention and 422 usual care) were included in the final analysis. The interventions involved EM in five trials, NMES in three trials, and both EM and NMES in one trial. Early rehabilitation decreased the likelihood of developing ICUAW: odds ratio of 0.63 (95% CI: 0.43 to 0.92) in the screened population, and 0.71 (95% CI: 0.53 to 0.95) in the randomized population. CONCLUSION, IMPLICATIONS OF KEY FINDINGS Early rehabilitation was associated with a decreased likelihood of developing ICUAW. Our findings support early rehabilitation in the ICU. While results were consistent in both the screened and randomized populations, the wide confidence intervals suggest that well-conducted trials are needed to validate our findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO registration ID: CRD42017065031.
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Affiliation(s)
- David E Anekwe
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Research Center, CIUSSS du Nord-de-l'Ile-de-Montréal, Sacré-Coeur Hospital, Université de Montréal, Montréal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation in Montreal, CISS du Nord-de-l'Île-de-Montréal, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Sharmistha Biswas
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation in Montreal, CISS du Nord-de-l'Île-de-Montréal, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Jadranka Spahija
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Research Center, CIUSSS du Nord-de-l'Ile-de-Montréal, Sacré-Coeur Hospital, Université de Montréal, Montréal, Quebec, Canada; Center for Interdisciplinary Research in Rehabilitation in Montreal, CISS du Nord-de-l'Île-de-Montréal, Jewish Rehabilitation Hospital, Laval, Quebec, Canada.
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LaBuzetta JN, Rosand J, Vranceanu AM. Review: Post-Intensive Care Syndrome: Unique Challenges in the Neurointensive Care Unit. Neurocrit Care 2019; 31:534-545. [PMID: 31486026 PMCID: PMC7007600 DOI: 10.1007/s12028-019-00826-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Within the last couple of decades, advances in critical care medicine have led to increased survival of critically ill patients, as well as the discovery of notable, long-term health challenges in survivors and their loved ones. The terms post-intensive care syndrome (PICS) and PICS-family (PICS-F) have been used in non-neurocritical care populations to characterize the cognitive, psychiatric, and physical sequelae associated with critical care hospitalization in survivors and their informal caregivers (e.g., family and friends who provide unpaid care). In this review, we first summarize the literature on the cognitive, psychiatric, and physical correlates of PICS and PICS-F in non-neurocritical patient populations and draw attention to their long-term negative health consequences. Next, keeping in mind the distinction between disease-related neurocognitive changes and those that are associated directly with the experience of a critical illness, we review the neuropsychological sequelae among patients with common neurocritical illnesses. We acknowledge the clinical factors contributing to the difficulty in studying PICS in the neurocritical care patient population, provide recommendations for future lines of research, and encourage collaboration among critical care physicians in all specialties to facilitate continuity of care and to help elucidate mechanism(s) of PICS and PICS-F in all critical illness survivors. Finally, we discuss the importance of early detection of PICS and PICS-F as an opportunity for multidisciplinary interventions to prevent and treat new neuropsychological deficits in the neurocritical care population.
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Affiliation(s)
- Jamie Nicole LaBuzetta
- Division of Neurocritical Care, Department of Neurosciences, University of California-San Diego, 9444 Medical Center Drive, ECOB 3-028, MC 7740, La Jolla, CA, 92037, USA.
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
| | - Ana-Maria Vranceanu
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, USA
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Higgins SD, Erdogan M, Coles SJ, Green RS. Early mobilization of trauma patients admitted to intensive care units: A systematic review and meta-analyses. Injury 2019; 50:1809-1815. [PMID: 31526602 DOI: 10.1016/j.injury.2019.09.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effect of early mobilization (EM) in trauma patients admitted to the ICU. Outcomes of interest included mortality, hospital and ICU length of stay (LOS), and duration of mechanical ventilation. METHODS We performed a systematic review of 4 electronic databases (Ovid MEDLINE, Embase, CINAHL, Cochrane Library) and the grey literature. Eligible study designs included randomized control trials, prospective cohorts, or retrospective cohorts. Studies must have compared EM to usual care (i.e., delayed or no mobilization) in trauma patients admitted to ICU. Overall, there were 2982 articles screened and 9 were included in the analysis. Two authors independently performed data extraction using a standardized form. Pertinent study design and population characteristics were recorded, as were prespecified outcome measures. Meta-analyses were performed using random effects models. Study quality was assessed using the Newcastle-Ottawa Scale. RESULTS Study cohorts ranged from 15 to 1132 patients (median 63) and varied in their inclusion criteria. Most studies utilized a progressive mobility protocol as their intervention. Mortality was reported in 5 studies, of which 3 observed a lower rate with EM; however, meta-analysis showed no difference in mortality between patients mobilized early and those receiving usual care. Eight studies reported on LOS (in-hospital and ICU); although all 8 studies found EM reduced LOS, the difference in LOS was not significant on meta-analysis. Finally, 3 studies reported on ventilator days, all of which observed a reduction in the EM group. On meta-analysis, duration of mechanical ventilation was significantly lower with EM (mean difference -1.18 days, 95% CI, -2.17 - -0.19). CONCLUSIONS Few studies have investigated the effects of EM in trauma ICU patients. The available evidence suggests that patients who receive EM require fewer days of mechanical ventilation, but have similar mortality and LOS compared to those receiving usual care.
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Affiliation(s)
- Sean D Higgins
- Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada; Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Mete Erdogan
- Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Sherry J Coles
- Faculty of Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada; Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Robert S Green
- Trauma Nova Scotia, Nova Scotia Department of Health and Wellness, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada; Departments of Emergency Medicine and Critical Care, Dalhousie University, Halifax, NS, B3H 4R2, Canada.
