1
|
Wang L, Lu JY, Ma XX, Ma LO. Study of the intensive care unit activity scale in the early rehabilitation of patients after direct cardiac surgery. World J Clin Cases 2024; 12:5930-5936. [PMID: 39286377 PMCID: PMC11287495 DOI: 10.12998/wjcc.v12.i26.5930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/29/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Direct cardiac surgery often necessitates intensive post-operative care, and the intensive care unit (ICU) activity scale represents a crucial metric in assessing and guiding early rehabilitation efforts to enhance patient recovery. AIM To clarify the clinical application value of the ICU activity scale in the early recovery of patients after cardiac surgery. METHODS One hundred and twenty patients who underwent cardiac surgery between September 2020 and October 2021 were selected and divided into two groups using the random number table method. The observation group was rated using the ICU activity scale and the corresponding graded rehabilitation interventions were conducted based on the ICU activity scale. The control group was assessed in accordance with the routine rehabilitation activities, and the postoperative rehabilitation indexes of the patients in both groups were compared (time of tracheal intubation, time of ICU admission, occurrence of complications, and activity scores before ICU transfer). The two groups were compared according to postoperative rehabilitation indicators (time of tracheal intubation, length of ICU stay, and occurrence of complications) and activity scores before ICU transfer. RESULTS In the observation group, tracheal intubation time lasted for 18.30 ± 3.28 h and ICU admission time was 4.04 ± 0.83 d, which were significantly shorter than the control group (t-values: 2.97 and 2.038, respectively, P < 0.05). The observation group also had a significantly lower number of complications and adverse events compared to the control group (P < 0.05). Before ICU transfer, the observation group (6.7%) had few complications and adverse events than the control group (30.0 %), and this difference was statistically significant (P < 0.05). Additionally, the activity score was significantly higher in the observation (26.89 ± 0.97) compared to the control groups (22.63 ± 1.12 points) (t-value; -17.83, P < 0.05). CONCLUSION Implementation of early goal-directed activities in patients who underwent cardiac surgery using the ICU activity scale can promote the recovery of cardiac function.
Collapse
Affiliation(s)
- Li Wang
- Intensive Care Unit, Dongyang People’s Hospital, Jinhua 322100, Zhejiang Province, China
| | - Jing-Ya Lu
- Intensive Care Unit, Dongyang People’s Hospital, Jinhua 322100, Zhejiang Province, China
| | - Xiao-Xiao Ma
- Department of Rehabilitation Medicine, Dongyang People’s Hospital, Jinhua 322100, Zhejiang Province, China
| | - Lan-Ou Ma
- Intensive Care Unit, Dongyang People’s Hospital, Jinhua 322100, Zhejiang Province, China
| |
Collapse
|
2
|
Wu H, Wu D, Geng X. Early mobilization in neurological intensive care units: Worthy of more attempts. Nurs Crit Care 2024; 29:857-860. [PMID: 39031648 DOI: 10.1111/nicc.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 07/22/2024]
Affiliation(s)
- Hao Wu
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Dan Wu
- Department of Neurosurgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xin Geng
- Department of Neurosurgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|
3
|
Maia TFLD, Magalhães PAF, Santos DTS, de Brito Gomes JL, Schwingel PA, de Freitas Brito A. Current Concepts in Early Mobilization of Critically Ill Patients Within the Context of Neurologic Pathology. Neurocrit Care 2024; 41:272-284. [PMID: 38396279 DOI: 10.1007/s12028-023-01934-8] [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: 01/11/2023] [Accepted: 12/27/2023] [Indexed: 02/25/2024]
Abstract
Neurocritical patients (NCPs) in the intensive care unit (ICU) rapidly progress to respiratory and peripheral muscle dysfunctions, which significantly impact morbidity and death. Early mobilization in NCPs to decrease the incidence of ICU-acquired weakness has been showing rapid growth, although pertinent literature is still scarce. With this review, we summarize and discuss current concepts in early mobilization of critically ill patients within the context of neurologic pathology in NCPs. A narrative synthesis of literature was undertaken trying to answer the following questions: How do the respiratory and musculoskeletal systems in NCPs behave? Which metabolic biomarkers influence physiological responses in NCPs? Which considerations should be taken when prescribing exercises in neurocritically ill patients? The present review detected safety, feasibility, and beneficial response for early mobilization in NCPs, given successes in other critically ill populations and many smaller intervention trials in neurocritical care. However, precautions should be taken to elect the patient for early care, as well as monitoring signs that indicate interruption for intervention, as worse outcomes were associated with very early mobilization in acute stroke trials.
Collapse
Affiliation(s)
- Thaís Ferreira Lopes Diniz Maia
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil.
| | - Paulo André Freire Magalhães
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Dasdores Tatiana Silva Santos
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Jorge Luiz de Brito Gomes
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Paulo Adriano Schwingel
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| | - Aline de Freitas Brito
- Post Graduation Program in Rehabilitation and Functional Performance, Universidade de Pernambuco, BR 203, Km 2, s/n, Vila Eduardo, 56, Petrolina, Pernambuco, 328-900, Brazil
| |
Collapse
|
4
|
Chen S, Liao SF, Lin YJ, Huang CY, Ho SC, Chang JH. Outcomes of different pulmonary rehabilitation protocols in patients under mechanical ventilation with difficult weaning: a retrospective cohort study. Respir Res 2024; 25:243. [PMID: 38879514 PMCID: PMC11180404 DOI: 10.1186/s12931-024-02866-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/04/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND The endeavor of liberating patients from ventilator dependence within respiratory care centers (RCCs) poses considerable challenges. Multiple factors contribute to this process, yet establishing an effective regimen for pulmonary rehabilitation (PR) remains uncertain. This retrospective study aimed to evaluate existing rehabilitation protocols, ascertain associations between clinical factors and patient outcomes, and explore the influence of these protocols on the outcomes of the patients to shape suitable rehabilitation programs. METHODS Conducted at a medical center in northern Taiwan, the retrospective study examined 320 newly admitted RCC patients between January 1, 2015, and December 31, 2017. Each patient received a tailored PR protocol, following which researchers evaluated weaning rates, RCC survival, and 3-month survival as outcome variables. Analyses scrutinized differences in baseline characteristics and prognoses among three PR protocols: protocol 1 (routine care), protocol 2 (routine care plus breathing training), and protocol 3 (routine care plus breathing and limb muscle training). RESULTS Among the patients, 28.75% followed protocol 1, 59.37% protocol 2, and 11.88% protocol 3. Variances in age, body-mass index, pneumonia diagnosis, do-not-resuscitate orders, Glasgow Coma Scale scores (≤ 14), and Acute Physiology and Chronic Health Evaluation II (APACHE) scores were notable across these protocols. Age, APACHE scores, and abnormal blood urea nitrogen levels (> 20 mg/dL) significantly correlated with outcomes-such as weaning, RCC survival, and 3-month survival. Elevated mean hemoglobin levels linked to increased weaning rates (p = 0.0065) and 3-month survival (p = 0.0102). Four adjusted models clarified the impact of rehabilitation protocols. Notably, the PR protocol 3 group exhibited significantly higher 3-month survival rates compared to protocol 1, with odds ratios (ORs) ranging from 3.87 to 3.97 across models. This association persisted when comparing with protocol 2, with ORs between 3.92 and 4.22. CONCLUSION Our study showed that distinct PR protocols significantly affected the outcomes of ventilator-dependent patients within RCCs. The study underlines the importance of tailored rehabilitation programs and identifies key clinical factors influencing patient outcomes. Recommendations advocate prospective studies with larger cohorts to comprehensively assess PR effects on RCC patients.
Collapse
Affiliation(s)
- Shiauyee Chen
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan
| | - Shu-Fen Liao
- Department of Medical Research, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yun-Jou Lin
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chao-Ying Huang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Shu-Chuan Ho
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan.
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
| | - Jer-Hwa Chang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan.
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
5
|
Yen HC, Chuang HJ, Hsiao WL, Tsai YC, Hsu PM, Chen WS, Han YY. Assessing the impact of early progressive mobilization on moderate-to-severe traumatic brain injury: a randomized controlled trial. Crit Care 2024; 28:172. [PMID: 38778416 PMCID: PMC11112875 DOI: 10.1186/s13054-024-04940-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major cause of neurodisability worldwide, with notably high disability rates among moderately severe TBI cases. Extensive previous research emphasizes the critical need for early initiation of rehabilitation interventions for these cases. However, the optimal timing and methodology of early mobilization in TBI remain to be conclusively determined. Therefore, we explored the impact of early progressive mobilization (EPM) protocols on the functional outcomes of ICU-admitted patients with moderate to severe TBI. METHODS This randomized controlled trial was conducted at a trauma ICU of a medical center; 65 patients were randomly assigned to either the EPM group or the early progressive upright positioning (EPUP) group. The EPM group received early out-of-bed mobilization therapy within seven days after injury, while the EPUP group underwent early in-bed upright position rehabilitation. The primary outcome was the Perme ICU Mobility Score and secondary outcomes included Functional Independence Measure motor domain (FIM-motor) score, phase angle (PhA), skeletal muscle index (SMI), the length of stay in the intensive care unit (ICU), and duration of ventilation. RESULTS Among 65 randomized patients, 33 were assigned to EPM and 32 to EPUP group. The EPM group significantly outperformed the EPUP group in the Perme ICU Mobility and FIM-motor scores, with a notably shorter ICU stay by 5.9 days (p < 0.001) and ventilation duration by 6.7 days (p = 0.001). However, no significant differences were observed in PhAs. CONCLUSION The early progressive out-of-bed mobilization protocol can enhance mobility and functional outcomes and shorten ICU stay and ventilation duration of patients with moderate-to-severe TBI. Our study's results support further investigation of EPM through larger, randomized clinical trials. Clinical trial registration ClinicalTrials.gov NCT04810273 . Registered 13 March 2021.
