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Ruo Yu L, Jia Jia W, Meng Tian W, Tian Cha H, Ji Yong J. Optimal timing for early mobilization initiatives in intensive care unit patients: A systematic review and network meta-analysis. Intensive Crit Care Nurs 2024; 82:103607. [PMID: 38158250 DOI: 10.1016/j.iccn.2023.103607] [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: 08/18/2023] [Revised: 11/25/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Analyse the effect of varying start times for early exercise interventions on the prevention of intensive care unit-acquired weakness. RESEARCH METHODOLOGY We conducted a comprehensive search on PubMed, Cochrane Library, Web of Science, Embase, China Biology Medicine Disc, China National Knowledge Infrastructure, Wan Fang Database, and reference lists up to May 2023. SETTING We systematically searched the literature for all randomized controlled trials on the effect of early mobilization in patients with critical illness. MAIN OUTCOME MEASURES The primary outcome assessed was the incidence of intensive care unit-acquired weakness. The secondary outcomes included: the Medical Research Council Score, the Barthel Index, duration of mechanical ventilation, length of intensive care unit stay, total length of hospital stay, mortality and incidence of intensive care unit-related complications. RESULTS The results of meta-analysis showed that compared with routine care, less than 24 hours after admission (RR = 0.44, 95 %CI: 0.28-0.68), more than 24 hours (RR = 0.33, 95 %CI: 0.16-0.67), less than 72 hours after admission (RR = 0.33, 95 %CI: 0.20-0.52) may lead to a lower incidence of intensive care unit-acquired weakness. The results of under surface cumulative ranking showed that early mobilization within 72 hours may have the lowest incidence of intensive care unit-acquired weakness (SUCRA = 81.9 %). CONCLUSIONS The current empirical evidence from intensive care unit patients suggests that initiating mobilization protocols within 24-72 hours timeframe following admission to the intensive care unit could potentially be the most beneficial strategy to reduce the incidence of intensive care unit-acquired weakness and the related medical complications. Moreover, this strategy seems to significantly improve rehabilitation and treatment outcomes for these patients. IMPLICATIONS FOR CLINICAL PRACTICE According to this study, medical and nursing staff in the intensive care unit have the chance to identify the most suitable timing for the implementation of early rehabilitative measures for patients. This can potentially prevent intensive care unit-acquired weakness and enhance various clinical outcomes for patients.
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Affiliation(s)
- Luo Ruo Yu
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Nursing, Zhejiang Chinese Medical University, Zhejiang 310053 China
| | - Wang Jia Jia
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Wang Meng Tian
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Huang Tian Cha
- Intensive Care Unit, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jing Ji Yong
- Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China; School of Nursing, Zhejiang Chinese Medical University, Zhejiang 310053 China.
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Cussen J, Mukpradab S, Tobiano G, Cooke C, Pearcy J, Marshall AP. Early mobility and family partnerships in the intensive care unit: A scoping review of reviews. Nurs Crit Care 2024; 29:597-613. [PMID: 37749618 DOI: 10.1111/nicc.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/09/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Critical illness significantly impacts the well-being of patients and families. Previous studies show that family members are willing to participate in patient care. Involving families in early mobility interventions may contribute to improved recovery and positive outcomes for patients and families. AIM In this scoping review, we investigated early mobility interventions for critically ill patients evaluated in randomized controlled trials and the extent to which family engagement in those interventions are reported in the literature. STUDY DESIGN In this scoping review of reviews, EMBASE, CINAHL, PubMed and Cochrane Central databases were searched in October 2019 and updated in February 2022. Systematic reviews were included and assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2. Data were synthesized using a narrative approach. PRISMA-ScR guidelines were adhered to for reporting. RESULTS Thirty-three reviews were included which described a range of early mobility interventions for critically ill patients; none explicitly mentioned family engagement. Almost half of the reviews were of low or critically low quality. Insufficient detail of early mobility interventions prompted information to be extracted from the primary studies. CONCLUSIONS There are a range of early mobility interventions for critically ill patients but few involve families. Given the positive outcomes of family participation, and family willingness to participate in care, there is a need to explore the feasibility and acceptability of family participation in early mobility interventions. RELEVANCE TO CLINICAL PRACTICE Family engagement in early mobility interventions for critically ill patients should be encouraged and supported. How to best support family members and clinicians in enacting family involvement in early mobility requires further investigation.
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Affiliation(s)
| | - Sasithorn Mukpradab
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Nursing, Prince of Songkla University, Thailand
| | - Georgia Tobiano
- Gold Coast Health, Queensland, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
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Farley C, Newman ANL, Hoogenes J, Brooks D, Duffett M, Kho ME. Treatment Fidelity in 94 Randomized Controlled Trials of Physical Rehabilitation in the ICU: A Scoping Review. Crit Care Med 2024; 52:717-728. [PMID: 38265271 DOI: 10.1097/ccm.0000000000006192] [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: 01/25/2024]
Abstract
OBJECTIVES Recent reviews demonstrated discordant effects of ICU-based physical rehabilitation on physical function. These inconsistencies may be related to differences in treatment fidelity-the extent to which a protocol is delivered as planned. Before evaluating the association of fidelity with outcomes, we must first understand the extent of treatment fidelity reporting in ICU-based physical rehabilitation randomized controlled trials (RCTs). DATA SOURCES Six electronic databases from inception to December 2022. STUDY SELECTION We included RCTs enrolling adults or children admitted to the ICU, if greater than or equal to 50% were invasively mechanically ventilated greater than 24 hours, and underwent an ICU-based physical rehabilitation intervention, with no limitation to comparators or outcomes. DATA EXTRACTION We screened and extracted data independently and in duplicate, with a third reviewer as needed. Extracted data included study characteristics, treatment descriptions, and the presence of National Institutes of Health Behaviour Change Consortium (NIH-BCC) treatment fidelity tool components. Treatment fidelity scores were calculated as the proportion of reported (numerator) out of total NIH-BCC components (denominator). We calculated scores across studies and by treatment group (intervention vs. comparator). We used linear regression to assess for a time trend in study treatment fidelity scores. DATA SYNTHESIS Of 20,433 citations, 94 studies met inclusion criteria. Authors reported a median (first-third quartiles) of 19% (14-26%) of treatment fidelity components across studies. Intervention group scores were higher than comparator groups (24% [19-33%] vs. 14% [5-24%], p < 0.01). We found a mean increase in study treatment fidelity scores by 0.7% (0.3 points) per year. CONCLUSIONS Only 19% of treatment fidelity components were reported across studies, with comparator groups more poorly reported. Future research could investigate ways to optimize treatment fidelity reporting and determine characteristics associated with treatment fidelity conduct in ICU-based physical rehabilitation RCTs.