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Mayer KP, Hornsby AR, Soriano VO, Lin TC, Cunningham JT, Yuan H, Hauschild CE, Morris PE, Neyra JA. Safety, Feasibility, and Efficacy of Early Rehabilitation in Patients Requiring Continuous Renal Replacement: A Quality Improvement Study. Kidney Int Rep 2019; 5:39-47. [PMID: 31922059 PMCID: PMC6943757 DOI: 10.1016/j.ekir.2019.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Early rehabilitation in critically ill patients is associated with improved outcomes. Recent research demonstrates that patients requiring continuous renal replacement therapy (CRRT) can safely engage in mobility. The purpose of this study was to assess safety and feasibility of early rehabilitation with focus on mobility in patients requiring CRRT. METHODS Study design was a mixed methods analysis of a quality improvement protocol. The setting was an intensive care unit (ICU) at a tertiary medical center. Safety was prospectively recorded by incidence of major adverse events including dislodgement of CRRT catheter, accidental extubation, bleeding, and hemodynamic emergency; and minor adverse events such as transient oxygen desaturation >10% of resting. Limited efficacy testing was performed to determine if rehabilitation parameters were associated with clinical outcomes. RESULTS A total of 67 patients (54.0 ± 15.6 years old, 44% women, body mass index 29.2 ± 9.3 kg/m2) received early rehabilitation under this protocol. The median days of CRRT were 6.0 (interquartile range [IQR], 2-11) and 72% of patients were on mechanical ventilation concomitantly with CRRT at the time of rehabilitation. A total of 112 rehabilitation sessions were performed of 152 attempts (74% completion rate). No major adverse events occurred. Patients achieving higher levels of mobility were more likely to be alive at discharge (P = 0.076). CONCLUSIONS The provision of early rehabilitation in critically ill patients requiring CRRT is safe and feasible. Further, these preliminary results suggest that early rehabilitation with focus on mobility may improve patient outcomes in this susceptible population.
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Affiliation(s)
- Kirby P. Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Amanda R. Hornsby
- Inpatient Rehabilitation Department, Chandler Medical Center, University of Kentucky, Lexington, Kentucky, USA
| | - Victor Ortiz Soriano
- Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Timothy C. Lin
- Inpatient Rehabilitation Department, Chandler Medical Center, University of Kentucky, Lexington, Kentucky, USA
| | - Jennifer T. Cunningham
- Inpatient Rehabilitation Department, Chandler Medical Center, University of Kentucky, Lexington, Kentucky, USA
| | - Hanwen Yuan
- Data, Analytics, and Statistical Core (DASC), Center for Health Services Research, University of Kentucky, Lexington, Kentucky, USA
| | - Caroline E. Hauschild
- Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA
| | - Peter E. Morris
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Javier A. Neyra
- Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, Lexington, Kentucky, USA,Correspondence: Javier A. Neyra, University of Kentucky Medical Center, 800 Rose Street, MN668, Lexington, Kentucky 40536, USA.
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Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, Yu K, Chen X, Zhu L, Ma J, Qin Y. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One 2019; 14:e0223185. [PMID: 31581205 PMCID: PMC6776357 DOI: 10.1371/journal.pone.0223185] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 09/16/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Physical therapy can prevent functional impairments and improve the quality of life of patients after hospital discharge. However, the effect of early mobilization on patients with a critical illness remains unclear. This study was performed to assess the evidence available regarding the effect of early mobilization on critically ill patients in the intensive care unit (ICU). METHODS Electronic databases were searched from their inception to March 21, 2019. Randomized controlled trials (RCTs) comprising critically ill patients who received early mobilization were included. The methodological quality and risk of bias of each eligible trial were assessed using the Cochrane Collaboration tool. Data were extracted using a standard collection form each included study, and processed using the Mantel-Haenszel (M-H) or inverse-variance (I-V) test in the STATA v12.0 statistical software. RESULTS A total of 1,898 records were screened. Twenty-three RCTs comprising 2,308 critically ill patients were ultimately included. Early mobilization decreased the incidence of ICU-acquired weakness (ICU-AW) at hospital discharge (three studies, 190 patients, relative risk (RR): 0.60, 95% confidence interval (CI) [0.40, 0.90]; p = 0.013, I2 = 0.0%), increased the number of patients who were able to stand (one study, 50 patients, 90% vs. 62%, p = 0.02), increased the number of ventilator-free days (six studies, 745 patients, standardized mean difference (SMD): 0.17, 95% CI [0.02, 0.31]; p = 0.023, I2 = 35.5%) during hospitalization, increased the distance the patient was able to walk unassisted (one study, 104 patients, 33.4 (0-91.4) meters vs. 0 (0-30.4) meters, p = 0.004) at hospital discharge, and increased the discharged-to-home rate (seven studies, 793 patients, RR: 1.16, 95% CI [1.00, 1.34]; p = 0.046). The mortality (28-day, ICU and hospital) and adverse event rates were moderately increased by early mobilization, but the differences were statistically non-significant. However, due to the substantial heterogeneity among the included studies, and the low quality of the evidence, the results of this study should be interpreted with caution. Publication bias was not identified. CONCLUSIONS Early mobilization appears to decrease the incidence of ICU-AW, improve the functional capacity, and increase the number of ventilator-free days and the discharged-to-home rate for patients with a critical illness in the ICU setting.