Collapse
Affiliation(s)
| | | | | | | | - Po-Min Hsu
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Yin-Yi Han
- National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
6
|
Rodrigues PSM, Shimano MM, de Oliveira E, Kawamura FM, Silveira AF, José Luvizutto G, de Souza LAPS. Adaptation and clinical application of assistive device chair for bedside sitting in acute stroke phase: two case reports. Disabil Rehabil Assist Technol 2024; 19:1272-1278. [PMID: 36630593 DOI: 10.1080/17483107.2023.2166600] [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: 05/12/2022] [Revised: 11/16/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE This report presents the adaptation of an assistive device chair for bedside sitting and its application in two patients with trunk control impairment in the acute stroke phase. MATERIALS AND METHODS The device was built with polyvinylchloride (PVC) pipes and designed by a team of mechanical engineers and physiotherapists to maintain a prolonged sitting position with less demand from therapists. To test the device, two patients were followed up during the acute phase of stroke. Both patients underwent an early mobilization program (30 min, twice a day, for three days) with an assistive device chair for bedside sitting. Patients were evaluated using the National Institutes of Health Stroke Scale (NIHSS), Trunk Impairment Scale (TIS), and International Classification of Functioning, Disability, and Health (ICF) checklist (b: body function; d: activity and participation). RESULTS The adaptations generated the following equipment: 1) foldable, 2) three levels of backrest inclination, and 3) a safety anterior support or an activity table. Both patients showed clinical improvement after the intervention period, with NIHSS score reduction, TIS improvement, and greater functionality and independence on the ICF framework. CONCLUSION The equipment with adaptations seems to be functional, easy to handle, and can potentially contribute to clinical and functional improvements in patients with trunk control deficits after stroke.
Collapse
Affiliation(s)
| | - Marcos Massao Shimano
- Department of Mechanical Engineering, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Edimar de Oliveira
- Student of the Mechanical Engineering, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Fábio Masao Kawamura
- Student of the Mechanical Engineering, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | - Ana Flávia Silveira
- Doctorate Student in Physiotherapy, Federal University of São Carlos, São Carlos, Brazil
| | - Gustavo José Luvizutto
- Department of Applied Physiotherapy, Federal University of Triângulo Mineiro, Uberaba, Brazil
| | | |
Collapse
|
7
|
Navarro Y, Huang E, Johnson C, Clark F, Coppola S, Modi S, Warren GL, Call JA. The Influence of COVID-19 on Patient Mobilization and Injury Attributes in the ICU: A Retrospective Analysis of a Level II Trauma Center. TRAUMA CARE 2024; 4:44-59. [PMID: 38606188 PMCID: PMC11007754 DOI: 10.3390/traumacare4010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Abstract
The objectives of this study were to determine the effect of COVID-19 on physical therapy (PT) mobilization of trauma patients and to determine if mobilization affected patient course in the ICU. This retrospective study included patients who were admitted to the ICU of a level II trauma center. The patients were divided into two groups, i.e., those admitted before (n = 378) and after (n = 499) 1 April 2020 when Georgia's COVID-19 shelter-in-place order was mandated. The two groups were contrasted on nominal and ratio variables using Chi-square and Student's t-tests. A secondary analysis focused specifically on the after-COVID patients examined the extent to which mobilization (n = 328) or lack of mobilization (n = 171) influenced ICU outcomes (e.g., mortality, readmission). The two groups were contrasted on nominal and ratio variables using Chi-square and Student's t-tests. The after-COVID patients had higher injury severity as a greater proportion was classified as severely injured (i.e., >15 on Injury Severity Score) compared to the before-COVID patients. After-COVID patients also had a greater cumulative number of comorbidities and experienced greater complications in the ICU. Despite this, there was no difference between patients in receiving a PT consultation or days to mobilization. Within the after-COVID cohort, those who were mobilized were older, had greater Glasgow Coma Scale scores, had longer total hospital days, and had a lesser mortality rate, and a higher proportion were female. Despite shifting patient injury attributes post-COVID-19, a communicable disease, mobilization care remained consistent and effective.
Collapse
Affiliation(s)
- Yelissa Navarro
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Elizabeth Huang
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Chandler Johnson
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Forrest Clark
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Samuel Coppola
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Suraj Modi
- Medical College of Georgia, AU/UGA Medical Partnership, Athens, GA 30602, USA
| | - Gordon L. Warren
- Department of Physical Therapy, Georgia State University, Atlanta, GA 30302, USA
| | - Jarrod A. Call
- Department of Physiology & Pharmacology, University of Georgia, Athens, GA 30602, USA
| |
Collapse
|
8
|
Yanase L, Clark D, Baraban E, Stuchiner T. A Retrospective Analysis of Ischemic Stroke Patients Supports That Very Early Mobilization Within 24 Hours After Intravenous Alteplase Is Safe and Possibly Beneficial. J Neurosci Nurs 2023; 55:188-193. [PMID: 37815279 DOI: 10.1097/jnn.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
ABSTRACT BACKGROUND: Stroke care guidelines recommend early mobilization of acute ischemic stroke patients, but there are sparse data regarding early mobilization of stroke patients receiving thrombolytic therapy. We developed the Providence Early Mobility for Stroke (PEMS) protocol to mobilize patients to their highest individual tolerance within 24 hours of stroke admission in 2010, and it has been in continuous use at our primary and comprehensive stroke centers for over a decade. In this study, we evaluated the PEMS protocol in all patients treated with intravenous alteplase without endovascular treatment. METHODS : This retrospective study includes 318 acute ischemic stroke patients treated with alteplase who were admitted to 2 urban stroke centers between January 2013 and December of 2017 and were mobilized with the PEMS protocol within 24 hours of receiving alteplase. Safety of PEMS was assessed by change in National Institutes of Health Stroke Scale at 24 hours by time first mobilized. Using multivariate and logistic regression models, we analyzed time first mobilized and 90-day modified Rankin scale (mRS). RESULTS : Median time first mobilized was 9 hours from administration of alteplase. For every hour delay in mobilization, the odds of being slightly or moderately disabled (mRS, 2-3) at 90 days increased by 7% (adjusted odds ratio, 1.07; P = .004), and the odds of being severely disabled or dead (mRS, 4-6) at 90 days increased by 7% (adjusted odds ratio, 1.07; P = .02). In addition, for every hour delay in mobilization, 24-hour National Institutes of Health Stroke Scale increased by 1.8%. DISCUSSION: Our results support that the PEMS protocol is safe, and possibly beneficial, for acute ischemic stroke patients treated with intravenous alteplase. Our protocol differs from other very early mobility protocols because it does not prescribe a "dose" of activity. Instead, each patient was mobilized to his/her individual highest degree as soon as it was safe to do so.
Collapse
|
9
|
Patel SV, Imburgio S, Johal AS, Ramirez C, DiSandro K, Mathur D, Walch B, Buccellato V, Hossain MA, Asif A. Improving Discharge Rates to Home With the Help of Mobility Technicians: A Step in the Right Direction. Cureus 2023; 15:e48298. [PMID: 38058341 PMCID: PMC10696277 DOI: 10.7759/cureus.48298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Background Early ambulation during acute hospitalization has been associated with improved clinical outcomes for patients. Despite the benefits of mobility in the hospital setting, physical therapists and nursing staff are often constrained by time. Mobility technicians (MTs) are individuals with specialized training who have emerged as a potential solution by providing safe ambulation for patients during their hospital stay. Objectives The purpose of this quality improvement project was to investigate the impact of MTs on clinical and financial outcomes for admitted patients at a high-volume tertiary institution. Methods A quality improvement project was implemented at Jersey Shore University Medical Center, Neptune City, from October 2022 to March 2023. The study was a prospective, single-institution cohort study and included patients admitted to two medical floors. Patients were divided into an experimental group that received services from MTs and a control group that did not receive this service but was eligible based on clinical status. The primary endpoint was the proportion of patients discharged to home. Secondary outcomes included the length of stay and financial impact. Results A total of 396 admitted patients were included, with 222 patients in the MT group and 174 in the non-MT group. Patients in the MT group were discharged home more frequently, at a rate of 79.7% compared to 66.1% for patients in the non-MT group (p = 0.002). MTs contributed to an average 2.4-day reduction in the length of hospital stay (7.8 days vs. 10.2 days, p = 0.007). The MT intervention led to an estimated net savings of $148,500 during the six-month study period. Additionally, 2.9 daily hospital beds were created. Conclusion Implementing an MT program significantly increased the discharge-to-home rates and decreased hospital length of stay. Preliminary analysis suggests that this intervention is cost-effective and can assist institutions in managing increased hospital capacity strain through the creation of additional hospital beds.
Collapse
Affiliation(s)
- Swapnil V Patel
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Steven Imburgio
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Anmol S Johal
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Claudia Ramirez
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Kristin DiSandro
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Divya Mathur
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Brian Walch
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Vito Buccellato
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Mohammad A Hossain
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| | - Arif Asif
- Internal Medicine, Jersey Shore University Medical Center, Neptune City, USA
| |
Collapse
|
10
|
Han PH, Shih CY, Wang AY, Chen YC, Yang CC, Fan YC, Hsiang HF, Chiu HY. Effects of an interactive handgrip game on surgical patients requiring intensive care: An assessor-blinded randomized controlled trial. Intensive Crit Care Nurs 2023; 78:103474. [PMID: 37354696 DOI: 10.1016/j.iccn.2023.103474] [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: 02/10/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To explore the effect of an interactive handgrip game on psychological distress and handgrip strength among critically ill surgical patients. DESIGN A randomised controlled trial. SETTING A surgical intensive care unit. INTERVENTION Participants were enrolled in the program within 48 hours of admission to the intensive care unit. Patients in the intervention group played a 20-minute interactive handgrip game twice daily for a maximum of three days in the intensive care unit in addition to routinely passive physical rehabilitation. Patients in the routine care group had a daily target of 20 min of passive physical rehabilitation as needed. MEASUREMENT The primary outcomes included depression, anxiety, and stress measured using the shortened version of the Depression Anxiety Stress Score scale. The secondary outcomes were perceived sleep evaluated using the Richards-Campbell Sleep Questionnaire, delirium assessed using the Intensive Care Delirium Screening Checklist, and handgrip strength measured using handgrip dynamometry within a handgrip device. RESULTS Two hundred and twenty-seven patients were eligible and 70 patients were recruited in the intervention (n = 35) and routine care groups (n = 35). The patients in the intervention group had lower scores (median = 6.0, 4.0, and 12.0) for depression, anxiety, and stress compared with those in the routine care group (12.0, 12.0, and 20.0; all p < 0.05). The interactive handgrip game did not significantly improve sleep quality and prevent the occurrence of delirium (both p > 0.05). The patients who received the interactive handgrip game intervention exhibited significantly enhanced handgrip strength in both hands over time (both p < 0.001). CONCLUSION An interactive handgrip game may benefit the psychological well-being and handgrip strength of critically ill patients. IMPLICATIONS FOR CLINICAL PRACTICE Interactive handgrip games is effective active exercise which should be integrated into routine nursing practice.