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Affiliation(s)
- Christopher Farley
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Anastasia N L Newman
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jen Hoogenes
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dina Brooks
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Mark Duffett
- Departments of Pediatrics and Health Research, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
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Uhlig SE, Rodrigues MK, Oliveira MF, Tanaka C. Timing to out-of-bed mobilization and mobility levels of COVID-19 patients admitted to the ICU: Experiences in Brazilian clinical practice. Physiother Theory Pract 2024; 40:865-873. [PMID: 36562697 DOI: 10.1080/09593985.2022.2160680] [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: 09/21/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there was scarce data about clinical/functional conditions during hospitalization or after hospital discharge. Little was known about COVID-19 repercussions and how to do early mobilization in intensive care unit (ICU). OBJECTIVE Identify the time to the initiation of out-of-bed mobilization and the levels of mobility (sitting over the edge of the bed, sitting in a chair, standing, and ambulating) reached by critically ill patients with COVID-19 during hospitalization and the factors that could impact early mobilization. METHODS This was a retrospective observational study of patients with COVID-19 in the ICU. RESULTS There were 157 surviving COVID-19 patients included in the study (median age: 61 years; median ICU length of stay: 12 days). The median time to initiate out-of-bed mobilization in the ICU was 6 days; between patients who received mechanical ventilation (MV) compared with those who did not, this time was 8 vs. 2.5 days (p < .001). Most patients who used MV were mobilized after extubation (79.6%). During ICU stays, 88.0% of all patients were mobilized out of bed, and 41.0% were able to ambulate either with assistance or independently. The time to initiate out-of-bed mobilization is associated with sedation time and MV time. CONCLUSION Despite the pandemic scenario, patients were quickly mobilized out of bed, and most of the patients achieved higher mobility levels in the ICU and at hospital discharge. Sedation time and MV time were associated with delays in initiating mobilization.
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Affiliation(s)
- Suélen E Uhlig
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
| | - Miguel K Rodrigues
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
| | - Mayron F Oliveira
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
- Science Division, Exercise Science, Lyon College, Batesville, AR, USA
| | - Clarice Tanaka
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
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Li S, Cai W, Zhu P, He W, Zheng J, Fang F, Yu H. Research on multi-dimensional intelligent quantitative assessment of upper limb function based on kinematic parameters. Technol Health Care 2024:THC231076. [PMID: 38759031 DOI: 10.3233/thc-231076] [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: 05/19/2024]
Abstract
BACKGROUND Rehabilitation assessment is a critical component of rehabilitation treatment. OBJECTIVE This study focuses on a comprehensive analysis of patients' movement performance using the upper limb rehabilitation robot. It quantitatively assessed patients' motor control ability and constructed an intelligent grading model of functional impairments. These findings contribute to a deeper understanding of patients' motor ability and provide valuable insights for personalized rehabilitation interventions. METHODS Patients at different Brunnstrom stages underwent rehabilitation training using the upper limb rehabilitation robot, and data on the distal movement positions of the patients' upper limbs were collected. A total of 22 assessment metrics related to movement efficiency, smoothness, and accuracy were extracted. The performance of these assessment metrics was measured using the Mann-Whitney U test and Pearson correlation analysis. Due to the issue of imbalanced sample categories, data augmentation was performed using the Synthetic Minority Over-sampling Technique (SMOTE) algorithm based on weighted sampling, and an intelligent grading model of functional impairment based on the Extreme Gradient Boosting Tree (XGBoost) algorithm was constructed. RESULTS Sixteen assessment metrics were screened. These metrics were effectively normalized to their maximum values, enabling the derivation of quantitative assessment scores for motor control ability across the three dimensions through a weighted fusion approach. Notably, when applied to the data-enhanced dataset, the intelligent grading model exhibited remarkable improvement, achieving an accuracy rate exceeding 0.98. Moreover, significant enhancements were observed in terms of precision, recall, and f1-score. CONCLUSION The research findings demonstrate that this study enables the quantitative assessment of patients' motor control ability and intelligent grading of functional impairments, thereby contributing to the efficiency enhancement of clinical rehabilitation assessment. Moreover, this method resolves the issues associated with the subjectivity and prolonged periods of traditional rehabilitation assessment methods.
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Affiliation(s)
- Sujiao Li
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Wenqian Cai
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | - Pei Zhu
- Changhai Hospital, Shanghai, China
| | - Wanying He
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jinyu Zheng
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
| | | | - Hongliu Yu
- Institute of Rehabilitation Engineering and Technology, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai Engineering Research Center of Assistive Devices, University of Shanghai for Science and Technology, Shanghai, China
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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 2024:10.1007/s12028-023-01934-8. [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] [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.
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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
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Vermander P, Mancisidor A, Cabanes I, Perez N. Intelligent systems for sitting posture monitoring and anomaly detection: an overview. J Neuroeng Rehabil 2024; 21:28. [PMID: 38378596 PMCID: PMC10880321 DOI: 10.1186/s12984-024-01322-z] [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: 11/28/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
The number of people who need to use wheelchair for proper mobility is increasing. The integration of technology into these devices enables the simultaneous and objective assessment of posture, while also facilitating the concurrent monitoring of the functional status of wheelchair users. In this way, both the health personnel and the user can be provided with relevant information for the recovery process. This information can be used to carry out an early adaptation of the rehabilitation of patients, thus allowing to prevent further musculoskeletal problems, as well as risk situations such as ulcers or falls. Thus, a higher quality of life is promoted in affected individuals. As a result, this paper presents an orderly and organized analysis of the existing postural diagnosis systems for detecting sitting anomalies in the literature. This analysis can be divided into two parts that compose such postural diagnosis: on the one hand, the monitoring devices necessary for the collection of postural data and, on the other hand, the techniques used for anomaly detection. These anomaly detection techniques will be explained under two different approaches: the traditional generalized approach followed to date by most works, where anomalies are treated as incorrect postures, and a new individualized approach treating anomalies as changes with respect to the normal sitting pattern. In this way, the advantages, limitations and opportunities of the different techniques are analyzed. The main contribution of this overview paper is to synthesize and organize information, identify trends, and provide a comprehensive understanding of sitting posture diagnosis systems, offering researchers an accessible resource for navigating the current state of knowledge of this particular field.