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Affiliation(s)
- Lan Zhang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Weishu Hu
- Department of Neurology, Chongqing General Hospital, Chongqing, P.R. China
| | - Zhiyou Cai
- Department of Neurology, Chongqing General Hospital, Chongqing, P.R. China
| | - Jihong Liu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Jianmei Wu
- Department of Neurology, Chongqing General Hospital, Chongqing, P.R. China
| | - Yangmin Deng
- Department of Neurology, Chongqing General Hospital, Chongqing, P.R. China
| | - Keping Yu
- Department of Neurology, Chongqing General Hospital, Chongqing, P.R. China
| | - Xiaohua Chen
- Department of Neurology, Chongqing General Hospital, Chongqing, P.R. China
| | - Li Zhu
- Department of Neurology, Chongqing General Hospital, Chongqing, P.R. China
| | - Jingxi Ma
- Department of Neurology, Chongqing General Hospital, Chongqing, P.R. China
| | - Yan Qin
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P.R. China
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Krupp AE, Ehlenbach WJ, King B. Factors Nurses in the Intensive Care Unit Consider When Making Decisions About Patient Mobility. Am J Crit Care 2019; 28:281-289. [PMID: 31263011 DOI: 10.4037/ajcc2019624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Early mobility interventions in the intensive care unit can improve patients' outcomes, yet they are not routinely implemented in many intensive care units. In an effort to identify opportunities to implement and sustain evidence-based practice, prior work has demonstrated that understanding the decision-making process of health professionals is critical for identifying opportunities to improve program implementation. Nurses are often responsible for mobilizing patients, but how they overcome barriers and make decisions to mobilize patients in the intensive care unit is not understood. OBJECTIVE To describe processes that nurses in intensive care units use to make decisions and barriers that influence their decision-making about patient mobility. METHODS An exploratory descriptive approach using semi-structured interviews of a purposive sample of registered nurses in 2 intensive care units at 2 hospitals was used. Interviews were transcribed and analyzed by using directed content analysis to identify categories that describe nurses' decision-making about patient mobility. RESULTS Semistructured interviews were conducted with 20 nurses in a 1-on-1 setting. Four main categories that influenced nurses' decision-making about mobility were identified in the directed content analysis: purpose of mobility, gathering information, establishing and activating the plan, and barriers to progressing the plan. CONCLUSIONS Deciding to mobilize patients in the intensive care unit is a multifaceted, individualized decision made by nurses, and numerous patient-, nurse-, and unit-related factors influence that decision. Future studies that target unit culture and interprofessional perspectives are needed.
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Affiliation(s)
- Anna E. Krupp
- Anna E. Krupp is a postdoctoral fellow at the Center for Health Outcomes and Policy Research and the National Clinician Scholars Program, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. William J. Ehlenbach is an assistant professor at the University of Wisconsin-Madison School of Medicine and Public Health. Barbara King is an associate professor at the University of Wisconsin-Madison School of Nursing
| | - William J. Ehlenbach
- Anna E. Krupp is a postdoctoral fellow at the Center for Health Outcomes and Policy Research and the National Clinician Scholars Program, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. William J. Ehlenbach is an assistant professor at the University of Wisconsin-Madison School of Medicine and Public Health. Barbara King is an associate professor at the University of Wisconsin-Madison School of Nursing
| | - Barbara King
- Anna E. Krupp is a postdoctoral fellow at the Center for Health Outcomes and Policy Research and the National Clinician Scholars Program, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania. William J. Ehlenbach is an assistant professor at the University of Wisconsin-Madison School of Medicine and Public Health. Barbara King is an associate professor at the University of Wisconsin-Madison School of Nursing
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[PROtocol-based MObilizaTION on intensive care units : Design of a cluster randomized pilot study]. Med Klin Intensivmed Notfmed 2019; 113:581-592. [PMID: 29026932 DOI: 10.1007/s00063-017-0358-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Despite convincing evidence for early mobilization of patients on intensive care units (ICU), implementation in practice is limited. Protocols for early mobilization, including in- and exclusion criteria, assessments, safety criteria, and step schemes may increase the rate of implementation and mobilization. HYPOTHESIS Patients (population) on ICUs with a protocol for early mobilization (intervention), compared to patients on ICUs without protocol (control), will be more frequently mobilized (outcome). METHODS A multicenter, stepped-wedge, cluster-randomized pilot study is presented. Five ICUs will receive an adapted, interprofessional protocol for early mobilization in randomized order. Before and after implementation, mobilization of ICU patients will be evaluated by randomized monthly one-day point prevalence surveys. Primary outcome is the percentage of patients mobilized out of bed, operationalized as a score of ≥3 on the ICU Mobility Scale. Secondary outcome parameters will be presence and/or length of mechanical ventilation, delirium, stay on ICU and in hospital, barriers to early mobilization, adverse events, and process parameters as identified barriers, used strategies, and adaptions to local conditions. EXPECTED RESULTS Exploratory evaluation of study feasibility and estimation of effect sizes as the basis for a future explanatory study.
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Lin F, Phelan S, Chaboyer W, Mitchell M. Early mobilisation of ventilated patients in the intensive care unit: A survey of critical care clinicians in an Australian tertiary hospital. Aust Crit Care 2019; 33:130-136. [PMID: 30935789 DOI: 10.1016/j.aucc.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Mobilising mechanically ventilated patients is safe and beneficial and improves outcomes. However, early mobilisation is not widely practiced and barriers to its implementation still exist. OBJECTIVE The objective of this study was to assess clinician perceptions, knowledge, attitudes, and behaviours towards mobilising critically ill ventilated patients in the intensive care unit, as well as perceived barriers and facilitators towards mobilisation. METHODS A prospective questionnaire based on three existing questionnaires was administered to nurses, physicians, and physiotherapists from a single mixed medical/surgical intensive care unit in an Australian tertiary hospital. The 32-item questionnaire focused on knowledge, attitudes, behaviour, and perceived facilitators and barriers. Various response options were used, and data were analysed using descriptive statistics. RESULTS The overall response rate was 56.6% (82 of 145). Overall, clinicians' knowledge score was 4.1 (standard deviation = 1.4) out of a possible score of 6. Early mobilisation was not perceived as a top priority by 40.2% of participants. One important facilitator was that majority of the participants perceived early mobilisation was important. The most common perceived barriers to early mobilisation were medical instability, delirium, sedation, and limited staffing. Clinicians' opinions varied on the timing and appropriateness for instituting early mobilisation. CONCLUSIONS Clinicians had various levels of knowledge on early mobilisation as a therapy for critically ill patients. Most clinicians believed that early mobility was important and were willing to reduce sedation; however, several key barriers were identified which need to be addressed by using targeted interventions. This will reduce or close the gap between knowledge and practice.