Collapse
Affiliation(s)
- Ping-Hsuan Han
- Department of Interaction Design, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Ying Shih
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - An-Yi Wang
- Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Chen Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chi-Chen Yang
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yen-Chun Fan
- College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hui-Fen Hsiang
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
11
|
Barra ME, Iracheta C, Tolland J, Jehle J, Minova L, Li K, Amatangelo M, Krause P, Batra A, Vaitkevicius H. Multidisciplinary Approach to Sedation and Early Mobility of Intubated Critically Ill Neurologic Patients Improves Mobility at Discharge. Neurohospitalist 2023; 13:351-360. [PMID: 37701262 PMCID: PMC10494812 DOI: 10.1177/19418744231182897] [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: 09/14/2023] Open
Abstract
Background and Purpose Over-sedation may confound neurologic assessment in critically ill neurologic patients and prolong duration of mechanical ventilation (MV). Decreased sedative use may facilitate early functional independence when combined with early mobility. The objective of this study was to evaluate the impact of a stepwise, multidisciplinary analgesia-first sedation pathway and early mobility protocol on medication use and mobility in the neuroscience intensive care unit (ICU). Methods We performed a single-center prospective cohort study with adult patients admitted to a neuroscience ICU between March and June 2016-2018 who required MV for greater than 48 hours. Patients were included from three separate phases of the study: Phase I - historical controls (2016); Phase II - analgesia-first pathway (2017); Phase III - early mobility protocol (2018). Primary outcomes included propofol requirements during MV, total rehabilitation therapy provided, and functional mobility during ICU admission. Results 156 patients were included in the analysis. Decreasing propofol exposure was observed during Phase I, II, and III (median 2243.7 mg/day vs 2065.6 mg/day vs 1360.8 mg/day, respectively; P = .04 between Phase I and III). Early mobility was provided in 59.7%, 40%, and 81.6% of patients while admitted to the ICU in Phase I, II, and III, respectively (P < .01). An increased proportion of patients in Phase III were walking or ambulating at ICU discharge (26.7%; 8/30) compared to Phase I (7.9%, 3/38, P = .05). Conclusions An interdisciplinary approach with an analgesia-first sedation pathway with early mobility protocol was associated with less sedative use, increased rehabilitation therapy, and improved functional mobility status at ICU discharge.
Collapse
Affiliation(s)
- Megan E. Barra
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA USA
| | - Christine Iracheta
- Department of Rehabilitation Services, Brigham and Women’s Hospital, Boston, MA USA
| | - Joseph Tolland
- Department of Rehabilitation Services, Brigham and Women’s Hospital, Boston, MA USA
| | - Johnathan Jehle
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA USA
- Department of Adult Palliative Care, Brigham and Women’s Hospital, Boston, MA USA
| | - Ljubica Minova
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA USA
| | - Karen Li
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA USA
| | - Mary Amatangelo
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA USA
| | - Patricia Krause
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA USA
| | - Ayush Batra
- Department of Neurology & Pathology, Northwestern University Feinberg School of Medicine, Chicago IL USA
| | | |
Collapse
|
12
|
Hoffman SE, Gupta S, O'Connor M, Jarvis CA, Zhao M, Hauser BM, Bernstock JD, Murphy S, Raftery SM, Lane K, Chiocca EA, Arnaout O. Reduced time to imaging, length of stay, and hospital charges following implementation of a novel postoperative pathway for craniotomy. J Neurosurg 2023; 139:373-384. [PMID: 36609368 PMCID: PMC10904334 DOI: 10.3171/2022.12.jns222123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/05/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The authors created a postoperative postanesthesia care unit (PACU) pathway to bypass routine intensive care unit (ICU) admissions of patients undergoing routine craniotomies, to improve ICU resource utilization and reduce overall hospital costs and lengths of stay while maintaining quality of care and patient satisfaction. In the present study, the authors evaluated this novel PACU-to-floor clinical pathway for a subset of patients undergoing craniotomy with a case time under 5 hours and blood loss under 500 ml. METHODS A single-institution retrospective cohort study was performed to compare 202 patients enrolled in the PACU-to-floor pathway and 193 historical controls who would have met pathway inclusion criteria. The pathway cohort consisted of all adult supratentorial brain tumor cases from the second half of January 2021 to the end of January 2022 that met the study inclusion criteria. Control cases were selected from the beginning of January 2020 to halfway through January 2021. The authors also discuss common themes of similar previously published pathways and the logistical and clinical barriers overcome for successful PACU pathway implementation. RESULTS Pathway enrollees had a median age of 61 years (IQR 49-69 years) and 53% were female. Age, sex, pathology, and American Society of Anesthesiologists physical status distributions were similar between pathway and control patients (p > 0.05). Most of the pathway cases (96%) were performed on weekdays, and 31% had start times before noon. Nineteen percent of pathway patients had 30-day readmissions, most frequently for headache (16%) and syncope (10%), whereas 18% of control patients had 30-day readmissions (p = 0.897). The average time to MRI was 6 hours faster for pathway patients (p < 0.001) and the time to inpatient physical therapy and/or occupational therapy evaluation was 4.1 hours faster (p = 0.046). The average total length of stay was 0.7 days shorter for pathway patients (p = 0.02). A home discharge occurred in 86% of pathway cases compared to 81% of controls (p = 0.225). The average total hospitalization charges were $13,448 lower for pathway patients, representing a 7.4% decrease (p = 0.0012, adjusted model). Seven pathway cases were escalated to the ICU postoperatively because of attending physician preference (2 cases), agitation (1 case), and new postoperative neurological deficits (4 cases), resulting in a 96.5% rate of successful discharge from the pathway. In bypassing the ICU, critical care resource utilization was improved by releasing 0.95 ICU days per patient, or 185 ICU days across the cohort. CONCLUSIONS The featured PACU-to-floor pathway reduces the stay of postoperative craniotomy patients and does not increase the risk of early hospital readmission.
Collapse
|
13
|
Cremer S, Vluggen S, Man-Van-Ginkel JMD, Metzelthin SF, Zwakhalen SM, Bleijlevens MHC. Effective nursing interventions in ADL care affecting independence and comfort - a systematic review. Geriatr Nurs 2023; 52:73-90. [PMID: 37269607 DOI: 10.1016/j.gerinurse.2023.04.015] [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: 01/27/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 06/05/2023]
Abstract
Despite its frequent provision, evidence of nursing interventions in Activities of Daily Living (ADL) remains unclear. Hence, we addressed the research question: What are the effects of ADL nursing interventions on independence and comfort in adults across all care settings? We conducted a systematic review of randomized controlled trials and quasi-experimental studies described in systematic reviews. In three databases, we searched for systematic reviews that we used as a portal to select (quasi) experimental studies. After narratively summarizing the studies on characteristics, effects, and interventions, we assessed the risk of bias. Among the 31 included studies, 14 studies evaluated independence, 14 studies measured comfort, and three studies assessed both outcomes. Seven interventions significantly improved independence and seven interventions significantly improved comfort. The studies varied highly in intervention components, outcome measures, and quality. Evidence on ADL nursing interventions affecting independence and comfort remains fragmented and inconclusive, limiting guidance for nursing professionals.
Collapse
Affiliation(s)
- S Cremer
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands.
| | - S Vluggen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - J M de Man-Van-Ginkel
- Department of Gerontology and Geriatrics, Nursing Science, Leiden University Medical Centre, Postzone C-07-Q, Postbus 9600, Leiden, RC 2300, The Netherlands
| | - S F Metzelthin
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - S M Zwakhalen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - M H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| |
Collapse
|
14
|
Liao J, Qi Z, Chen B, Lei P. Association between early ambulation exercise and short-term postoperative recovery after open transforaminal lumbar interbody fusion: a single center retrospective analysis. BMC Musculoskelet Disord 2023; 24:345. [PMID: 37143006 PMCID: PMC10158157 DOI: 10.1186/s12891-023-06395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/04/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Early ambulation in patients undergoing transforaminal lumbar interbody fusion (TLIF) surgery is recommended, however, the precise time interval after open surgery has never been specified. Current retrospective analysis was conducted aiming to clarify an accurate time interval. METHODS A retrospective analysis of eligible patients was conducted using the databases of the Bone Surgery Department, Third Affiliated Hospital of Sun Yat-sen University from 2016 to 2021. Data pertaining to postoperative hospital stay length, expenses, incidence of complications were extracted and compared using Pearson's χ2 or Student's t-tests. A multivariate linear regression model was conducted to identify the relationship between length of hospital stay (LOS) and other outcomes of interest. A propensity analysis was conducted to minimize bias and to evaluate the reliability of results. RESULTS A total of 303 patients met the criteria and were included for the data analysis. Multivariate linear regression results demonstrated that a high ASA grade (p = 0.016), increased blood loss (p = 0.003), cardiac disease (p < 0.001), occurrence of postoperative complications(p < 0.001) and longer ambulatory interval (p < 0.001) was significantly associated with an increased LOS. The cut-off analysis manifested that patients should start mobilization within 3 days after open TLIF surgery (B = 2.843, [1.395-4.292], p = 0.0001). Further comparative analysis indicated that patients who start ambulatory exercise within 3 days have shorter LOS (8.52 ± 3.28d vs 12.24 ± 5.88d, p < 0.001), total expenses ( 9398.12 ± 2790.82vs 10701.03 ± 2994.03 [USD], p = 0.002). Propensity analysis revealed such superiority was stable along with lower incidence of postoperative complications (2/61 vs 8/61, p = 0.0048). CONCLUSIONS The current analysis suggested that ambulatory exercise within 3 days for patients who underwent open TLIF surgery was significantly associated with reduced LOS, total hospital expenses, and postoperative complications. Further causal relationship would be confirmed by future randomized controlled trials.