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Affiliation(s)
- Patrick Vermander
- Department of Automatic Control and Systems Engineering, Bilbao School of Engineering, University of the Basque Country (UPV/EHU), Plaza Ingeniero Torres Quevedo, 48013, Bilbao, Spain.
| | - Aitziber Mancisidor
- Department of Automatic Control and Systems Engineering, Bilbao School of Engineering, University of the Basque Country (UPV/EHU), Plaza Ingeniero Torres Quevedo, 48013, Bilbao, Spain
| | - Itziar Cabanes
- Department of Automatic Control and Systems Engineering, Bilbao School of Engineering, University of the Basque Country (UPV/EHU), Plaza Ingeniero Torres Quevedo, 48013, Bilbao, Spain
| | - Nerea Perez
- Department of Automatic Control and Systems Engineering, Bilbao School of Engineering, University of the Basque Country (UPV/EHU), Plaza Ingeniero Torres Quevedo, 48013, Bilbao, Spain
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Daum N, Drewniok N, Bald A, Ulm B, Buyukli A, Grunow JJ, Schaller SJ. Early mobilisation within 72 hours after admission of critically ill patients in the intensive care unit: A systematic review with network meta-analysis. Intensive Crit Care Nurs 2024; 80:103573. [PMID: 37948898 DOI: 10.1016/j.iccn.2023.103573] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Early mobilisation within 72 hours of intensive care unit admission counteracts complications caused by critical illness. The effect of different interventions on intensive care unit length of stay and other outcomes is unclear. We aimed to investigate the effectiveness of various early mobilisation interventions within 72 hours of admission to the intensive care unit on length of stay and other outcomes. METHODS A systematic review and (network) meta-analysis examining the effect of early mobilisation on length of stay in the intensive care unit and other outcomes, conducting searches in four databases. Randomised controlled trials were included from inception to 10/08/2022. Early mobilisation was defined as interventions that initiates and/or supports passive/active range-of-motion exercises within 72 hours of admission. In multi-arm studies, interventions used in other studies were declared as early intervention and were included in subgroup meta-analysis. Risk-of-bias was assessed using RoB2. RESULTS Of 29,680 studies screened, 18 studies with 1923 patients (three high, eleven some, four low risk-of-bias) and seven discriminable interventions of early mobilisation met inclusion criteria. Early mobilisation alone (WMD 0.78 days, 95 %CI [-1.38;-0.18], 11 studies, n = 1124) and early mobilisation with early nutrition (WMD -1.19 days, 95 %CI [-2.34;-0.03], 1 study, n = 100) were able to significantly shorten length of stay. Early mobilisation alone could also substantially shorten hospital length of stay (WMD -1.05 days, 95 %CI [-1.74;-0.36], 8 studies, n = 977). This effect in hospital length of stay was furthermore seen in the early intervention group compared with standard care (WMD -1.71 days, 95 %CI [-2.99;-0.43], 14 studies, n = 1587). Also, functionality and quality of life could significantly be improved by an early start of mobilisation. CONCLUSION In the network meta-analysis, early mobilisation alone and early mobilisation with early nutrition demonstrated a significant effect on intensive care length of stay. Early mobilisation could also reduce hospital length of stay and positively influence functionality and quality of life. IMPLICATION FOR CLINICAL PRACTICE Early mobilisation and early mobilisation with early nutrition seemed to be beneficial compared to other interventions like cycling on intensive care length of stay.
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Affiliation(s)
- Nils Daum
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Germany
| | - Nils Drewniok
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Germany
| | - Annika Bald
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Germany
| | - Bernhard Ulm
- Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Department of Anaesthesiology and Intensive Care Medicine, Germany; Department of Anesthesiology and Intensive Care Medicine, University of Ulm, Faculty of Medicine, Ulm, Germany
| | - Alyona Buyukli
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Germany
| | - Julius J Grunow
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Germany
| | - Stefan J Schaller
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Germany; Technical University of Munich, School of Medicine and Health, Klinikum rechts der Isar, Department of Anaesthesiology and Intensive Care Medicine, Germany.
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Xu C, Yang F, Wang Q, Gao W. Effect of neuromuscular electrical stimulation in critically ill adults with mechanical ventilation: a systematic review and network meta-analysis. BMC Pulm Med 2024; 24:56. [PMID: 38273243 PMCID: PMC10811936 DOI: 10.1186/s12890-024-02854-9] [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: 11/25/2023] [Accepted: 01/08/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) is widely used as a rehabilitation methods to restore muscle mass and function in prolonged immobilization individuals. However, its effect in mechanically ventilated patients to improve clinical outcomes remains unclear. METHODS A comprehensive search was conducted using PubMed, Embase, Web of Science, PEDro, and the Cochrane Library from their inception until December 24th, 2023. The search targeted randomized controlled trials (RCTs) comparing NMES with physical therapy (PT) or usual ICU care (CG), for improving clinical outcomes in mechanically ventilated patients. We performed a network meta-analysis utilizing Stata version 14.0 and R 4.3.1. RESULTS We included 23 RCTs comprising 1312 mechanically ventilated adults. The treatments analyzed were NMES, PT, NMES combined with PT (NMES+PT), and CG. Network meta-analyses revealed that NMES or NMES+PT significantly improved extubation success rate compared to CG, with ORs of 1.85 (95% CI: 1.11, 3.08) and 5.89 (95% CI: 1.77, 19.65), respectively. Additionally, NMES exhibited a slight decrease in extubation success rate compared with NMES+PT, with OR of 0.31 (95% CI: 0.11, 0.93). Nevertheless, neither NMES nor NMES+PT showed any significant improvement in ICU length of stay (LOS), ventilation duration, or mortality when compared with PT or CG. NMES+PT emerged as the most effective strategy for all considered clinical outcomes according to the ranking probabilities. The evidence quality ranged from "low" to "very low" in this network meta-analysis. CONCLUSIONS NMES appears to be a straightforward and safe modality for critically ill, mechanically ventilated patients. When combined with PT, it significantly improved the extubation success rate against standard ICU care and NMES alone, and showed a better ranking over PT or NMES alone for clinical outcomes. Therefore, NMES combined with PT may be a superior rehabilitation strategy for this patient group.