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Affiliation(s)
- Frances Lin
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia.
| | - Sonja Phelan
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Australia; Princess Alexandra Hospital, Australia
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Qutub HO, Matani AS, Farooqi FA. Survey of Respiratory Care Professionals' Knowledge in Early Mobilization: A Pilot Study. J Epidemiol Glob Health 2019; 8:208-212. [PMID: 30864765 PMCID: PMC7377566 DOI: 10.2991/j.jegh.2018.06.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/15/2018] [Indexed: 11/11/2022] Open
Abstract
Early mobilization (EM) is practiced for intensive care unit (ICU) patients in many hospitals in the Eastern Province in Saudi Arabia. Respiratory care professionals’ knowledge about using EM was, therefore, surveyed and investigated to improve and update its practice and ultimately to develop related regulations and policies. A survey including 156 respiratory care professionals was conducted using a validated questionnaire. The focus was on collecting information on participants’ relevant backgrounds and on proper use of EM. Knowledge and proper use of EM were calculated in relation to participants’ demographic and professional characteristics. The statistical analysis using analysis of variance and Student t-test showed that factors that affected knowledge of EM were the respiratory care professional’s age, gender, nationality, and years of experience in intensive care medicine. How many patients these professionals treated using EM also significantly correlated with their knowledge of EM. The survey showed the extent of respiratory care professionals’ knowledge about the proper use of EM. More importantly, the survey also identified important shortfalls in practice of some experienced medical practitioners.
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Affiliation(s)
- Hatem Othman Qutub
- Department of Internal Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Abdelaziz Smiah Matani
- Department of Biomedical Engineering, College of Engineering, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faraz Ahmed Farooqi
- Academic Affairs, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Chiarici A, Andrenelli E, Serpilli O, Andreolini M, Tedesco S, Pomponio G, Gallo MM, Martini C, Papa R, Coccia M, Ceravolo MG. An Early Tailored Approach Is the Key to Effective Rehabilitation in the Intensive Care Unit. Arch Phys Med Rehabil 2019; 100:1506-1514. [PMID: 30796918 DOI: 10.1016/j.apmr.2019.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/04/2019] [Accepted: 01/19/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate the effectiveness, feasibility, and safety of an evidence-based rehabilitation care pathway in the intensive care unit (ICU) in different patient populations. DESIGN Observational prospective cohort study, with retrospective controls. SETTING ICUs of a university hospital. PARTICIPANTS Patients admitted between April 1, 2015, and June 30, 2015, were compared to a retrospective cohort admitted to the same ICUs during the same 3-month period in 2014. The number of patients studied (N=285) included 152 in the prospective group and 133 in the retrospective group. INTERVENTIONS The prospective cohort benefited of a rehabilitation care pathway based on (1) interdisciplinary teamwork; (2) early customized and goal-oriented rehabilitation; (3) daily functional monitoring and treatment revision; (4) agreed discharge policy; and (5) continuity of care. The retrospective cohort underwent usual care. MAIN OUTCOME MEASURES Included the following: (1) proportions of patients undergoing rehabilitation team evaluation; (2) latency between patient admission to ICUs and rehabilitation team assessment; (3) proportions of patients undergoing rehabilitation treatment during ICU stay; (4) latency between the patient admission to ICUs and rehabilitation start; (5) ICU stay and total acute hospital stay; and (5) proportion of ventilator-free days out of ICU stay. RESULTS The novel rehabilitation care pathway led to (1) an increased proportion of patients receiving rehabilitative assessment (P<.0001); (2) a decreased latency from ICU admission to both rehabilitation team assessment and rehabilitation start (P<.0001); (3) an increased proportion of patients undergoing rehabilitation (P<.0001); (4) a shorter length of stay in ICUs (P<.0001) and in hospital (P=.047); and (5) a shorter mechanical ventilation duration (P<.02). A direct relationship between rehabilitation start latency and ICU length of stay was observed. CONCLUSIONS An early, interdisciplinary team approach, providing a customized dynamic planning of physiotherapy programs, increases ventilator-free time and reduces total hospital stay, especially in patients admitted to the ICU after general surgery. This rehabilitation care pathway can be generalized to different geopolitical scenarios, being feasible, safe and cost effective.
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Affiliation(s)
- Alice Chiarici
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy.