Collapse
Affiliation(s)
- Jingwen Liao
- Department of Bone Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhou Qi
- Department of Bone Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Biying Chen
- Department of Bone Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Purun Lei
- Department of Gastrointestinal Surgery, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|
15
|
Rosa D, Negro A, Marcomini I, Pendoni R, Albabesi B, Pennino G, Terzoni S, Destrebecq A, Villa G. The Effects of Early Mobilization on Acquired Weakness in Intensive Care Units: A Literature Review. Dimens Crit Care Nurs 2023; 42:146-152. [PMID: 36996359 DOI: 10.1097/dcc.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Intensive care unit (ICU)-acquired weakness (ICUAW) is defined as a clinical syndrome of neuromuscular weakness, and a consequence of critical illness, unrelated to any other etiology. It is associated with difficult weaning from the ventilator, prolonged ICU stay, increased mortality, and other important long-term outcomes. Early mobilization is defined as any active exercise in which patients use their muscle strength actively or passively within the first 2 to 5 days of critical illness. Early mobilization can be safely initiated from the first day of admission to the ICU during mechanical ventilation. OBJECTIVES The purpose of this review is to describe the effects of early mobilization on complications from ICUAW. METHOD This was a literature review. Inclusion criteria were as follows: observational studies and randomized controlled trials conducted with adult patients (aged ≥18 years) admitted to the ICU were included. Studies selected were published in the last 11 years (2010-2021). RESULTS Ten articles were included. Early mobilization reduces muscle atrophy, ventilation, length of hospital stay, and ventilator-associated pneumonia and improves patients' responses to inflammation and hyperglycemia. DISCUSSION Early mobilization appears to have a significant impact on the prevention of ICUAW and appears to be safe and feasible. The results of this review could be useful for improving the provision of efficient and effective tailored care for ICU patients.
Collapse
|
16
|
Chou A, Johnson JK, Jones DB, Euloth T, Matcho BA, Bilderback A, Freburger JK. Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study. Health Serv Res 2023; 58 Suppl 1:51-62. [PMID: 36271503 PMCID: PMC9843085 DOI: 10.1111/1475-6773.14087] [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: 01/21/2023] Open
Abstract
OBJECTIVE To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission. DATA SOURCES EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017-February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019-July 2021). STUDY DESIGN We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted. DATA EXTRACTION We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay. PRINCIPAL FINDINGS In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI -0.57, -0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (β = 0.01; 95% CI -0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI -0.88, -0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA. CONCLUSIONS Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.
Collapse
Affiliation(s)
- Aileen Chou
- Department of Physical TherapyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Joshua K. Johnson
- Department of Physical Medicine and RehabilitationNeurological Institute, Cleveland ClinicClevelandOhioUSA
| | - Daniel B. Jones
- Graduate School of Public and International AffairsUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Tracey Euloth
- UPMC Rehabilitation ServicesPittsburghPennsylvaniaUSA
| | | | | | - Janet K. Freburger
- Department of Physical TherapyUniversity of PittsburghPittsburghPennsylvaniaUSA
| |
Collapse
|
17
|
Wu RY, Yeh HJ, Chang KJ, Tsai MW. Effects of different types and frequencies of early rehabilitation on ventilator weaning among patients in intensive care units: A systematic review and meta-analysis. PLoS One 2023; 18:e0284923. [PMID: 37093879 PMCID: PMC10124886 DOI: 10.1371/journal.pone.0284923] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/11/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the effects of different types and frequencies of physiotherapy on ventilator weaning among patients in the intensive care unit (ICU) and to identify the optimal type and frequency of intervention. DATA SOURCES PubMed, Cochrane Library, EMBASE, and Airiti Library. STUDY SELECTION Randomized controlled trials that provided information on the dosage of ICU rehabilitation and the parameters related to ventilator weaning were included. DATA EXTRACTION AND MANAGEMENT Treatment types were classified into conventional physical therapy, exercise-based physical therapy, neuromuscular electrical stimulation (NEMS), progressive mobility, and multi-component. The frequencies were divided into high (≥ 2 sessions/day or NEMS of > 60 minutes/day), moderate (one session/day, 3-7 days/week or NEMS of 30-60 minutes/day), and low (one session/day, < 3 days/week, or NEMS of < 30 minutes/day). DATA SYNTHESIS Twenty-four articles were included for systematic review and 15 out of 24 articles were analyzed in the meta-analysis. Early rehabilitation, especially the progressive mobility treatment exerted an optimal effect in reducing the ventilator duration in patients in the ICU (standardized mean difference [SMD] = 0.91; 95% confidence interval [CI] = 0.23-1.58; P < 0.01). Regarding the treatment frequency, the high-frequency intervention did not result in a favorable effect on ventilator duration compared with the moderate frequency of treatment (SMD = 0.75; 95% CI = -1.13-2.64; P = 0.43). CONCLUSION Early rehabilitation with progressive mobility is highly recommended to decrease the ventilation duration received by patients in the ICU. Depending on clinical resources and the tolerance of patients, the frequency of interventions should reach moderate-to-high frequency, that is, at least one session per day and 3 days a week. TRIAL REGISTRATION Registration number: PROSPERO (CRD42021243331).
Collapse
Affiliation(s)
- Ruo-Yan Wu
- Division of Physical Medicine and Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- The Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huan-Jui Yeh
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- The Department of Physical Medicine and Rehabilitation, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
| | - Kai-Jie Chang
- Division of Physical Medicine and Rehabilitation, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Mei-Wun Tsai
- The Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
18
|
Yang X, Cao L, Zhang T, Qu X, Chen W, Cheng W, Qi M, Wang N, Song W, Wang N. More is less: Effect of ICF-based early progressive mobilization on severe aneurysmal subarachnoid hemorrhage in the NICU. Front Neurol 2022; 13:951071. [PMID: 36588882 PMCID: PMC9794623 DOI: 10.3389/fneur.2022.951071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Aneurysmal subarachnoid hemorrhage (aSAH) is a type of stroke that occurs due to a ruptured intracranial aneurysm. Although advanced therapies have been applied to treat aSAH, patients still suffer from functional impairment leading to prolonged stays in the NICU. The effect of early progressive mobilization as an intervention implemented in the ICU setting for critically ill patients remains unclear. Methods This retrospective study evaluated ICF-based early progressive mobilization's validity, safety, and feasibility in severe aSAH patients. Sixty-eight patients with aSAH with Hunt-Hess grades III-IV were included. They were divided into two groups-progressive mobilization and passive movement. Patients in the progressive mobilization group received progressive ICF-based mobilization intervention, and those in the passive movement group received passive joint movement training. The incidence of pneumonia, duration of mechanical ventilation, length of NICU stay, and incidence of deep vein thrombosis were evaluated for validity. In contrast, the incidence of cerebral vasospasm, abnormally high ICP, and other safety events were assessed for safety. We also described the feasibility of the early mobilization initiation time and the rate of participation at each level for patients in the progressive mobilization group. Results The results showed that the incidence of pneumonia, duration of mechanical ventilation, and length of NICU stay were significantly lower among patients in the progressive mobilization group than in the passive movement group (P = 0.031, P = 0.004, P = 0.012), but the incidence of deep vein thrombosis did not significantly differ between the two groups. Regarding safety, patients in the progressive mobilization group had a lower incidence of cerebral vasospasm than those in the passive movement group. Considering the effect of an external ventricular drain on cerebral vasospasm (P = 0.015), we further analyzed those patients in the progressive mobilization group who had a lower incidence of cerebral vasospasm in patients who did not have an external ventricular drain (P = 0.011). Although we found 2 events of abnormally increased intracranial pressure in the progressive mobilization group, there was no abnormal decrease in cerebral perfusion pressure in the 2 events. In addition, among other safety events, there was no difference in the occurrence of adverse events between the two groups (P = 0.073), but the number of potential adverse events was higher in the progressive mobilization group (P = 0.001). Regarding feasibility, patients in the progressive mobilization group were commonly initiated 72 h after admission to the NICU, and 47.06% were in the third level of the mobilization protocol. Discussion We conclude that the ICF-based early progressive mobilization protocol is an effective and feasible intervention tool. For validity, more mobilization interventions might lead to less pneumonia, duration of mechanical ventilation and length of stay for patients with severe aSAH in the NICU, Moreover, it is necessary to pay attention over potential adverse events (especially line problems), although we did not find serious safety events.
Collapse
Affiliation(s)
- Xiaolong Yang
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lei Cao
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Tiantian Zhang
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Qu
- Intensive Care Unit, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenjin Chen
- Intensive Care Unit, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weitao Cheng
- Intensive Care Unit, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Meng Qi
- Intensive Care Unit, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Na Wang
- Intensive Care Unit, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China,*Correspondence: Weiqun Song
| | - Ning Wang
- Intensive Care Unit, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China,Ning Wang
| |
Collapse
|
19
|
Bach C, Hetland B. A Step Forward for Intensive Care Unit Patients: Early Mobility Interventions and Associated Outcome Measures. Crit Care Nurse 2022; 42:13-24. [DOI: 10.4037/ccn2022459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background
Critical illness survivors have impairments across physical, psychological, and cognitive health domains known as post–intensive care syndrome. Although physical activity can improve outcomes across all health domains, most intensive care unit early mobility studies focus solely on physical outcomes.
Objective
To explore the role of early mobility for adult patients in the intensive care unit by analyzing early mobility intervention studies with physical, psychological, or cognitive outcome measures.
Methods
This integrative review used Whittemore and Knafl’s methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, Embase, PubMed, PsycINFO, and Scopus databases were searched for primary research articles published from 2005 through 2021 on adult intensive care unit early mobility interventions evaluated by physical, cognitive, or psychological outcome measures during or after intervention delivery. Interventions comprising only passive mobility were excluded.
Results
Of 1009 articles screened, 20 were included. Variations in outcome measures, measurement timing, instruments, and control groups made synthesis difficult. No study evaluated an intervention using outcome measures from all 3 health domains. Five studies measured physical and cognitive outcomes; 6 studies measured physical and psychological outcomes.
Conclusion
Early mobility is primarily addressed objectively and unidimensionally, limiting understanding of the implications of early mobility for patients. Post–intensive care syndrome prevention begins in the intensive care unit; early mobility is a promising intervention for targeting multiple risk factors. Studies that measure outcomes in all health domains during or after early mobility are needed to better evaluate the comprehensive effects of early mobility.