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Affiliation(s)
- Cuiping Xu
- Department of Respiratory and Critical Care Medicine, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, China.
| | - Feng Yang
- Department of Respiratory and Critical Care Medicine, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, China
| | - Qimin Wang
- Department of Respiratory and Critical Care Medicine, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, China
| | - Wei Gao
- Department of Respiratory and Critical Care Medicine, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, Beijing, China.
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Zheng Y, Zhang L, Ma S, Wu B, Chen P, Xu Y, Tan W, Li H, Wu Q, Zheng J. Care intervention on psychological outcomes among patients admitted to intensive care unit: an umbrella review of systematic reviews and meta-analyses. Syst Rev 2023; 12:237. [PMID: 38098025 PMCID: PMC10720116 DOI: 10.1186/s13643-023-02372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Numerous studies have explored care interventions to improve the psychological outcome of intensive care unit (ICU) patients, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to get familiar with all available literature and find appropriate interventions. This umbrella review aimed to analyze the relationship between care intervention and psychological outcomes of ICU patients based on existing systematic reviews. METHODS An umbrella review of evidence across systematic reviews and meta-analyses published between 1987 and 2023 was undertaken. We systematically searched reviews that examined the association between care intervention and the improvement of adverse psychological outcomes in ICU patients using PubMed, EMBASE, Web of Science, Cochrane Library, and manual reference screening. The measurement tool (AMSTAR 2) was applied to evaluate the methodological quality of included studies. The excess significance bias, between-study heterogeneity expressed by I2, small-study effect, and evidence class were estimated. RESULTS A total of 5110 articles were initially identified from the search databases and nine of them were included in the analysis. By applying standardized criteria, only weak evidence was observed in 13 associations, even though most included reviews were of moderate to high methodological quality. These associations pertained to eight interventions (music therapy, early rehabilitation, post-ICU follow-up, ICU diary, information intervention, preoperative education, communication and psychological support, surrogate decision-making) and five psychological outcomes (post-intensive care syndrome, transfer anxiety, post-traumatic stress disorder, anxiety, and depression). Weak or null association was shown among the rest of the associations (e.g., weak association between music therapy and maternal anxiety or stress level). CONCLUSIONS The evidence of these eight supporting interventions to improve the adverse psychological outcomes of ICU patients and caregivers was weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence.
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Affiliation(s)
- Yafang Zheng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Lijuan Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Shihong Ma
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Bian Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Peipei Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Yan Xu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Wenting Tan
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Hanzhan Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China
| | - Qiaomei Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China.
| | - Jingxia Zheng
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
- Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Guangzhou, 510120, People's Republic of China.
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11
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Giraldo ND, Carvajal C, Muñoz F, Restrepo MDP, García MA, Arias JM, Mojica JL, Torres JC, García Á, Muñoz D, Rodríguez FC, Arias J, Mejía LM, De La Rosa G. Decrease in the intensive care unit-acquired weakness with a multicomponent protocol implementation: A quasi-experimental clinical trial. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:438-446. [PMID: 38109142 PMCID: PMC10826465 DOI: 10.7705/biomedica.6947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/03/2023] [Indexed: 12/19/2023]
Abstract
Introduction Intensive care unit-acquired weakness is a frequent complication that affects the prognosis of critical illness during hospital stay and after hospital discharge. Objectives To determine if a multicomponent protocol of early active mobility involving adequate pain control, non-sedation, non-pharmacologic delirium prevention, cognitive stimulation, and family support, reduces intensive care unit-acquired weakness at the moment of discharge. Materials and methods We carried out a non-randomized clinical trial in two mixed intensive care units in a high-complexity hospital, including patients over 14 years old with invasive mechanical ventilation for more than 48 hours. We compared the intervention –the multicomponent protocol– during intensive care hospitalization versus the standard care. Results We analyzed 82 patients in the intervention group and 106 in the control group. Muscle weakness acquired in the intensive care unit at the moment of discharge was less frequent in the intervention group (41.3% versus 78.9%, p<0.00001). The mobility score at intensive unit care discharge was better in the intervention group (median = 3.5 versus 2, p < 0.0138). There were no statistically significant differences in the invasive mechanical ventilation-free days at day 28 (18 versus 15 days, p<0.49), and neither in the mortality (18.2 versus 27.3%, p<0.167). Conclusion A multi-component protocol of early active mobility significantly reduces intensive care unit-acquired muscle weakness at the moment of discharge.
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Affiliation(s)
- Nelson Darío Giraldo
- Departamento de Cuidado Crítico del Adulto, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | - Carlos Carvajal
- Departamento de Cuidado Crítico del Adulto, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | - Fabián Muñoz
- Departamento de Cuidado Crítico del Adulto, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | | | | | - Juan Miguel Arias
- Departamento de Cuidado Crítico del Adulto, Hospital Pablo Tobón Uribe, Medellín, Colombia; Facultad de Medicina, Universidad CES, Medellín, Colombia.
| | - José Leonardo Mojica
- Departamento de Cuidado Crítico del Adulto, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | - Juan Carlos Torres
- Departamento de Cuidado Crítico del Adulto, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | - Álex García
- Departamento de Cuidado Crítico del Adulto, Hospital Pablo Tobón Uribe, Medellín, Colombia; Sección de Anestesiología y Reanimación, Universidad de Antioquia, Medellín, Colombia.
| | - Diego Muñoz
- Departamento de Cuidado Crítico del Adulto, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | | | - Jorge Arias
- Unidad de Rehabilitación, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | - Lina María Mejía
- Unidad de Rehabilitación, Hospital Pablo Tobón Uribe, Medellín, Colombia.
| | - Gisela De La Rosa
- Departamento de Cuidado Crítico del Adulto, Hospital Pablo Tobón Uribe, Medellín, Colombia.