| | - Oletta Serpilli
- Neurorehabilitation Clinic, United Hospitals of Ancona, Ancona, Italy
| | - Matteo Andreolini
- Neurorehabilitation Clinic, United Hospitals of Ancona, Ancona, Italy
| | - Silvia Tedesco
- Department of Clinical and Molecular Science, Internal Medicine, Marche Polytechnic University, Ancona, Italy
| | - Giovanni Pomponio
- Department of Clinical and Molecular Science, Internal Medicine, Marche Polytechnic University, Ancona, Italy
| | - Maria Mattea Gallo
- Clinical Management Directorate, United Hospitals of Ancona, Ancona, Italy
| | - Claudio Martini
- Clinical Management Directorate, United Hospitals of Ancona, Ancona, Italy
| | - Roberto Papa
- Clinical Management Directorate, United Hospitals of Ancona, Ancona, Italy
| | - Michela Coccia
- Neurorehabilitation Clinic, United Hospitals of Ancona, Ancona, Italy
| | - Maria Gabriella Ceravolo
- Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy
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Clarissa C, Salisbury L, Rodgers S, Kean S. Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities. J Intensive Care 2019; 7:3. [PMID: 30680218 PMCID: PMC6337811 DOI: 10.1186/s40560-018-0355-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/11/2018] [Indexed: 12/18/2022] Open
Abstract
Background Mechanically ventilated patients often develop muscle weakness post-intensive care admission. Current evidence suggests that early mobilisation of these patients can be an effective intervention in improving their outcomes. However, what constitutes early mobilisation in mechanically ventilated patients (EM-MV) remains unclear. We aimed to systematically explore the definitions and activity types of EM-MV in the literature. Methods Whittemore and Knafl’s framework guided this review. CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, and Cochrane Library were searched to capture studies from 2000 to 2018, combined with hand search of grey literature and reference lists of included studies. The Critical Appraisal Skills Programme tools were used to assess the methodological quality of included studies. Data extraction and quality assessment of studies were performed independently by each reviewer before coming together in sub-groups for discussion and agreement. An inductive and data-driven thematic analysis was undertaken on verbatim extracts of EM-MV definitions and activities in included studies. Results Seventy-six studies were included from which four major themes were inferred: (1) non-standardised definition, (2) contextual factors, (3) negotiated process and (4) collaboration between patients and staff. The first theme indicates that EM-MV is either not fully defined in studies or when a definition is provided this is not standardised across studies. The remaining themes reflect the diversity of EM-MV activities which depends on patients’ characteristics and ICU settings; the negotiated decision-making process between patients and staff; and their interdependent relationship during the implementation. Conclusions This review highlights the absence of an agreed definition and on what constitutes early mobilisation in mechanically ventilated patients. To advance research and practice an agreed and shared definition is a pre-requisite.
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Affiliation(s)
- Catherine Clarissa
- 1Department of Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Lisa Salisbury
- 2Division of Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography, Queen Margaret University, Queen Margaret University Drive, Musselburgh, EH21 6UU UK
| | - Sheila Rodgers
- 1Department of Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Susanne Kean
- 1Department of Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
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Huang D, Slocum C, Silver JK, Morgan JW, Goldstein R, Zafonte R, Schneider JC. Functional status predicts acute care readmission in the traumatic spinal cord injury population. J Spinal Cord Med 2019; 42:20-31. [PMID: 29596035 PMCID: PMC6340280 DOI: 10.1080/10790268.2018.1453436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
CONTEXT/OBJECTIVE Acute care readmission has been identified as an important marker of healthcare quality. Most previous models assessing risk prediction of readmission incorporate variables for medical comorbidity. We hypothesized that functional status is a more robust predictor of readmission in the spinal cord injury population than medical comorbidities. DESIGN Retrospective cross-sectional analysis. SETTING Inpatient rehabilitation facilities, Uniform Data System for Medical Rehabilitation data from 2002 to 2012. PARTICIPANTS traumatic spinal cord injury patients. OUTCOME MEASURES A logistic regression model for predicting acute care readmission based on demographic variables and functional status (Functional Model) was compared with models incorporating demographics, functional status, and medical comorbidities (Functional-Plus) or models including demographics and medical comorbidities (Demographic-Comorbidity). The primary outcomes were 3- and 30-day readmission, and the primary measure of model performance was the c-statistic. RESULTS There were a total of 68,395 patients with 1,469 (2.15%) readmitted at 3 days and 7,081 (10.35%) readmitted at 30 days. The c-statistics for the Functional Model were 0.703 and 0.654 for 3 and 30 days. The Functional Model outperformed Demographic-Comorbidity models at 3 days (c-statistic difference: 0.066-0.096) and outperformed two of the three Demographic-Comorbidity models at 30 days (c-statistic difference: 0.029-0.056). The Functional-Plus models exhibited negligible improvements (0.002-0.010) in model performance compared to the Functional models. CONCLUSION Readmissions are used as a marker of hospital performance. Function-based readmission models in the spinal cord injury population outperform models incorporating medical comorbidities. Readmission risk models for this population would benefit from the inclusion of functional status.
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Affiliation(s)
- Donna Huang
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA,Correspondence to: Donna Huang, MD, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, 300 First Ave, Charlestown, MA02129, USA; Ph: 404-667-1138.
| | - Chloe Slocum
- Commonwealth Fund Mongan Fellow, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Massachusetts, USA
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - James W. Morgan
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
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Zhu YP, Xia LX, Li GH. Management of early mobilization in intensive care units: a multicenter cross-sectional study. FRONTIERS OF NURSING 2018. [DOI: 10.1515/fon-2018-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective
The aim of this study was to assess the management of early mobilization (EM) in Chinese intensive care units (ICUs).
Methods
This survey used a cross-sectional, observational design. A total of 65 tertiary and secondary hospitals were enrolled by convenience sampling and investigated using self-designed questionnaires.
Results
We identified 69 ICUs in Jiangsu, China (response rate: 94.2%). 74.2% (1,004/1,353) of the nurses and nursing managers from 65 ICUs reported mobility practice. For the mobility level, 98.1% (1,327) reported use of in-bed exercise, 5.7% (77) sitting on a side of bed, 21.7% (294) transfer to chair, and 2.4% (33) walking. The most frequently reported barriers to early mobility were unplanned extubation, nursing resource, and absence of physical therapist. Nurses’ educational backgrounds, nursing experience, the lack of nursing resources, absence of physician, and the weakness of patient were the factors that influenced ICU early rehabilitation (P<0.01).
Conclusions
Although implementation rates for EM in critically ill patients are high, the activity level is generally poor in most of the involved ICUs.