Collapse
Affiliation(s)
- Christina Bach
- Christina Bach is a PhD student and research assistant at the University of Nebraska Medical Center College of Nursing and a staff nurse and relief lead in the oncology intensive care unit at Nebraska Medicine in Omaha, Nebraska
| | - Breanna Hetland
- Breanna Hetland is an assistant professor at the University of Nebraska Medical Center College of Nursing and a critical nurse scientist at Nebraska Medicine in Omaha
| |
Collapse
|
20
|
Caba LW, Goldin D, Marenus MW. Promoting Nurse-Led Mobility Protocols for Hospitalized Older Adults: A Systematic Review. J Gerontol Nurs 2022; 48:24-30. [PMID: 35771066 DOI: 10.3928/00989134-20220606-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hospitalized older adults (aged ≥65 years) are at risk for functional decline and negative outcomes associated with immobility, such as pressure injuries and falls. There is a paucity of research that examines impacts of mobility interventions in older adults in medical surgical units. The current systematic review examines the impact of mobility-related interventions in this population. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided this review. Eligibility determination and data extraction, synthesis, and evaluation were independently performed by the authors. Findings revealed that older adult patients who participated in mobility protocols or early mobility programs were mobilized significantly more and were more mobile after discharge. Several studies also showed reduced hospital length of stay (LOS). The literature supports mobility programs as interventions that can have significant impacts on mobilization for medical surgical patients and reduce hospital LOS. [Journal of Gerontological Nursing, 48(7), 24-30.].
Collapse
|
21
|
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.
Collapse
|
22
|
Lall A, Behan D. Mobilizing Ventilated Neurosurgery Patients: An Integrative Literature Review. J Neurosci Nurs 2022; 54:13-18. [PMID: 34864793 DOI: 10.1097/jnn.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT BACKGROUND: Lack of mobilization in ventilated neurosurgery patients is problematic due to significant consequences. Although early mobility addresses these complications, few studies have been conducted in this population, resulting in infrequent mobilization efforts. Nurses prioritize and implement patient care interventions, including mobilization, with multidisciplinary teams. This integrative literature review examines what is known regarding nursing perceptions on mobilization and their role within a multidisciplinary team for mobilization in ventilated neurosurgery patients. METHODS: A comprehensive literature search was conducted using online databases to identify research articles on early mobility studies in ventilated critically ill and neurosurgical patients from 2010 to 2020. RESULTS: Twenty studies were identified and indicated a paucity of research specific to mobilizing ventilated neurosurgery patients. Nurses understand the purpose and benefits of early mobility in critically ill and mechanically ventilated patients. Mixed perceptions exist regarding the responsibility for prioritizing and initiating mobilization. Main barriers include patient safety concerns, untimeliness due to limited resources, unit culture, lack of nursing knowledge, and need for improved teamwork. Associations between teamwork-based interventions and decreased length of stay, increased rates of mobility, and faster time to early mobilization exist. Nurse-led interventions showed additional benefits including positive perceptions such as empowerment, confidence, increased knowledge, and a progressive shift in unit culture. CONCLUSION: This review demonstrates a continued need for understanding nursing perceptions and role in teamwork to mobilize ventilated neurosurgery patients. Future research should focus on testing nurse-led mobility interventions so higher rates of mobilization and provision of holistic patient care can be achieved.
Collapse
|
23
|
Mukpradab S, Mitchell M, Marshall AP. An Interprofessional Team Approach to Early Mobilisation of Critically Ill Adults: An Integrative Review. Int J Nurs Stud 2022; 129:104210. [DOI: 10.1016/j.ijnurstu.2022.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
|
24
|
Rezvani H, Esmaeili M, Maroufizadeh S, Rahimi B. The Effect of Early Mobilization on Respiratory Parameters of Mechanically Ventilated Patients With Respiratory Failure. Crit Care Nurs Q 2021; 45:74-82. [PMID: 34818300 DOI: 10.1097/cnq.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The effect of early mobilization on hemodynamic parameters of patients under mechanical ventilation has been associated with positive results and yet its effect on specific respiratory parameters is less well appreciated. This article reports the results of a study of a randomized clinical trial of intensive care unit patients receiving mechanical ventilation. The findings of this study confirmed that a 4-step protocol for early mobilization can improve Pao2, O2 saturation, Pao2/Fio2 (fraction of inspired oxygen) ratio, and pulmonary compliance. The value of interdisciplinary collaboration supporting early mobilization was confirmed.
Collapse
Affiliation(s)
- Hamid Rezvani
- School of Nursing and Midwifery (Mr Rezvani), Nursing and Midwifery Care Research Center, School of Nursing and Midwifery (Dr Esmaeili), and Advanced Thoracic Research Center (Dr Rahimi), Tehran University of Medical Sciences, Tehran, Iran; and Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran (Dr Maroufizadeh)
| | | | | | | |
Collapse
|
25
|
Weinberger J, Cocoros N, Klompas M. Ventilator-Associated Events: Epidemiology, Risk Factors, and Prevention. Infect Dis Clin North Am 2021; 35:871-899. [PMID: 34752224 DOI: 10.1016/j.idc.2021.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The Centers for Disease Control and Prevention shifted the focus of safety surveillance in mechanically ventilated patients from ventilator-associated pneumonia to ventilator-associated events in 2013 to increase the objectivity and reproducibility of surveillance and to encourage quality improvement programs to focus on preventing a broader array of complications. Ventilator-associated events are associated with a doubling of the risk of dying. Prospective studies have found that minimizing sedation, increasing spontaneous awakening and breathing trials, and conservative fluid management can decrease event rates and the duration of ventilation. Multifaceted interventions to enhance these practices can decrease ventilator-associated event rates.
Collapse
Affiliation(s)
- Jeremy Weinberger
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Street, Suite 401, Boston, MA 02215, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, 200 Washington Street, Boston, MA 02111, USA
| | - Noelle Cocoros
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Street, Suite 401, Boston, MA 02215, USA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Street, Suite 401, Boston, MA 02215, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
26
|
Mate K, Fulmer T, Pelton L, Berman A, Bonner A, Huang W, Zhang J. Evidence for the 4Ms: Interactions and Outcomes across the Care Continuum. J Aging Health 2021; 33:469-481. [PMID: 33555233 PMCID: PMC8236661 DOI: 10.1177/0898264321991658] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives: An expert panel reviewed and summarized the literature related to the evidence for the 4Ms-what matters, medication, mentation, and mobility-in supporting care for older adults. Methods: In 2017, geriatric experts and health system executives collaborated with the Institute for Healthcare Improvement (IHI) to develop the 4Ms framework. Through a strategic search of the IHI database and recent literature, evidence was compiled in support of the framework's positive clinical outcomes. Results: Asking what matters from the outset of care planning improved both psychological and physiological health statuses. Using screening protocols such as the Beers' criteria inhibited overprescribing. Mentation strategies aided in prevention and treatment. Fall risk and physical function assessment with early goals and safe environments allowed for safe mobility. Discussion: Through a framework that reduces cognitive load of providers and improves the reliability of evidence-based care for older adults, all clinicians and healthcare workers can engage in age-friendly care.
Collapse
Affiliation(s)
- Kedar Mate
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Terry Fulmer
- The John A. Hartford Foundation, New York, NY, USA
| | - Leslie Pelton
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Amy Berman
- The John A. Hartford Foundation, New York, NY, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Cambridge, MA, USA
| | - Wendy Huang
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Jinghan Zhang
- Columbia University Mailman School of Public Health, New York, NY, USA
| |
Collapse
|
27
|
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.
Collapse
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
| |
Collapse
|
28
|
Kresevic D, Pettis JL. Acute care for elders (ACE) units - ensuring age-friendly interdisciplinary care for older. Geriatr Nurs 2021; 42:776-779. [PMID: 34006402 DOI: 10.1016/j.gerinurse.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Denise Kresevic
- University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106 USA.
| | - Jennifer L Pettis
- Acting Director, Programs, NICHE, NYU Meyers College of Nursing, 380 Second Avenue, Suite 306, New York, NY 10010 USA.
| |
Collapse
|
29
|
Development and Implementation of Pediatric ICU-based Mobility Guidelines: A Quality Improvement Initiative. Pediatr Qual Saf 2021; 6:e414. [PMID: 34046543 PMCID: PMC8143751 DOI: 10.1097/pq9.0000000000000414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is available in the text. Critical illness results in physical impairments which may be mitigated by intensive care unit (ICU)-based early mobility. This initiative aimed to develop and implement ICU-based mobility guidelines for critically ill children.
Collapse
|
30
|
Zink EK, Kumble S, Beier M, George P, Stevens RD, Bahouth MN. Physiological Responses to In-Bed Cycle Ergometry Treatment in Intensive Care Unit Patients with External Ventricular Drainage. Neurocrit Care 2021; 35:707-713. [PMID: 33751389 PMCID: PMC7983346 DOI: 10.1007/s12028-021-01204-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/30/2021] [Indexed: 01/02/2023]
Abstract
Purpose Evidence suggests that early physical activity can be accomplished safely in the neurocritical care unit (NCCU); however, many NCCU patients are often maintained in a state of inactivity due to impaired consciousness, sensorimotor deficits, and concerns for intracranial pressure elevation or cerebral hypoperfusion in the setting of autoregulatory failure. Structured in-bed mobility interventions have been proposed to prevent sequelae of complete immobility in such patients, yet the feasibility and safety of these interventions is unknown. We studied neurological and hemodynamic changes before and after cycle ergometry (CE) in a subset of NCCU patients with external ventricular drains (EVDs). Methods Patients admitted to the NCCU who had an EVD placed for cerebrospinal fluid drainage and intracranial pressure (ICP) monitoring underwent supine CE therapy with passive and active cycling settings. Neurologic status, ICP and hemodynamic parameters were monitored before and after each CE session. Results Twenty-seven patients successfully underwent in-bed CE in the NCCU. No clinically significant changes were recorded in neurologic or in physiological parameters before or after CE. There were no device dislodgements or other adverse effects requiring cessation of a CE session. Conclusion These data suggest that supine CE in a heterogeneous cohort of neurocritical care patients with EVDs is safe and tolerable. Larger prospective studies are needed to determine the efficacy and optimal dose and timing of supine CE in neurocritical care patients.