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12
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Brockman A, Krupp A, Bach C, Mu J, Vasilevskis EE, Tan A, Mion LC, Balas MC. Clinicians' perceptions on implementation strategies used to facilitate ABCDEF bundle adoption: A multicenter survey. Heart Lung 2023; 62:108-115. [PMID: 37399777 PMCID: PMC10592449 DOI: 10.1016/j.hrtlng.2023.06.006] [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: 03/24/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Intensive care unit (ICU) clinicians struggle to routinely implement the ICU Liberation bundle (ABCDEF bundle). As a result, critically ill patients experience increased risk of morbidity and mortality. Despite extensive research related to the barriers and facilitators of bundle use, little is known regarding which implementation strategies are used to facilitate its adoption and sustainability. OBJECTIVES To identify implementation strategies used to increase adoption of the ABCDEF bundle and how those strategies are perceived by end-users (i.e., ICU clinicians) related to their helpfulness, acceptability, feasibility, and cost. METHODS We conducted a national, cross-sectional survey of ICU clinicians from the 68 ICU sites that previously participated in the Society of Critical Care Medicine's ICU Liberation Collaborative. The survey was structured using the 73 Expert Recommendations for Implementing Change (ERIC) implementation strategies. Surveys were delivered electronically to site contacts. RESULTS Nineteen ICUs (28%) returned completed surveys. Sites used 63 of the 73 ERIC implementation strategies, with frequent use of strategies that may be readily available to clinicians (e.g., providing educational meetings or ongoing training), but less use of strategies that require changes to well-established organizational systems (e.g., alter incentive allowance structure). Overall, sites described the ERIC strategies used in their implementation process to be moderately helpful (mean score >3<4 on a 5-point Likert scale), somewhat acceptable and feasible (mean score >2<3), and either not-at-all or somewhat costly (mean scores >1<3). CONCLUSIONS Our results show a potential over-reliance on accessible strategies and the possible benefit of unused ERIC strategies related to changing infrastructure and utilizing financial strategies.
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Affiliation(s)
- Audrey Brockman
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH. 43210. USA.
| | - Anna Krupp
- The University of Iowa College of Nursing, 50 Newton Rd, CNB 480, Iowa City, IA. 52246. USA
| | - Christina Bach
- University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, Omaha, NE. 68198-5330. USA
| | - Jinjian Mu
- The Ohio State University College of Nursing, Center for Research and Health Analytics 1585 Neil Avenue, Columbus, OH. 43210. USA
| | - Eduard E Vasilevskis
- Center for Clinical Quality and Implementation Science, Section of Hospital Medicine, Department of Medicine, Vanderbilt University Medical Center, 2525 West End, Suite 450, Nashville, TN 37027. USA
| | - Alai Tan
- The Ohio State University College of Nursing, Center for Research and Health Analytics 1585 Neil Avenue, Columbus, OH. 43210. USA
| | - Lorraine C Mion
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH. 43210. USA
| | - Michele C Balas
- University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, Omaha, NE. 68198-5330. USA
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Rapolthy-Beck A, Fleming J, Turpin M, Sosnowski K, Dullaway S, White H. Efficacy of Early Enhanced Occupational Therapy in an Intensive Care Unit (EFFORT-ICU): A Single-Site Feasibility Trial. Am J Occup Ther 2023; 77:7706205110. [PMID: 38015492 DOI: 10.5014/ajot.2023.050230] [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: 11/29/2023] Open
Abstract
IMPORTANCE This research trial contributes to the evidence for occupational therapy service delivery in intensive care settings. OBJECTIVE To explore the feasibility of a trial to evaluate the impact of early enhanced occupational therapy on mechanically ventilated patients in intensive care. DESIGN Single-site assessor-blinded randomized controlled feasibility trial. SETTING Level 5 8-bed adult medical-surgical intensive care unit (ICU) at Logan Hospital, Brisbane, Australia. PARTICIPANTS Participants were 30 mechanically ventilated patients randomly allocated to two groups. OUTCOMES AND MEASURES We compared standard care with enhanced occupational therapy with outcomes measured at discharge from the ICU, hospital discharge, and 90 days post randomization. The primary outcome measure was the FIM®. Secondary outcomes included the Modified Barthel Index (MBI); Montreal Cognitive Assessment; grip strength, measured using a dynamometer; Hospital Anxiety and Depression Scale; and the 36-Item Short-Form Health Survey (Version 2). The intervention group received daily occupational therapy, including cognitive stimulation, upper limb retraining, and activities of daily living. Data were analyzed using independent groups t tests and effect sizes. RESULTS Measures and procedures were feasible. A significant difference was found between groups on FIM Motor score at 90 days with a large effect size (p = .05, d = 0.76), and MBI scores for the intervention group approached significance (p = .051) with a large effect size (d = 0.75) at 90 days. Further moderate to large effect sizes were obtained for the intervention group for cognitive status, functional ability, and quality of life. CONCLUSIONS AND RELEVANCE This trial demonstrated that occupational therapy is feasible and beneficial in the ICU. Criteria to progress to a full-scale randomized controlled trial were met. This study contributes to embedding ongoing consistency of practice and scope of service delivery for occupational therapy in this field. What This Article Adds: Occupational therapists should be considered core team members in the critical care-ICU, with funding to support ongoing service provision and optimization of patient outcomes based on effective and feasible service delivery.