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Affiliation(s)
- Yan-Ping Zhu
- Intensive Care Units, Zhongda Hospital , Southeast University , Nanjing , Jiangsu 210009 , China
| | - Li-Xia Xia
- Department of Nursing , Jiangsu Provincial Hospital , Nanjing , Jiangsu 210009 , China
| | - Guo-Hong Li
- Department of Nursing , Zhongda Hospital , Southeast University , Nanjing , Jiangsu 210009 , China
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Fontela PC, Forgiarini LA, Friedman G. Clinical attitudes and perceived barriers to early mobilization of critically ill patients in adult intensive care units. Rev Bras Ter Intensiva 2018; 30:187-194. [PMID: 29995084 PMCID: PMC6031424 DOI: 10.5935/0103-507x.20180037] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 02/21/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To investigate the knowledge of multi-professional staff members about the early mobilization of critically ill adult patients and identify attitudes and perceived barriers to its application. METHODS A cross-sectional study was conducted during the second semester of 2016 with physicians, nursing professionals and physical therapists from six intensive care units at two teaching hospitals. Questions were answered on a 5-point Likert scale and analyzed as proportions of professionals who agreed or disagreed with statements. The chi-square and Fisher's exact tests were used to investigate differences in the responses according to educational/training level, previous experience with early mobilization and years of experience in intensive care units. RESULTS The questionnaire was answered by 98 out of 514 professionals (response rate: 19%). The acknowledged benefits of early mobilization were maintenance of muscle strength (53%) and shortened length of mechanical ventilation (83%). Favorable attitudes toward early mobilization included recognition that its benefits for patients under mechanical ventilation exceed the risks for both patients and staff, that early mobilization should be routinely performed via nursing and physical therapy protocols, and readiness to change the parameters of mechanical ventilation and reduce sedation to facilitate the early mobilization of patients. The main barriers mentioned were the unavailability of professionals and time to mobilize patients, excessive sedation, delirium, risk of musculoskeletal self-injury and excessive stress at work. CONCLUSION The participants were aware of the benefits of early mobilization and manifested attitudes favorable to its application. However, the actual performance of early mobilization was perceived as a challenge, mainly due to the lack of professionals and time, excessive sedation, delirium, risk of musculoskeletal self-injury and excessive stress at work.
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Affiliation(s)
- Paula Caitano Fontela
- Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Luiz Alberto Forgiarini
- Programa de Pós-Graduação em Biociências e Reabilitação e Reabilitação e Inclusão, Centro Universitário Metodista IPA - Porto Alegre (RS), Brasil
| | - Gilberto Friedman
- Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil
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Chohan S, Ash S, Senior L. A team approach to the introduction of safe early mobilisation in an adult critical care unit. BMJ Open Qual 2018; 7:e000339. [PMID: 30515467 PMCID: PMC6231105 DOI: 10.1136/bmjoq-2018-000339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/13/2018] [Accepted: 10/02/2018] [Indexed: 12/23/2022] Open
Abstract
Delirium and intensive care unit acquired weakness are common in patients requiring critical care and associated with higher mortality and poor long-term outcomes. Early mobilisation has been shown to reduce the duration of both conditions and is recommended as part of a strategy of rehabilitation of critically ill patients starting during their stay in intensive care. Our aim was to achieve 95% reliability with a standardised mobilisation process. Multidisciplinary involvement through the use of regular focus groups lead to the development of a standardised process of sitting a ventilated or non-ventilated patient at the side of the bed for a set period of time, which was called the daily dangle. Team learning from Plan, Do, Study, Act (PDSA)cycles, as well as feedback from both staff and patients, allowed us to develop the process and achieve a median 87% reliability. Delirium rates fell from 54.1% to 28.8%. There was no change in average length of stay, and no adverse events. Ownership by the staff, development of the process by staff, iterative testing and learning, and designs for reliability were the factors behind the successful adoption of a new and challenging process. Particular changes which drove reliability were standardisation of the criteria for a dangle, standardisation of the dangle itself and a reminder included on the daily goals checklist.
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Affiliation(s)
- Sanjiv Chohan
- Department of Intensive Care, Monklands Hospital, Airdrie, North Lanarkshire, UK
| | - Sara Ash
- Department of Intensive Care, Monklands Hospital, Airdrie, North Lanarkshire, UK
| | - Lorraine Senior
- Department of Intensive Care, Monklands Hospital, Airdrie, North Lanarkshire, UK
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Fontela PC, Lisboa TC, Forgiarini-Júnior LA, Friedman G. Early mobilization practices of mechanically ventilated patients: a 1-day point-prevalence study in southern Brazil. Clinics (Sao Paulo) 2018; 73:e241. [PMID: 30379221 PMCID: PMC6201137 DOI: 10.6061/clinics/2018/e241] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/05/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To assess early mobilization practices of mechanically ventilated patients in southern Brazilian intensive care units (ICUs) and to identify barriers associated with early mobilization and possible complications. METHODS A prospective, observational, multicenter, 1-day point-prevalence study was conducted across 11 ICUs and included all mechanically ventilated adult patients. Hospital and ICU characteristics and patients' demographic data, the highest level of mobilization achieved in the 24 hours prior to the survey and related barriers, and complications that occurred during mobilization were collected in the hospital and the ICU. RESULTS A total of 140 patients were included with a mean age of 57±17 years. The median and interquartile range was 7 (3-17) days for the length of ICU stay to the day of the survey and 7 (3-16) days for the duration of mechanical ventilation (MV). The 8-level mobilization scale was classified into two categories: 126 patients (90%) remained in bed (level 1-3) and 14 (10%) were mobilized out of bed (level 4-8). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 2%, 23%, and 50% were mobilized out of bed, respectively (p<0.001 for differences among the three groups). Weakness (20%), cardiovascular instability (19%), and sedation (18%) were the most commonly observed barriers to achieving a higher level of mobilization. No complications were reported. CONCLUSIONS In southern Brazilian ICUs, the prevalence of patient mobilization was low, with only 10% of all mechanically ventilated patients and only 2% of patients with an endotracheal tube mobilized out of bed as part of routine care.