Collapse
Affiliation(s)
- Elizabeth K Zink
- Department of Neurosciences Nursing, The Johns Hopkins Hospital, 1800 Orleans Street, Zayed 3 West, Room 3074, Baltimore, MD, 21287, USA. .,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Sowmya Kumble
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Meghan Beier
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Pravin George
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
| | - Robert D Stevens
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mona N Bahouth
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
31
|
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: 17] [Impact Index Per Article: 4.3] [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.
Collapse
|
32
|
Nieto-García L, Carpio-Pérez A, Moreiro-Barroso MT, Alonso-Sardón M. Can an early mobilisation programme prevent hospital-acquired pressure injures in an intensive care unit?: A systematic review and meta-analysis. Int Wound J 2020; 18:209-220. [PMID: 33236855 PMCID: PMC8244014 DOI: 10.1111/iwj.13516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 12/23/2022] Open
Abstract
A systematic review and meta-analysis were conducted to clarify the effect of an early mobilisation programme on the prevention of hospital-acquired pressure injuries in an intensive care unit as opposed to standard care. We searched a total of 11 databases until 1 May 2020 and included seven studies (n = 7.520) related to the effect of early mobilisation protocol in the prevention of hospital-acquired pressure injuries (five quasi-experimental and two random comparative). The five quasi-experimental studies were significantly heterogeneous (P = .02 for Q test and 66% for I2 ), and the odds ratio was 0.97 (95% CI: 0.49-1.91) with a non-significant statistical difference between both groups (P = .93). Our study shows inconclusive outcomes related to the effect of the implementation of an early mobility programme in the prevention of pressure injuries in critical patients. Future research is needed considering the small number of articles on the topic.
Collapse
Affiliation(s)
| | - Adela Carpio-Pérez
- Institute for Biomedical Research of Salamanca (IBSAL), Tropical Disease Research Centre of the University of Salamanca (CIETUS), Salamanca, Spain.,Internal Medicine Service, University Hospital of Salamanca, Salamanca, Spain
| | | | - Montserrat Alonso-Sardón
- Preventive Medicine and Public Health Area, Institute for Biomedical Research of Salamanca (IBSAL), Tropical Disease Research Centre of the University of Salamanca (CIETUS), Salamanca, Spain
| |
Collapse
|
33
|
Alderden JG, Shibily F, Cowan L. Best Practice in Pressure Injury Prevention Among Critical Care Patients. Crit Care Nurs Clin North Am 2020; 32:489-500. [PMID: 33129409 DOI: 10.1016/j.cnc.2020.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pressure injuries are areas of damage to the skin and underlying tissue caused by pressure or pressure in combination with shear. Pressure injury prevention in the critical care population necessitates risk assessment, selection of appropriate preventive interventions, and ongoing assessment to determine the adequacy of the preventive interventions. Best practices in preventive interventions among critical care patients, including skin and tissue assessment, skin care, repositioning, nutrition, support surfaces, and early mobilization, are described. Unique considerations in special populations including older adults and individuals with obesity are also addressed.
Collapse
Affiliation(s)
- Jenny G Alderden
- University of Utah College of Nursing, 10 2000 East, Salt Lake City, UT 84112, USA.
| | - Faygah Shibily
- Faculty of Nursing, King Abdulaziz University, P.O.Box 42828, Jeddah 21551, Saudi Arabia
| | - Linda Cowan
- VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital and Clinics, 13000 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
| |
Collapse
|
34
|
Yasmeen I, Krewulak KD, Grant C, Stelfox HT, Fiest KM. The Effect of Caregiver-Mediated Mobility Interventions in Hospitalized Patients on Patient, Caregiver, and Health System Outcomes: A Systematic Review. Arch Rehabil Res Clin Transl 2020; 2:100053. [PMID: 33543080 PMCID: PMC7853382 DOI: 10.1016/j.arrct.2020.100053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To synthesize the evidence examining caregiver-mediated mobility interventions in a hospital setting and whether they improve patient, caregiver, or health system outcomes. DATA SOURCES We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases from inception to September 7, 2018. STUDY SELECTION Two reviewers independently selected original research in inpatient settings that reported on an intervention delivered by a caregiver (eg, family, friend, paid worker) and directed to the patient's mobility. Mobility interventions were categorized based on the level of caregiver engagement using a 3-category framework: inform (provision of education on patient's condition and management), activate (prompting caregivers to take action in patient care), and collaborate (encouraging interaction with providers or other caregivers). DATA EXTRACTION One reviewer extracted data, and another checked the data. Quality was assessed using the Cochrane Collaboration's risk of bias tool and Grading of Recommendations, Assessment, Development and Evaluation approach. DATA SYNTHESIS Forty studies met the inclusion criteria; most were randomized controlled trials (n=16/40, 40.0%) and investigated older adults (n=18/40, 45.0%) with stroke (n=20/40, 50.0%). Inform (n=2) and activate (n=4) interventions and combined inform-activate (n=5/6, 83.3%) and inform-activate-collaborate (n=6/10, 60.0%) interventions were reported to improve patient mobility. Inform-activate and inform-collaborate interventions were reported to improve caregiver outcomes (eg, burden) (n=13/19, 68.4%). Studies that engaged caregivers in all 3 strategies (inform-activate-collaborate) were reported to improve health system outcomes (eg, hospital readmission) (n=4/6, 66.7%). Most studies were of unclear (n=22/40, 55.0%) or low risk of bias (n=11/40, 27.5%) for most domains. CONCLUSIONS Engaging caregivers in mobility of hospitalized patients may improve patient mobility as well as caregiver and health system outcomes.
Collapse
Affiliation(s)
- Israt Yasmeen
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D. Krewulak
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Grant
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Kirsten M. Fiest
- Department of Critical Care Medicine, Alberta Health Services and Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
35
|
Lisanti AJ, Helman S, Sorbello A, Fitzgerald J, D'Amato A, Zhang X, Gaynor JW. Holding and Mobility of Pediatric Patients With Transthoracic Intracardiac Catheters. Crit Care Nurse 2020; 40:16-24. [PMID: 32737488 DOI: 10.4037/ccn2020260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Nursing care of pediatric patients after cardiac surgery consists of close hemodynamic monitoring, often through transthoracic intracardiac catheters, requiring patients to remain on bed rest and limiting holding and mobility. OBJECTIVES The primary aim of this quality improvement project was to determine the feasibility of safely mobilizing pediatric patients with transthoracic intracardiac catheters out of bed. Once feasibility was established, the secondary aim was to increase the number of days such patients were out of bed. METHODS AND INTERVENTIONS New standards and procedures were implemented in July 2015 for pediatric patients with transthoracic intracardiac catheters. After initiation of the new policies, complications were tracked prospectively. Nursing documentation of activity and positioning for all patients with transthoracic intracardiac catheters was extracted from electronic health records for 2 fiscal years before and 3 fiscal years after the new policies were implemented. The Cochran-Armitage test for trend was used to determine whether patterns of out-of-bed documentation changed over time. RESULTS A total of 1358 patients (approximately 250 to 300 patients each fiscal year) had activity and positioning documented while transthoracic intracardiac catheters were in place. The Cochran-Armitage test for trend revealed that out-of-bed documentation significantly increased after the new policies and procedures were initiated (P < .001). No major complications were noted resulting from patient mobility with transthoracic intracardiac catheters. CONCLUSION Pediatric patients with transthoracic intracardiac catheters can be safely held and mobilized out of bed.
Collapse
Affiliation(s)
- Amy Jo Lisanti
- Amy Jo Lisanti is a nurse scientist - clinical nurse specialist, Cardiac Nursing and the Center for Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia and Adjunct Assistant Professor of Nursing, University of Pennsylvania, School of Nursing. She was a Ruth L. Kirschstein National Research Service Award Postdoctoral fellow, University of Pennsylvania School of Nursing, while this work was performed
| | - Stephanie Helman
- Stephanie Helman was a clinical nurse specialist in the cardiac intensive care unit, Children's Hospital of Philadelphia, while this work was performed. She is currently a doctoral student at the University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Andrea Sorbello
- Andrea Sorbello is a nurse practitioner in the cardiac intensive care unit, Jamie Fitzgerald and Annemarie D'Amato are quality improvement advisors, Xuemei Zhang is a biostatistician in the Cardiac Center Research Core, and J. William Gaynor is a professor of surgery in the Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Philadelphia
| | - Jamie Fitzgerald
- Andrea Sorbello is a nurse practitioner in the cardiac intensive care unit, Jamie Fitzgerald and Annemarie D'Amato are quality improvement advisors, Xuemei Zhang is a biostatistician in the Cardiac Center Research Core, and J. William Gaynor is a professor of surgery in the Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Philadelphia
| | - Annemarie D'Amato
- Andrea Sorbello is a nurse practitioner in the cardiac intensive care unit, Jamie Fitzgerald and Annemarie D'Amato are quality improvement advisors, Xuemei Zhang is a biostatistician in the Cardiac Center Research Core, and J. William Gaynor is a professor of surgery in the Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Philadelphia
| | - Xuemei Zhang
- Andrea Sorbello is a nurse practitioner in the cardiac intensive care unit, Jamie Fitzgerald and Annemarie D'Amato are quality improvement advisors, Xuemei Zhang is a biostatistician in the Cardiac Center Research Core, and J. William Gaynor is a professor of surgery in the Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Philadelphia
| | - J William Gaynor
- Andrea Sorbello is a nurse practitioner in the cardiac intensive care unit, Jamie Fitzgerald and Annemarie D'Amato are quality improvement advisors, Xuemei Zhang is a biostatistician in the Cardiac Center Research Core, and J. William Gaynor is a professor of surgery in the Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Philadelphia
| |
Collapse
|
36
|
Osis SL, Diccini S. Incidence and risk factors associated with pressure injury in patients with traumatic brain injury. Int J Nurs Pract 2020; 26:e12821. [PMID: 31994827 PMCID: PMC9285356 DOI: 10.1111/ijn.12821] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/22/2019] [Accepted: 01/06/2020] [Indexed: 02/04/2023]
Abstract
AIM To identify the prevalence of pressure injury in patients diagnosed with traumatic brain injury and analyse the risk factors involved during hospitalization. METHODS This was a prospective study evaluating patients who were diagnosed with traumatic brain injury between November 2013 and September 2014. Patient characteristics, clinical and metabolic factors and therapeutic interventions, were evaluated within 30 days of hospital admission. RESULTS Most of the 240 patients included in the study were male, young, and non-Caucasian. The incidence of pressure injury was 18.8%. In terms of severity classification, the incidence of pressure injury was 2.7%, 23.2%, and 42.6% in mild, moderate, and severe traumatic brain injury, respectively. Pressure injury development was more likely in the first 10 days of hospitalization. A moderate or severe traumatic brain injury classification, the use of noradrenaline, and older age were pressure injury risk factors. The presence of pressure injury was associated with mortality within 30 days of hospitalization (P < .001). CONCLUSION The incidence of pressure injury was high in patients diagnosed with traumatic brain injury, especially in those whose injury was classified as severe. Older age, noradrenaline use, and a classification of moderate or severe traumatic brain injury were identified as pressure injury risk factors.