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Affiliation(s)
- Andrea Rapolthy-Beck
- Andrea Rapolthy-Beck, MSc Neurorehabilitation, BScOccTher, BSc(Med)ExSc, is Senior Occupational Therapist, Occupational Therapy Department, Surgical Treatment and Rehabilitation Service, Herston Health Precinct, Queensland, Australia; Senior Occupational Therapist, Occupational Therapy Department, Logan Hospital, Meadowbrook, Queensland, Australia; and PhD Candidate, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia;
| | - Jennifer Fleming
- Jennifer Fleming, PhD, BOccThy (Hons), FOTARA, is Professor and Head, Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Merrill Turpin
- Merrill Turpin, PhD, BOccThy, GradDipCounsel, is Senior Lecturer, Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kellie Sosnowski
- Kellie Sosnowski, MNursing(Hons), BNursing, GradCertHlthMgt, GradDipCriticalCare, is Nurse Unit Manager, Intensive Care Unit, Logan Hospital, Meadowbrook, Queensland, Australia
| | - Simone Dullaway
- Simone Dullaway, BAppSc (Occ Ther), is Senior Occupational Therapist, Chronic Disease Team, Metro South Health and Hospital Service, Queensland, Australia
| | - Hayden White
- Hayden White, PhD, MBBCH, FCP (SA), MMED (Wits), FCICM, FRACP, is Deputy Director, Intensive Care Unit, Logan Hospital, Meadowbrook, Queensland, Australia
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14
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Wang L, Hua Y, Wang L, Zou X, Zhang Y, Ou X. The effects of early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1202754. [PMID: 37448799 PMCID: PMC10336545 DOI: 10.3389/fmed.2023.1202754] [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: 04/09/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023] Open
Abstract
Background The effects of early mobilization (EM) on intensive care unit (ICU) patients remain unclear. A meta-analysis of randomized controlled trials was performed to evaluate its effect in mechanically ventilated adult ICU patients. Methods We searched randomized controlled trials (RCTs) published in Medline, Embase, and CENTRAL databases (from inception to November 2022). According to the difference in timing and type, the intervention group was defined as a systematic EM group, and comparator groups were divided into the late mobilization group and the standard EM group. The primary outcome was mortality. The secondary outcomes were ICU length of stay, duration of mechanical ventilation (MV), and adverse events. EM had no impact on 180-day mortality and hospital mortality between intervention groups and comparator groups (RR 1.09, 95% CI 0.89-1.33, p = 0.39). Systemic EM reduced the ICU length of stay (LOS) (MD -2.18, 95% CI -4.22--0.13, p = 0.04) and the duration of MV (MD -2.27, 95% CI -3.99--0.56, p = 0.009), but it may increase the incidence of adverse events in patients compared with the standard EM group (RR 1.99, 95% CI 1.25-3.16, p = 0.004). Conclusion Systematic EM has no significant effect on short- or long-term mortality in mechanically ventilated adult ICU patients, but systematic EM could reduce the ICU LOS and duration of MV.
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Affiliation(s)
- Lijie Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yusi Hua
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Luping Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xia Zou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yan Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaofeng Ou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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15
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O'Grady HK, Reid JC, Farley C, Hanna QEB, Unger J, Zorko DJ, Bosch J, Turkstra LS, Kho ME. Comparator Groups in ICU-Based Studies of Physical Rehabilitation: A Scoping Review of 125 Studies. Crit Care Explor 2023; 5:e0917. [PMID: 37181539 PMCID: PMC10171473 DOI: 10.1097/cce.0000000000000917] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
To characterize comparator groups (CGs) in ICU-based studies of physical rehabilitation (PR), including the type, content, and reporting. DATA SOURCES We followed a five-stage scoping review methodology, searching five databases from inception to June 30, 2022. Study selection and data extraction were completed independently, in duplicate. STUDY SELECTION We screened studies by title and abstract, then full-text. We included prospective studies with greater than or equal to two arms enrolling mechanically ventilated adults (≥ 18 yr), with any planned PR intervention initiated in the ICU. DATA EXTRACTION We conducted a quantitative content analysis of authors' description of CG type and content. We categorized similar CG types (e.g., usual care), classified content into unique activities (e.g., positioning), and summarized these data using counts (proportions). We assessed reporting using Consensus on Exercise Reporting Template (CERT; proportion of reported items/total applicable). DATA SYNTHESIS One hundred twenty-five studies were included, representing 127 CGs. PR was planned in 112 CGs (88.2%; 110 studies), representing four types: usual care (n = 81, 63.8%), alternative treatment than usual care (e.g., different from intervention; n = 18, 14.2%), alternative treatment plus usual care (n = 7, 5.5%), and sham (n = 6, 4.7%). Of 112 CGs with planned PR, 90 CGs (88 studies) reported 60 unique activities, most commonly passive range of motion (n = 47, 52.2%). The remaining 22 CGs (19.6%; 22 studies) reported vague descriptions. PR was not planned in 12 CGs (9.5%; 12 studies), and three CGs (2.4%; three studies) reported no details. Studies reported a median (Q1-Q3) of 46.6% (25.0-73.3%) CERT items. Overall, 20.0% of studies reported no detail to understand planned CG activities. CONCLUSIONS The most common type of CG was usual care. We identified heterogeneity in planned activities and CERT reporting deficiencies. Our results could help guide the selection, design, and reporting of CGs in future ICU-based PR studies.