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Affiliation(s)
- Paula Caitano Fontela
- Programa de Pos-Graduacao em Ciencias Pneumologicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
| | - Thiago Costa Lisboa
- Programa de Pos-Graduacao em Ciencias Pneumologicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
- Serviço de Medicina Intensiva, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, BR
- Rede Institucional de Pesquisa e Inovacao em Medicina Intensiva, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS, BR
| | - Luiz Alberto Forgiarini-Júnior
- Programa de Pos-Graduacao em Biociencias e Reabilitacao e Reabilitacao e Inclusao, Centro Universitario Metodista – IPA, Porto Alegre, RS, BR
| | - Gilberto Friedman
- Programa de Pos-Graduacao em Ciencias Pneumologicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, BR
- Serviço de Medicina Intensiva, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, BR
- *Corresponding author: E-mail:
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Dos Santos FV, Cipriano G, Vieira L, Güntzel Chiappa AM, Cipriano GBF, Vieira P, Zago JG, Castilhos M, da Silva ML, Chiappa GR. Neuromuscular electrical stimulation combined with exercise decreases duration of mechanical ventilation in ICU patients: A randomized controlled trial. Physiother Theory Pract 2018; 36:580-588. [PMID: 30321084 DOI: 10.1080/09593985.2018.1490363] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Early mobilization can be employed to minimize the duration of intensive care. However, a protocol combining neuromuscular electrical stimulation (NMES) with early mobilization has not yet been tested in ICU patients. Our aim was to assess the efficacy of NMES, exercise (EX), and combined therapy (NMES + EX) on duration of mechanical ventilation (MV) in critically ill patients. METHODS The participants in this randomized double-blind trial were prospectively recruited within 24 hours following admission to the intensive care unit of a tertiary hospital. Eligible patients had 18 years of age or older; MV for less than 72 hours; and no known neuromuscular disease. Computer-generated permuted block randomization was used to assign patients to NMES, EX, NMES + EX, or standard care (control group). The main endpoint was duration of MV. Clinical characteristics were also evaluated and intention to treat analysis was employed. RESULTS One hundred forty-four patients were assessed for eligibility to participate in the trial, 51 of whom were enrolled and randomly allocated into four groups: 11 patients in the NMES group, 13 in the EX group, 12 in the NMES + EX group, and 15 in the control group (CG). Duration of MV (days) was significantly shorter in the combined therapy (5.7 ± 1.1) and NMEN (9.0 ± 7.0) groups in comparison to CG (14.8 ± 5.4). CONCLUSIONS NMES + EX consisting of NMES and active EXs was well tolerated and resulted in shorter duration of MV in comparison to standard care or isolated therapy (NMES or EX alone).
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Affiliation(s)
- Francisco Valdez Dos Santos
- Physical Therapy Department, University of Brasilia , Brasilia, Brazil.,Cancer Institute of São Paulo, São Paulo , Brazil
| | - Gerson Cipriano
- Physical Therapy Department, University of Brasilia , Brasilia, Brazil
| | - Luciana Vieira
- Physical Therapy Department, University of Brasilia , Brasilia, Brazil.,Clinical Research Center, Hospital de Base do Distrito Federal , Brasilia, Brazil
| | | | | | - Paulo Vieira
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Julio G Zago
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Gaspar R Chiappa
- Physical Therapy Department, University of Brasilia , Brasilia, Brazil.,Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Centro Universitário do Planalto Central Professor Apparecido dos Santos , Brasilia, Brazil
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Jovanović G, Jakovljević DK, Lukić-Šarkanović M. Enhanced Recovery in Surgical Intensive Care: A Review. Front Med (Lausanne) 2018; 5:256. [PMID: 30338259 PMCID: PMC6180254 DOI: 10.3389/fmed.2018.00256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/23/2018] [Indexed: 12/30/2022] Open
Abstract
Patients are admitted to the surgical intensive care (SICU) unit after emergency and elective surgery. After elective surgery, for further support, or to manage coexisting comorbidities. The implementation of the ERAS (Enhanced recovery after surgery) protocols in surgery should decrease the need for ICU beds, but there will always be unpredicted complications after surgery. These will require individual management. What we can do for our surgical patients in ICU to further enhance their recovery? To promote early enhanced recovery in surgical intensive care—SICU, three areas need to be addressed, sedation, analgesia, and delirium. Tools for measurement and protocols for management in these three areas should be developed to ensure best practice in each SICU. The fourth important area is Nutrition. Preoperative screening and post-operative measurement of the state of nutrition also need to be developed in the SICU. The fifth important area is early mobilization. ERAS protocols encourage early mobilization of the critically ill patients, even if on mechanical ventilation. Early mobilization is possible and should be implemented by special multidisciplinary ICU team. All team members must be familiar with protocols to be able to implement them in their field of expertise. Personal and professional attitudes are critical for implementation. In the core of all our efforts should be the patient and his well-being.
