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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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Gojda J, Waldauf P, Hrušková N, Blahutová B, Krajčová A, Urban T, Tůma P, Řasová K, Duška F. Lactate production without hypoxia in skeletal muscle during electrical cycling: Crossover study of femoral venous-arterial differences in healthy volunteers. PLoS One 2019; 14:e0200228. [PMID: 30822305 PMCID: PMC6396965 DOI: 10.1371/journal.pone.0200228] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/11/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Aim of the study was to compare metabolic response of leg skeletal muscle during functional electrical stimulation-driven unloaded cycling (FES) to that seen during volitional supine cycling. METHODS Fourteen healthy volunteers were exposed in random order to supine cycling, either volitional (10-25-50 W, 10 min) or FES assisted (unloaded, 10 min) in a crossover design. Whole body and leg muscle metabolism were assessed by indirect calorimetry with concomitant repeated measurements of femoral venous-arterial differences of blood gases, glucose, lactate and amino acids. RESULTS Unloaded FES cycling, but not volitional exercise, led to a significant increase in across-leg lactate production (from -1.1±2.1 to 5.5±7.4 mmol/min, p<0.001) and mild elevation of arterial lactate (from 1.8±0.7 to 2.5±0.8 mM). This occurred without widening of across-leg veno-arterial (VA) O2 and CO2 gaps. Femoral SvO2 difference was directly proportional to VA difference of lactate (R2 = 0.60, p = 0.002). Across-leg glucose uptake did not change with either type of exercise. Systemic oxygen consumption increased with FES cycling to similarly to 25W volitional exercise (138±29% resp. 124±23% of baseline). There was a net uptake of branched-chain amino acids and net release of Alanine from skeletal muscle, which were unaltered by either type of exercise. CONCLUSIONS Unloaded FES cycling, but not volitional exercise causes significant lactate production without hypoxia in skeletal muscle. This phenomenon can be significant in vulnerable patients' groups.
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Affiliation(s)
- Jan Gojda
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
- 2 Department of Internal Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
- * E-mail:
| | - Petr Waldauf
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Natália Hrušková
- Department of Rehabilitation, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Barbora Blahutová
- Department of Rehabilitation, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Adéla Krajčová
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
- 2 Department of Internal Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomáš Urban
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Tůma
- Department of Hygiene, The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Kamila Řasová
- Department of Rehabilitation, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - František Duška
- Department of Anaesthesia and Intensive Care Medicine, Kralovske Vinohrady University Hospital and The Third Faculty of Medicine, Charles University, Prague, Czech Republic
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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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Factors Influencing Weaning Older Adults From Mechanical Ventilation: An Integrative Review. Crit Care Nurs Q 2017; 40:165-177. [PMID: 28240700 DOI: 10.1097/cnq.0000000000000154] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aim was to describe the influences that affect weaning from mechanical ventilation among older adults in the intensive care unit (ICU). Adults older than 65 years comprised only 14.5% of the US population in 2014; however, they accounted up to 45% of all ICU admissions. As this population grows, the number of ICU admissions is expected to increase. One of the most common procedures for hospitalized adults 75 years and older is mechanical ventilation. An integrative review methodology was applied to analyze and synthesize primary research reports. A search for the articles was performed using the PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases; using the keywords and Boolean operators "older adults," "weaning," "mechanical ventilation," and intensive care unit. Although physiologic changes that occur with aging place older adults at higher risk for respiratory complications and mortality, there are many factors, other than chronological age, that can determine a patient's ability to be successfully weaned from mechanical ventilation. Of the 6 studies reviewed, all identified various predictors of weaning outcome, which included maximal inspiratory pressure, rapid shallow breathing index, fluid balance, comorbidity burden, severity of illness, emphysematous changes, and low serum albumin. Age, in and of itself, is not a predictor of weaning from mechanical ventilation. More studies are needed to describe the influences affecting weaning older adults from mechanical ventilation.
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Moreno-Chaparro J, Cubillos-Mesa C, Duarte-Torres SC. Terapia ocupacional en unidad de cuidados intensivos. REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n2.59342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introducción. Desde su inicio, la terapia ocupacional ha actuado en ambientes intrahospitalarios. En la actualidad, una de las metas para la consolidación de campos de conocimiento, atención y prospectiva es profundizar en la intervención que realiza el respectivo profesional en la unidad de cuidados intensivos (UCI).Objetivo. Mostrar la evidencia científica de la intervención de terapia ocupacional en una UCI de adulto a través de una revisión bibliográfica entre el 2010 y 2015, durante la cual se analizaron las categorías de evaluación, modalidades de intervención y resultados.Materiales y métodos. Estudio de carácter investigativo mixto, el cual busca especificar las fuentes teóricas y prácticas que relacionan los términos de la investigación. Además, se realizó un proceso de análisis selectivo a partir de los intereses y la significancia.Resultados. La terapia ocupacional hace una caracterización de las actividades basándose en la movilización, cambios posicionales, actividades de la vida diaria, estimulación, ferulaje, tecnología de asistencia, entre otras; además trae beneficios como reducción de estancia, complicaciones y costos.Conclusión. Se evidencia la importancia del trabajo del terapeuta ocupacional en la UCI de adulto, pues beneficios como reducción de la estancia y mejora funcional de las personas, al momento del egreso, son claros en las investigaciones internacionales.
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Ecklund MM, Bloss JW. Progressive mobility as a team effort in transitional care. Crit Care Nurse 2017; 35:62-8. [PMID: 26033102 DOI: 10.4037/ccn2015622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
With changing health care, progressive care nurses are working in diverse practice settings to meet patient care needs. Progressive care is practiced along the continuum from the intensive care unit to home. The benefits of early progressive mobility are examined with a focus on the interdisciplinary collaboration for care in a transitional care program of a skilled nursing facility. The program's goals are improved functional status, self-care management, and home discharge with reduced risk for hospital readmission. The core culture of the program is interdisciplinary collaboration and team partnership for care of patients and their families.