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Affiliation(s)
- Heather K O'Grady
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Julie C Reid
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Christopher Farley
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Quincy E B Hanna
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Janelle Unger
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
| | - David J Zorko
- Department of Pediatric Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jackie Bosch
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lyn S Turkstra
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
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16
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Silva-Gutiérrez A, Artigas-Arias M, Alegría-Molina A, Guerra-Vega P, Navarrete P, Venegas Á, Montecinos C, Vásquez L, Moraga K, Rubilar C, Villagrán G, Parada R, Vitzel KF, Marzuca-Nassr GN. Characterization of muscle mass, strength and mobility of critically ill patients with SARS-CoV-2 pneumonia: Distribution by sex, age, days on mechanical ventilation, and muscle weakness. Front Physiol 2023; 14:1095228. [PMID: 36846316 PMCID: PMC9950093 DOI: 10.3389/fphys.2023.1095228] [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: 11/10/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
Objective: Quantify and categorize by sex, age, and time spent on mechanical ventilation (MV), the decline in skeletal muscle mass, strength and mobility in critically ill patients infected with SARS-CoV-2 and requiring mechanical ventilation while at intensive care unit (ICU). Design: Prospective observational study including participants recruited between June 2020 and February 2021 at Hospital Clínico Herminda Martin (HCHM), Chillán, Chile. The thickness of the quadriceps muscle was evaluated by ultrasonography (US) at intensive care unit admission and awakening. Muscle strength and mobility were assessed, respectively, through the Medical Research Council Sum Score (MRC-SS) and the Functional Status Score for the Intensive Care Unit Scale (FSS-ICU) both at awakening and at ICU discharge. Results were categorized by sex (female or male), age (<60 years old or ≥60 years old) and time spent on MV (≤10 days or >10 days). Setting: Intensive care unit in a public hospital. Participants: 132 participants aged 18 years old or above (women n = 49, 60 ± 13 years; men n = 85, 59 ± 12 years) admitted to intensive care unit with a confirmed diagnosis of severe SARS-CoV-2 and requiring MV for more than 48 h were included in the study. Patients with previous physical and or cognitive disorders were excluded. Interventions: Not applicable. Results: Muscle thickness have significantly decreased during intensive care unit stay, vastus intermedius (-11%; p = 0.025), rectus femoris (-20%; p < 0.001) and total quadriceps (-16%; p < 0.001). Muscle strength and mobility were improved at intensive care unit discharge when compared with measurements at awakening in intensive care unit (time effect, p < 0.001). Patients ≥60 years old or on MV for >10 days presented greater muscle loss, alongside with lower muscle strength and mobility. Conclusion: Critically ill patients infected with SARS-CoV-2 and requiring MV presented decreased muscle mass, strength, and mobility during their intensive care unit stay. Factors associated with muscle mass, such as age >60 years and >10 days of MV, exacerbated the critical condition and impaired recovery.
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Affiliation(s)
| | - Macarena Artigas-Arias
- Doctorado en Ciencias mención Biología Celular y Molecular Aplicada, Universidad de La Frontera, Temuco, Chile,Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco, Chile
| | - Andrea Alegría-Molina
- Magíster en Terapia Física con mención, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | | | - Pablo Navarrete
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Ángela Venegas
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Carlos Montecinos
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Lorena Vásquez
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Karen Moraga
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - César Rubilar
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Germán Villagrán
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Rodrigo Parada
- Unidad de Paciente Crítico Adulto, Hospital Clínico Herminda Martín, Chillán, Chile
| | - Kaio Fernando Vitzel
- School of Health Sciences, College of Health, Massey University, Auckland, New Zealand
| | - Gabriel Nasri Marzuca-Nassr
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile,*Correspondence: Gabriel Nasri Marzuca-Nassr,
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17
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Role of Kinesiotherapy in the Prevention of Heterotopic Ossification: A Systematic Review. Am J Phys Med Rehabil 2023; 102:110-119. [PMID: 35512120 DOI: 10.1097/phm.0000000000002043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The role of kinesiotherapy in heterotopic ossification remains unclear. The goal of this study was to revisit the literature on the preventive role of kinesiotherapy against heterotopic ossification formation and maturation. DESIGN A systematic review was performed in MEDLINE, OVID, Scopus, and Cochrane databases. RESULTS A high-quality clinical trial is missing from the literature. Of 9617 studies primarily identified, nine studies offered the proper data and were included. They infer that satisfactory results on neurogenic heterotopic ossification prevention were achieved with passive exercises, including continuous passive motion, that were initiated early and at a painless range of motion. On the contrary, for elbow posttraumatic heterotopic ossification and major joints burn-associated heterotopic ossification, active range of motion is indicated as early as possible. CONCLUSIONS Because of the very low quality of the studies included in this review, firm conclusions cannot be drawn about the effectiveness of kinesiotherapy. Nevertheless, it is recommended that controlled passive range of motion exercises (especially continuous passive motion) be applied early and pain-free especially in the neurogenic heterotopic ossification patients while active range of motion in painless limits is beneficial in the heterotopic ossification prevention of traumatic elbows or burn joints.
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18
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Gephine S, Lemyze M, Pauquet P, Rouzic OL, Fry S, Chenivesse C, Grosbois JM. Effectiveness of a home-based pulmonary rehabilitation programme in people recovering from a severe and critically COVID-19 infection. Respir Med Res 2023; 83:100991. [PMID: 37043972 PMCID: PMC9827746 DOI: 10.1016/j.resmer.2023.100991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/18/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Sarah Gephine
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, EA 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, F-59000 Lille, France.,FormAction Santé, F-59840 Pérenchies, France
| | - Malcolm Lemyze
- CH Arras, Service de réanimation et Unité de Sevrage Intensif et Réhabilitation Post-Réanimation, F-62000 Arras
| | - Philippe Pauquet
- CH Arras, Service de réanimation et Unité de Sevrage Intensif et Réhabilitation Post-Réanimation, F-62000 Arras
| | - Olivier Le Rouzic
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, F-59000 Lille
| | - Stéphanie Fry
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, F-59000 Lille
| | - Cécile Chenivesse
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, F-59000 Lille
| | - Jean-Marie Grosbois
- FormAction Santé, F-59840 Pérenchies, France.,Corresponding author: Jean-Marie Grosbois, Zone d'Activité du Bois, Rue de Pietralunga, Pérenchies F-59840, France
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Cartotto R, Johnson L, Rood JM, Lorello D, Matherly A, Parry I, Romanowski K, Wiechman S, Bettencourt A, Carson JS, Lam HT, Nedelec B. Clinical Practice Guideline: Early Mobilization and Rehabilitation of Critically Ill Burn Patients. J Burn Care Res 2023; 44:1-15. [PMID: 35639543 DOI: 10.1093/jbcr/irac008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This Clinical Practice Guideline addresses early mobilization and rehabilitation (EMR) of critically ill adult burn patients in an intensive care unit (ICU) setting. We defined EMR as any systematic or protocolized intervention that could include muscle activation, active exercises in bed, active resistance exercises, active side-to-side turning, or mobilization to sitting at the bedside, standing, or walking, including mobilization using assistance with hoists or tilt tables, which was initiated within at least 14 days of injury, while the patient was still in an ICU setting. After developing relevant PICO (Population, Intervention, Comparator, Outcomes) questions, a comprehensive literature search was conducted with the help of a professional medical librarian. Available literature was reviewed and systematically evaluated. Recommendations were formulated through the consensus of a multidisciplinary committee, which included burn nurses, physicians, and rehabilitation therapists, based on the available scientific evidence. No recommendation could be formed on the use of EMR to reduce the duration of mechanical ventilation in the burn ICU, but we conditionally recommend the use of EMR to reduce ICU-acquired weakness in critically ill burn patients. No recommendation could be made regarding EMR's effects on the development of hospital-acquired pressure injuries or disruption or damage to the skin grafts and skin substitutes. We conditionally recommend the use of EMR to reduce delirium in critically ill burn patients in the ICU.