Collapse
Affiliation(s)
- Sibila Lilian Osis
- School of NursingState University of Amazonas, Brazilian Association Critical Care NursesManausBrazil
| | - Solange Diccini
- School of NursingFederal University of São PauloSão PauloBrazil
| |
Collapse
|
37
|
Colwell BRL, Olufs E, Zuckerman K, Kelly SP, Ibsen LM, Williams CN. PICU Early Mobilization and Impact on Parent Stress. Hosp Pediatr 2020; 9:265-272. [PMID: 30914449 DOI: 10.1542/hpeds.2018-0155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Early mobilization of critically ill children may improve outcomes, but parent refusal of mobilization therapies is an identified barrier. We aimed to evaluate parent stress related to mobilization therapy in the PICU. METHODS We conducted a cross-sectional survey to measure parent stress and a retrospective chart review of child characteristics. Parents or legal guardians of children admitted for ≥1 night to an academic, tertiary-care PICU who were proficient in English or Spanish were surveyed. Parents were excluded if their child's death was imminent, child abuse or neglect was suspected, or there was a contraindication to child mobilization. RESULTS We studied 120 parent-child dyads. Parent mobilization stress was correlated with parent PICU-related stress (rs [119] = 0.489; P ≤ .001) and overall parent stress (rs [110] = 0.272; P = .004). Increased parent mobilization stress was associated with higher levels of parent education, a lower baseline child functional status, more strenuous mobilization activities, and mobilization therapies being conducted by individuals other than the children's nurses (all P < .05). Parents reported mobilization stress from medical equipment (79%), subjective pain and fragility concerns (75%), and perceived dyspnea (24%). Parent-reported positive aspects of mobilization were clinical improvement of the child (70%), parent participation in care (46%), and increased alertness (38%). CONCLUSIONS Parent mobilization stress was correlated with other measures of parent stress and was associated with child-, parent-, and therapy-related factors. Parents identified positive and stressful aspects of mobilization therapy that can guide clinical care and educational interventions aimed at reducing parent stress and improving the implementation of mobilization therapies.
Collapse
Affiliation(s)
- Blair R L Colwell
- Division of Pediatric Critical Care, Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Erin Olufs
- University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | | | | | - Laura M Ibsen
- Oregon Health and Science University, Portland, Oregon
| | | |
Collapse
|
38
|
Executive Summary: Post-Intensive Care Syndrome in the Neurocritical Intensive Care Unit. J Neurosci Nurs 2020; 51:158-161. [PMID: 30964847 DOI: 10.1097/jnn.0000000000000438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Early Progressive Mobilization of Patients with External Ventricular Drains: Safety and Feasibility. Neurocrit Care 2020; 30:414-420. [PMID: 30357597 DOI: 10.1007/s12028-018-0632-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND/OBJECTIVE Early mobilization of critically ill patients has been shown to improve functional outcomes. Neurosurgery patients with an external ventricular drain (EVD) due to increased intracranial pressure often remain on bed rest while EVD remains in place. The prevalence of mobilizing patients with EVD has not been described, and the literature regarding the safety and feasibility of mobilizing patients with EVDs is limited. The aim of our study was to describe the outcomes and adverse events of the first mobilization attempt in neurosurgery patients with EVD who participated in early functional mobilization with physical therapy or occupational therapy. METHODS We performed a single-site, retrospective chart review of 153 patients who underwent placement of an EVD. Hemodynamically stable patients deemed appropriate for mobilization by physical or occupational therapy were included. Mobilization and activity details were recorded. RESULTS The most common principal diagnoses were subarachnoid hemorrhage (61.4%) and intracerebral hemorrhage (17.0%) requiring EVD for symptomatic hydrocephalus. A total of 117 patients were mobilized (76.5%), and the median time to first mobilization after EVD placement in this group of 117 patients was 38 h. Decreased level of consciousness was the most common reason for lack of mobilization. The highest level of mobility on the patient's first attempt was ambulation (43.6%), followed by sitting on the side of the bed (30.8%), transferring to a bedside chair (17.1%), and standing up from the side of the bed (8.5%). No major safety events, such as EVD dislodgment, occurred in any patient. Transient adverse events with mobilization were infrequent at 6.9% and had no permanent neurological sequelae and were mostly headache, nausea, and transient diastolic blood pressure elevation. CONCLUSION Early progressive mobilization of neurosurgical intensive care unit patients with external ventricular drains appears safe and feasible.
Collapse
|
40
|
Kayser SA, Wiggermann NE, Kumpar D. Factors associated with safe patient handling practice in acute care and its relationship with patient mobilization: A cross-sectional study. Int J Nurs Stud 2019; 104:103508. [PMID: 32105973 DOI: 10.1016/j.ijnurstu.2019.103508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Mobilizing hospital patients is associated with improved outcomes and shorter length of stay. Safe patient handling and mobility programs that include mechanical lift use facilitate mobilizing patients and reduce the likelihood of musculoskeletal disorders in staff. However, there is little information on the prevalence of lift use or why some patients are more likely to have a lift used than others. Such information is needed to inform public policy, benchmark lift use over time, and contextualize barriers for lift use. OBJECTIVE To determine the percentage of patients that had a lift used during care in US acute care facilities, identify attributes related to the patient and their hospital stay that affect the lift use, examine whether state legislation increased lift use, and determine whether lift use was correlated with more frequent mobilization out of bed. DESIGN Retrospective analysis of the 2018 International Pressure Ulcer Prevalence ™ data. PARTICIPANTS 40,856 patients in 642 US acute care hospitals over the age of 18 with complete data. METHODS Lift use prevalence was calculated as the percentage of patients that met inclusion criteria that had a lift used for care. Prevalence was then analyzed by patient mobility level. A logistic regression examined the influence of patient and facility related attributes. For patients with limited mobility (that could not stand or turn themselves), a t-test of proportions evaluated whether lift use during a patient's stay was correlated with an increased likelihood of being out of bed at the time of the survey. RESULTS 3.7% of patients had a lift used during their care. 11.1% of limited mobility patients had a lift used. Lift use was associated with higher body mass, longer length of stay, lower Braden score, pressure injury prevention methods in place, being in an intensive care unit, being in a smaller hospital, and being in a state with safe patient handling and mobility legislation. Limited mobility patients moved with lifts during their stay were more likely to be observed in a bedside chair and less likely to be observed in bed, as compared to patients that never had a lift used. CONCLUSIONS Despite the benefits to patients and caregivers, US acute care facilities are largely not using lifts to safely mobilize patients. Results suggested that safe patient handling and mobility legislation has increased the rate of lift use. Finally, lift use was correlated with patients being mobilized out of bed.
Collapse
Affiliation(s)
- Susan A Kayser
- Hill-Rom Holdings, Inc., 1069 State Road 46 East, Batesville, IN 47006, United States.
| | - Neal E Wiggermann
- Hill-Rom Holdings, Inc., 1069 State Road 46 East, Batesville, IN 47006, United States.
| | - Dee Kumpar
- Hill-Rom Holdings, Inc., 1069 State Road 46 East, Batesville, IN 47006, United States.
| |
Collapse
|
41
|
Yen HC, Jeng JS, Chen WS, Pan GS, Chuang Pt Bs WY, Lee YY, Teng T. Early Mobilization of Mild-Moderate Intracerebral Hemorrhage Patients in a Stroke Center: A Randomized Controlled Trial. Neurorehabil Neural Repair 2019; 34:72-81. [PMID: 31858865 DOI: 10.1177/1545968319893294] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Few studies have addressed early out-of-bed mobilization specifically in acute intracerebral hemorrhage (ICH) patients. Patient benefit in such cases is unclear, with early intervention timing and duration identical to those in standard care. Objective. We investigated the efficacy of an early mobilization (EM) protocol, administered within 24 to 72 hours of stroke onset, for early functional independence in mild-moderate ICH patients. Methods. Sixty patients admitted to a stroke center within 24 hours of ICH were randomly assigned to early mobilization (EM) or standard early rehabilitation (SER). The EM group underwent an early out-of-bed mobilization protocol, while the SER group underwent a standard protocol focusing on in-bed training in the stroke center. Intervention in both groups lasted 30 minutes per session, once a day, 5 days a week. Motor subscales of the Functional Independence Measure (FIM-motor; primary outcome), Postural Assessment Scale for Stroke Patients, and Functional Ambulation Category (FAC) were evaluated (assessor-blinded) at baseline, and at 2 weeks, 4 weeks, and 3 months after stroke. Length of stay in the stroke center was also recorded. Results. The EM group showed significant improvement in FIM-motor score at all evaluated time points (P = .004) and in FAC outcomes at 2 weeks (P = .033) and 4 weeks (P = .011) after stroke. Length of stay in the stroke center was significantly shorter for the EM group (P = .004). Conclusion. Early out-of-bed mobilization via rehabilitation in a stroke center, within 24 to 72 hours of ICH, may improve early functional independence compared with standard early rehabilitation. Clinical Trial Registration: NCT03292211.
