Early mobilisation within 72 hours after admission of critically ill patients in the intensive care unit: A systematic review with network meta-analysis

Guideline on positioning and early mobilisation in the critically ill by an expert panel

A scientific panel was created consisting of 23 interdisciplinary and interprofessional experts in intensive care medicine, physiotherapy, nursing care, surgery, rehabilitative medicine, and pneumology delegated from scientific societies together with a patient representative and a delegate from the Association of the Scientific Medical Societies who advised methodological implementation. The guideline was created according to the German Association of the Scientific Medical Societies (AWMF), based on The Appraisal of Guidelines for Research and Evaluation (AGREE) II. The topics of (early) mobilisation, neuromuscular electrical stimulation, assist devices for mobilisation, and positioning, including prone positioning, were identified as areas to be addressed and assigned to specialist expert groups, taking conflicts of interest into account. The panel formulated PICO questions (addressing the population, intervention, comparison or control group as well as the resulting outcomes), conducted a systematic literature review with abstract screening and full-text analysis and created summary tables. This was followed by grading the evidence according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence and a risk of bias assessment. The recommendations were finalized according to GRADE and voted using an online Delphi process followed by a final hybrid consensus conference. The German long version of the guideline was approved by the professional associations. For this English version an update of the systematic review was conducted until April 2024 and recommendation adapted based on new evidence in systematic reviews and randomized controlled trials. In total, 46 recommendations were developed and research gaps addressed.

The effect of abdominal massage and in-bed ROM exercise on gastrointestinal complications and comfort in intensive care unit patients receiving enteral nutrition: A randomized controlled trial

AIM

Abdominal massage facilitates gastric and colonic motility, reduces intra-abdominal distension and increases circulation. In-bed range of motion (ROM) exercise has effects on muscle strength, cardiac parameters and excretion. The aim of this study was to assess the effects of abdominal massage and in-bed ROM exercise on gastrointestinal complications and patient comfort in intensive care patients receiving enteral nutrition.

METHODS

This randomized controlled trial was conducted in the internal intensive care units of two tertiary public hospitals. The sample consisted of 130 patients randomly assigned to three groups (abdominal massage = 44, in-bed ROM exercise = 43, control = 43). The individuals received abdominal massage and in-bed ROM exercises every morning before enteral feeding for 3 days. We assessed gastrointestinal complications and comfort levels of the patients 24 h after each intervention.

RESULTS

While the differences in abdominal distention, defecation status, constipation, and gastric residual volume complications were significant (p < .05), there was no significant difference in diarrhea and vomiting (p > .05). Comfort level showed a statistically significant change in the experimental groups in the in-group comparison (p < .05).

CONCLUSION

Abdominal massage and in-bed ROM exercise reduce abdominal distention, constipation and gastric residual volume. Abdominal massage affects the frequency of defecation; and, both interventions increase the comfort while reducing the pain level over time.

Rehabilitation for adult patients undergoing extracorporeal membrane oxygenation

BACKGROUND AND PURPOSE

Current information on the latest rehabilitative practices is limited, with previous reviews only covering data up to October 2021, and some considering only patients on awake ECMO or with COVID-19. This review aims to present a concise overview of the latest findings on rehabilitation and highlight emerging trends for patients undergoing ECMO support.

METHODS

This integrative review was conducted by searching the National Library of Medicine - PubMed database. Two different search strings "extracorporeal membrane oxygenation" AND "rehabilitation" and "extracorporeal membrane oxygenation" AND "physiotherapy" were used to search the published literature. Articles that did not describe rehabilitation techniques, editorials, conference proceedings, letters to editor, reviews and research protocols were excluded. Studies conducted on pediatric populations were also excluded. The search process was completed in December 2023.

RESULTS

Thirteen articles were included in the final analysis. Eight hundred and thirty-nine patients aged between 27 and 63 years were included; 428 were men (51%). In 31% of the included studies, patients had COVID-19; nevertheless, rehabilitative activities did not differ from non-COVID-19 patients. In most studies, rehabilitation commenced within the first 48-96 h and consisted of progressive exercise and out-of-bed activities such as sitting, standing and walking.

CONCLUSION

Current practice focuses on rehabilitative protocols that incorporate exercise routines with progressive intensity, greater emphasis on out-of-bed activities, and a multidisciplinary approach to patient mobilization.