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Affiliation(s)
- Gordana Jovanović
- University of Novi Sad, Faculty of Medicine, Department of Anesthesia and Perioperative Medicine, Novi Sad, Serbia.,Clinic for Anesthesia and Intensive Care Therapy, Clinical Center of Vojvodina, Novi Sad, Serbia.,University of Novi Sad, Faculty of Medicine, Department of Physiology and Sports Medicine, Novi Sad, Serbia
| | - Dea Karaba Jakovljević
- University of Novi Sad, Faculty of Medicine, Department of Physiology and Sports Medicine, Novi Sad, Serbia
| | - Mirka Lukić-Šarkanović
- Clinic for Anesthesia and Intensive Care Therapy, Clinical Center of Vojvodina, Novi Sad, Serbia
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Felten-Barentsz KM, van Oorsouw R, Haans AJC, Staal JB, van der Hoeven JG, Nijhuis-van der Sanden MGW. Patient views regarding the impact of hydrotherapy on critically ill ventilated patients: A qualitative exploration study. J Crit Care 2018; 48:321-327. [PMID: 30286401 DOI: 10.1016/j.jcrc.2018.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intensive Care Unit Acquired Weakness can be mitigated by early activity and progressive mobilization. Hydrotherapy enables patients to work on their recovery in a very early stage. This may lead to higher levels of self-efficacy, subsequently higher activity-rates and faster functional recovery. Hydrotherapy might positively affect the regaining of control, hope and trust. Our aim is to explore patient perspective regarding the impact of hydrotherapy on critically ill ventilated patients. METHODS This qualitative exploration study adopted an interpretative phenomenological approach using in-depth, face to face, semi-structured interviews. Questions covered: pre-admission physical activity, perception of hydrotherapy, affection to water, positive and negative experiences and feelings towards the recovery process. Interviews were analyzed using thematic analysis. RESULTS Twelve patients were enrolled, of which eight could be interviewed. After analyzing, five main themes were found: experiencing consequences of critical illness, feeling safe in the water, being able to move, positive experiences relating to hydrotherapy and experiencing a turning point. CONCLUSIONS Hydrotherapy seemed to help patients regain control and belief in their recovery. Patients experienced exercising in water as a turning point in their recovery process. This study encourages to continue providing hydrotherapy to critically ill ventilated patients and may stimulate future research.
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Affiliation(s)
| | - Roel van Oorsouw
- Radboud university medical center, Central Department of Physical Therapy, Nijmegen, the Netherlands.
| | - Antonius J C Haans
- Radboud university medical center, Department of intensive care, Nijmegen, the Netherlands.
| | - J Bart Staal
- Radboud university medical center, Research Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands; HAN University of Applied Sciences, Research group Musculoskeletal Rehabilitation, Nijmegen, the Netherlands.
| | | | - Maria G W Nijhuis-van der Sanden
- Radboud university medical center, Department of Rehabilitation, Nijmegen, the Netherlands; Radboud university medical center, Research Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands.
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Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. Rehabilitation and early mobilization in the critical patient: systematic review. J Phys Ther Sci 2018; 30:1193-1201. [PMID: 30214124 PMCID: PMC6127491 DOI: 10.1589/jpts.30.1193] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/29/2018] [Indexed: 12/23/2022] Open
Abstract
[Purpose] To review the literature that examines rehabilitation and early mobilization
and that involves different practices (effects of interventions) for the critically ill
patient. [Materials and Methods] A PRISMA-Systematic review has been conducted based on
different data sources: Biblioteca Virtual en Salud, CINHAL, Pubmed, Scopus, and Web of
Science were used to identify randomized controlled trials, crossover trials, and
case-control studies. [Results] Eleven studies were included. Early rehabilitation had no
significant effect on the length of stay and number of cases of Intensive Care Unit
Acquired Weaknesses. However, early rehabilitation had a significant effect on the
functional status, muscle strength, mechanical ventilation duration, walking ability at
discharge, and health quality of life. [Conclusion] Rehabilitation and early mobilization
are associated with an increased probability of walking more distance at discharge. Early
rehabilitation is associated with an increase in functional capacity and muscle strength,
an improvement in walking distance and better perception of the health-related quality of
life. Cycloergometer and electrical stimulation can be used to maintain muscle strength.
Further research is needed to establish stronger evidences.
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Affiliation(s)
- Patricia Arias-Fernández
- Health Sciences School, Department of Nursing and Physiotherapy, Intensive Care Unit, University Hospital of León, Spain
| | | | - Juan Gómez-Salgado
- Nursing School, University of Huelva: 21071 Huelva, Spain.,University Espiritu Santo, Ecuador
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Affiliation(s)
- Won Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Krupp A, Steege L, King B. A systematic review evaluating the role of nurses and processes for delivering early mobility interventions in the intensive care unit. Intensive Crit Care Nurs 2018; 47:30-38. [PMID: 29681432 DOI: 10.1016/j.iccn.2018.04.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To investigate processes for delivering early mobility interventions in adult intensive care unit patients used in research and quality improvement studies and the role of nurses in early mobility interventions. METHODS A systematic review was conducted. Electronic databases PubMED, CINAHL, PEDro, and Cochrane were searched for studies published from 2000 to June 2017 that implemented an early mobility intervention in adult intensive care units. Included studies involved progression to ambulation as a component of the intervention, included the role of the nurse in preparing for or delivering the intervention, and reported at least one patient or organisational outcome measure. The System Engineering Initiative for Patient Safety (SEIPS) model, a framework for understanding structure, processes, and healthcare outcomes, was used to evaluate studies. RESULTS 25 studies were included in the final review. Studies consisted of randomised control trials, prospective, retrospective, or mixed designs. A range of processes to support the delivery of early mobility were found. These processes include forming interdisciplinary teams, increasing mobility staff, mobility protocols, interdisciplinary education, champions, communication, and feedback. CONCLUSION Variation exists in the process of delivering early mobility in the intensive care unit. In particular, further rigorous studies are needed to better understand the role of nurses in implementing early mobility to maintain a patient's functional status.
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Affiliation(s)
- Anna Krupp
- University of Wisconsin-Madison, School of Nursing, Madison, WI, United States.
| | - Linsey Steege
- University of Wisconsin-Madison, School of Nursing, Madison, WI, United States
| | - Barbara King
- University of Wisconsin-Madison, School of Nursing, Madison, WI, United States
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