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Affiliation(s)
- Margaret M Ecklund
- Margaret M. Ecklund is a lead advance practice nurse for the complex care transitional program in the Rochester General Health System, Rochester, New York.Jill W. Bloss is a physical therapist for the complex care transitional program in the Rochester General Health System.
| | - Jill W Bloss
- Margaret M. Ecklund is a lead advance practice nurse for the complex care transitional program in the Rochester General Health System, Rochester, New York.Jill W. Bloss is a physical therapist for the complex care transitional program in the Rochester General Health System
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Messer A, Comer L, Forst S. Implementation of a Progressive Mobilization Program in a Medical-Surgical Intensive Care Unit. Crit Care Nurse 2017; 35:28-42. [PMID: 26427973 DOI: 10.4037/ccn2015469] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Current literature supports implementation of progressive mobility protocols in intensive care units. Education can help nurses overcome barriers to mobility and increase knowledge about the positive effects of mobility. OBJECTIVE To evaluate the effect of education for a progressive mobilization program for intensive care nurses on knowledge and performance. METHODS A pretest-posttest evaluation was conducted for 41 nurses, and a chart review was performed before and after implementation of the educational intervention to evaluate changes in knowledge and mobilization. RESULTS Scores after the educational intervention were significantly higher than scores before the intervention (t = 2.02; P < .001). Overall mobilization (P = .04) and dangling (P = .01) increased significantly after the education. No significant increases occurred in ambulating or getting patients up to a chair. CONCLUSIONS Mobilization education was effective and increased nurses' knowledge about the benefits of mobility for critically ill patients. The educational program also affected how nurses performed mobility interventions. Although provision of education had positive effects on patients' mobility, leadership and coaching are still important components in implementing change.
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Affiliation(s)
- April Messer
- April Messer is a staff nurse in a medical-surgical intensive care unit at Mission Health, Asheville, North Carolina, and previously served as chairperson of the nurse practice council for the hospital where she practices.Linda Comer is the executive associate director, School of Nursing, Western Carolina University. She is also the coordinator for the nurse educator master's program and teaches the nurse educator specialty courses.Steve Forst is an assistant professor, School of Nursing, Western Carolina University.
| | - Linda Comer
- April Messer is a staff nurse in a medical-surgical intensive care unit at Mission Health, Asheville, North Carolina, and previously served as chairperson of the nurse practice council for the hospital where she practices.Linda Comer is the executive associate director, School of Nursing, Western Carolina University. She is also the coordinator for the nurse educator master's program and teaches the nurse educator specialty courses.Steve Forst is an assistant professor, School of Nursing, Western Carolina University
| | - Steve Forst
- April Messer is a staff nurse in a medical-surgical intensive care unit at Mission Health, Asheville, North Carolina, and previously served as chairperson of the nurse practice council for the hospital where she practices.Linda Comer is the executive associate director, School of Nursing, Western Carolina University. She is also the coordinator for the nurse educator master's program and teaches the nurse educator specialty courses.Steve Forst is an assistant professor, School of Nursing, Western Carolina University
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Tadyanemhandu C, Manie S. Implementation of the physical function ICU test tool in a resource constrained intensive care unit to promote early mobilisation of critically ill patients- a feasibility study. Arch Physiother 2016; 6:12. [PMID: 29340193 PMCID: PMC5759917 DOI: 10.1186/s40945-016-0026-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 10/06/2016] [Indexed: 12/21/2022] Open
Abstract
Background The shift of focus in outcome measures from mortality to assessment of functional status in intensive care unit (ICU) patients has resulted in the emergence of mobilisation of critically ill patients as a standard physiotherapy practice in most medium and high income countries. The aim of this study was to determine the feasibility of an early mobilisation program and to report on the changes in patient clinical outcomes following the intervention in a low income country. Methods A prospective cohort study was carried out at one public hospital. An adult cohort of 35 patients was recruited within 24 h of being admitted into the unit, irrespective of ventilation method over a period of three months. An early mobilisation programme was implemented and prescribed using the Physical Function ICU Test (PFIT-s) which commenced in either the ICU or high dependent unit. Results The median age of the 35 patients was 29 years (IQR = 24–45 years). More than half of the patients had undergone surgery due to either gastrointestinal problems or obstetrical complications. A total of 94 out of a possible of 219 exercise sessions were delivered to the patients (43.0 %). The tool was implemented in 32 (91.4 %) patients on the initial PFIT-s measurement and 16 (45.7 %) of the patients required the assistance of two people to stand. The Initial PFIT-s mean score was 5.3 ± 1.8. On final PFIT-s measurement, out of the 30 (85.7 %) patients seen, 15 (42.9 %) of the patients did not require any assistance to stand and the final PFIT-s mean score was 7.0 ± 1.9. There was a significant difference in both the initial PFIT-s total score (t-value = 2.34, df = 30, p = .03) and the final PFIT-s score (t-value = 3.66, df = 28, p = .001) between males and females. During the treatment, no adverse event occurred in any of the patients. Conclusion An early mobilisation program using PFIT-s was feasible and safe. There was a difference in functional capability based on gender, with males being more functionally active. Specific inclusion and exclusion criteria can lead to a delayed early mobilisation activities in ICU patients. Trial registration Pan African Clinical Trials Registry PACTR201408000829202. Registered 15 August 2014.
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Affiliation(s)
- Cathrine Tadyanemhandu
- Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, PO Box AV 178. Avondale, Harare, Zimbabwe
| | - Shamila Manie
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, Division of Physiotherapy, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa
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