Collapse
Affiliation(s)
- Hsiao-Ching Yen
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center & Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Guan-Shuo Pan
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Ying Chuang Pt Bs
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ting Teng
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| |
Collapse
|
42
|
Yayla A, Özer N. Effects of early mobilization protocol performed after cardiac surgery on patient care outcomes. Int J Nurs Pract 2019; 25:e12784. [PMID: 31617651 DOI: 10.1111/ijn.12784] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 12/26/2022]
Abstract
AIM This study aimed to determine the effects of an early mobilization protocol performed in patients who underwent cardiac surgery on post-operative outcomes. BACKGROUND Post-operative complications are common in patients undergoing cardiac surgery. Early mobilization is recommended for patients who undergo cardiac surgery to prevent complications and achieve successful outcomes in post-operative care. DESIGN The study design was quasi-experimental with a control group. METHODS Participants were patients who underwent cardiac surgery between January and October 2015. The study included 102 patients (51 patients each in the experimental and control groups). The introductory characteristics form, the Richards-Campbell Sleep Questionnaire (RCSQ), duration of hospital stay (post-operatively), and development of a post-operative late complications form were used to collect data. RESULTS The study results revealed that patients in the experimental group had better improvement in RCSQ scores, shorter duration of hospitalization, and fewer late complications after surgery than patients in the control group. CONCLUSION Early mobilization is feasible in adult cardiac surgery patients and has significant benefits. More research is recommended into the effectiveness of early mobilization in different patient groups.
Collapse
Affiliation(s)
- Ayşegül Yayla
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
| | - Nadiye Özer
- Department of Surgical Nursing, Faculty of Nursing, Atatürk University, Erzurum, Turkey
| |
Collapse
|
43
|
Impact of Early Mobilization in the Intensive Care Unit on Psychological Issues. Crit Care Nurs Clin North Am 2019; 31:501-505. [PMID: 31685116 DOI: 10.1016/j.cnc.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Early mobilization is an intervention protocol that can be employed in the critically ill population to effectively reduce the risks and consequences normally associated with immobility in high-acuity patients. In turn, rate and quality of recovery are improved as well as overall patient outcomes. Although there are many challenges inherent to the implementation of an early mobilization program, success of such a program is achievable through structured education of staff and diligence in its application. As a result, staff and patient experience the benefits of medical treatment that addresses a patient's immediate needs without ignoring that treatment's long-term effect.
Collapse
|
44
|
Abstract
BACKGROUND Safe Patient Handling and Mobility (SPHM) programs reduce staff injuries from lifting and repositioning patients. Early Mobility programs improve many patient-centered outcomes. Reframing SPHM equipment as mobilization tools can help safely mobilize hospitalized patients to their highest abilities. PROBLEM Combining SPHM and Early Mobility programs is logical, but to date, no one has articulated the process of integration. INTERVENTION A quality improvement process was developed at the Phoenix Veterans Affairs Health Care System to integrate an Early Exercise and Progressive Mobility initiative in the intensive care unit into an ongoing SPHM program using the Iowa Model for Evidence-Based Implementation. RESULTS Integration of these programs was possible through extensive collaboration between stakeholders throughout planning, implementation, and refinement phases. Interdisciplinary Early Exercise and Progressive Mobility simulation training, standardized assessment, communication of patient status, and appropriate equipment use facilitated staff confidence to safely mobilize patients. CONCLUSIONS Successful integration of Early Exercise and Progressive Mobility and SPHM was achieved at the Phoenix Veterans Affairs Health Care System.
Collapse
|
45
|
Early Protocolized Versus Usual Care Rehabilitation for Pediatric Neurocritical Care Patients: A Randomized Controlled Trial. Pediatr Crit Care Med 2019; 20:540-550. [PMID: 30707210 PMCID: PMC7112470 DOI: 10.1097/pcc.0000000000001881] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE s: Few feasibility, safety, and efficacy data exist regarding ICU-based rehabilitative services for children. We hypothesized that early protocolized assessment and therapy would be feasible and safe versus usual care in pediatric neurocritical care patients. DESIGN Randomized controlled trial. SETTING Three tertiary care PICUs in the United States. PATIENTS Fifty-eight children between the ages of 3-17 years with new traumatic or nontraumatic brain insult and expected ICU admission greater than 48 hours. INTERVENTIONS Early protocolized (consultation of physical therapy, occupational therapy, and speech and language therapy within 72 hr ICU admission, n = 26) or usual care (consultation per treating team, n = 32). MEASUREMENTS AND MAIN RESULTS Primary outcomes were consultation timing, treatment type, and frequency of deferrals and safety events. Secondary outcomes included patient and family functional and quality of life outcomes at 6 months. Comparing early protocolized (n = 26) and usual care groups (n = 32), physical therapy was consulted during the hospital admission in 26 of 26 versus 28 of 32 subjects (p = 0.062) on day 2.4 ± 0.8 versus 7.7 ± 4.8 (p = 0.001); occupational therapy in 26 of 26 versus 23 of 32 (p = 0.003), on day 2.3 ± 0.6 versus 6.9 ± 4.8 (p = 0.001); and speech and language therapy in 26 of 26 versus 17 of 32 (p = 0.011) on day 2.3 ± 0.7 versus 13.0 ± 10.8 (p = 0.026). More children in the early protocolized group had consults and treatments occur in the ICU versus ward for all three services (all p < 0.001). Eleven sessions were discontinued early: nine during physical therapy and two during occupational therapy, none impacting patient outcome. There were no group differences in functional or quality of life outcomes. CONCLUSIONS A protocol for early personalized rehabilitation by physical therapy, occupational therapy, and speech and language therapy in pediatric neurocritical care patients could be safely implemented and led to more ICU-based treatment sessions, accelerating the temporal profile and changing composition of interventions versus usual care, but not altering the total dose of rehabilitation.
Collapse
|
46
|
|
47
|
Stout K, Ankam NS, Athar MK, Bu P, Dabbish NS, Leiby BE, Melnyk S, Shah SO, Tarkiainen A. Early Mobilization of Patients With External Ventricular Drains: Does Therapist Experience Matter? JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2019. [DOI: 10.1097/jat.0000000000000096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
48
|
Nurse-Initiated Mobilization Practices in 2 Community Intensive Care Units: A Pilot Study. Dimens Crit Care Nurs 2019; 37:318-323. [PMID: 30273218 DOI: 10.1097/dcc.0000000000000320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Critical-care nurses play a vital role in promoting safe early mobilization in intensive care unit (ICU) settings to reduce the risks associated with immobility in ICUs, including the risk of delirium, ICU-acquired weakness, and functional decline. OBJECTIVE The purposes of this study were to describe nurse-led mobilization practices in 2 community hospital ICUs and to report differences and similarities between the 2 settings. METHODS This was a cross-sectional exploratory study of 18 nurses (ICU A: n = 12, ICU B: n = 6) and 124 patients (ICU A: n = 50, ICU B: n = 74). Patient-specific therapeutic intervention needs and nurse-initiated mobilization practices were tracked over a 1-month period. RESULTS Differences in patient characteristics and nurse-led mobilization activities were observed between ICUs. After controlling for patient characteristics, we found statistically significant differences in nurse-led mobilization activities between the 2 units, suggesting that factors other than patient characteristics may explain differences in nurse-led mobilization practices.
Collapse
|
49
|
The Benefits of Implementing an Early Mobility Protocol in Postoperative Neurosurgical Spine Patients. Am J Nurs 2019; 118:46-53. [PMID: 29794923 DOI: 10.1097/01.naj.0000534851.58255.41] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Background: Despite the known benefits of early postsurgical mobility, there are no clear recommendations on early mobility among uncomplicated postoperative neurosurgical spine patients. PURPOSE The purpose of this quality improvement initiative was to establish an NP-led early mobility protocol to reduce uncomplicated postsurgical spine patients' length of stay (LOS) in the hospital and eliminate the variability of postsurgical care. A secondary objective was to educate and empower nursing staff to initiate the early mobility protocol independently and incorporate it in their practice to improve patient care. METHODS Two neurosurgery NPs led an interprofessional team to develop the early mobility protocol. Team members provided preadmission preoperative education to communicate the necessity for early mobility and provide information about the protocol. New nursing guidelines called for patient mobility on the day of surgery, within six hours of arrival on the medical-surgical unit. Nurses were empowered to get patients out of bed independently, without a physical therapy consultation; they also removed urinary catheters and discontinued IV opioids when patients' status permitted. RESULTS Over a one-year period, implementation of the protocol resulted in a nine-hour reduction in LOS per hospitalization in neurosurgical spine patients who underwent lumbar laminectomies. The protocol also allowed nurses more autonomy in patient care and was a catalyst for patient involvement in their postoperative mobility. Given the success of the protocol, it is being replicated by other surgical services throughout the organization. CONCLUSIONS This low-cost, high-reward initiative aligns with the strategic plan of the organization and ensures that high-quality, patient-centered care remains the priority. NPs in other institutions can modify this protocol to promote postoperative mobility in their organizations.
Collapse
|
50
|
Feasibility of Early, Motor-Assisted Cycle Ergometry in Critically Ill Neurological Patients With Upper Limb Weakness and Variable Cognitive Status: A Case Series. Am J Phys Med Rehabil 2019; 97:e37-e41. [PMID: 29095167 DOI: 10.1097/phm.0000000000000857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Upper limb paresis, common in many neurological conditions, is a major contributor of long-term disability and decreased quality of life. Evidence shows that repetitive, bilateral arm movement improves upper limb coordination after neurological injury. However, it is difficult to integrate upper limb interventions into very early rehabilitation of critically ill neurological patients because of patient arousal and medical acuity. This report describes the safety and feasibility of bilateral upper limb cycling in critically ill neurological patients with bilateral or unilateral paresis. Patients were included in this pilot observational series if they used upper limb cycle ergometry with occupational therapy while in the neurocritical care unit between May and August 2016. Patient demographics, neurological function, and hemodynamic status were recorded precycling and postcycling. Cycling parameters including duration and active and/or passive cycling were collected. No significant changes in hemodynamic or respiratory status were noted postintervention. No adverse effects or safety events were noted. In this series, upper limb cycle ergometry was a safe and feasible intervention for early rehabilitation in critically ill patients in the neurocritical care unit. Future studies will prospectively measure the impact of early upper limb cycle ergometry on neurological recovery and functional outcome in this population.
Collapse
|