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Affiliation(s)
- Robert Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Laura Johnson
- Burns and Trauma, MedStar Washington Hospital Center, Georgetown University, Washington, DC, USA
| | - Jody M Rood
- Regions Hospital Burn Center, St. Paul, Minneapolis, USA
| | | | - Annette Matherly
- University of Utah Health Burn Center, Salt Lake City, Utah, USA
| | - Ingrid Parry
- Shriners Hospital for Children, Northern California, University of California at Davis, Sacramento, California, USA
| | - Kathleen Romanowski
- Firefighters Burn Institute Regional Burn Center, University of California at Davis, Sacramento, California, USA
| | - Shelley Wiechman
- Regional Burn Center at Harborview, University of Washington, Seattle, Washington, USA
| | | | | | - Henry T Lam
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Biagioni J, Easley T, DeAlmeida ML, Vova J, Fujimoto AB, Graessle S, Nelson J. Early mobilization in a pediatric intensive care unit and WeeFIM scores at rehabilitation: A retrospective study. J Pediatr Rehabil Med 2023; 16:507-515. [PMID: 37066924 DOI: 10.3233/prm-220043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023] Open
Abstract
PURPOSE The purpose of this study was to examine the relationship between early mobility (EM) of pediatric patients mechanically ventilated and functional outcomes in rehabilitation using WeeFIM scores, as well as hospital length of stay (LOS), ICU LOS, and rehabilitation LOS. METHODS A retrospective chart review of 189 patients was completed to compare those who received EM interventions to those who did not in the ICU. Data extracted from the years 2015-2019 included: all patients who were between zero and 21 years, were mechanically ventilated via endotracheal tube (ETT) for > 48 hours, and then transferred to the comprehensive inpatient rehabilitation unit (IRU). RESULTS For respiratory patients, the EM group had higher WeeFIM scores in all categories at admission to IRU compared to the comparison group. Neurosurgery patients had higher cognition and total WeeFIM scores in the EM group at admission to IRU. All diagnoses demonstrated shorter hospital, ICU, and IRU LOS for the comparison group versus the EM group. CONCLUSION EM of mechanically ventilated pediatric patients with a primary respiratory diagnosis demonstrated improved function at admission to IRU compared to those who did not participate in EM. Prospective research needs to be done to examine this relationship further.
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Affiliation(s)
| | | | - Mary L DeAlmeida
- Childrens Healthcare of Atlanta, Atlanta, GA, USA
- Emory University Department of Pediatrics, Atlanta, GA, USA
| | - Joshua Vova
- Childrens Healthcare of Atlanta, Atlanta, GA, USA
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Younger DS. Critical illness-associated weakness and related motor disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:707-777. [PMID: 37562893 DOI: 10.1016/b978-0-323-98818-6.00031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Weakness of limb and respiratory muscles that occurs in the course of critical illness has become an increasingly common and serious complication of adult and pediatric intensive care unit patients and a cause of prolonged ventilatory support, morbidity, and prolonged hospitalization. Two motor disorders that occur singly or together, namely critical illness polyneuropathy and critical illness myopathy, cause weakness of limb and of breathing muscles, making it difficult to be weaned from ventilatory support, commencing rehabilitation, and extending the length of stay in the intensive care unit, with higher rates of morbidity and mortality. Recovery can take weeks or months and in severe cases, and may be incomplete or absent. Recent findings suggest an improved prognosis of critical illness myopathy compared to polyneuropathy. Prevention and treatment are therefore very important. Its management requires an integrated team approach commencing with neurologic consultation, creatine kinase (CK) measurement, detailed electrodiagnostic, respiratory and neuroimaging studies, and potentially muscle biopsy to elucidate the etiopathogenesis of the weakness in the peripheral and/or central nervous system, for which there may be a variety of causes. These tenets of care are being applied to new cases and survivors of the coronavirus-2 disease pandemic of 2019. This chapter provides an update to the understanding and approach to critical illness motor disorders.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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Barros-Poblete M, Bernardes Neto SC, Benavides-Cordoba V, Vieira RP, Baz M, Martí JD, Spruit MA, Torres-Castro R. Early mobilization in intensive care unit in Latin America: A survey based on clinical practice. Front Med (Lausanne) 2022; 9:1005732. [PMID: 36479097 PMCID: PMC9720404 DOI: 10.3389/fmed.2022.1005732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/28/2022] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The application of early mobilization (EM) in intensive care units (ICUs) has shown to improve the physical and ventilatory status of critically ill patients, even after ICU stay. This study aimed to describe the practices regarding EM in ICUs in Latin America. METHODS We conducted an observational, cross-sectional study of professionals from all countries in Latin America. Over 3 months, professionals working in ICU units in Latin America were invited to answer the survey, which was designed by an expert committee and incorporated preliminary questions based on studies about EM recommendations. RESULTS As many as 174 health professionals from 17 countries completed the survey. The interventions carried out within each ICU were active mobilization (90.5%), passive mobilization (85.0%), manual and instrumental techniques for drainage of mucus secretion (81.8%), and positioning techniques (81%). The professionals who most participated in the rehabilitation process in ICUs were physiotherapists (98.7%), intensive care physicians (61.6%), nurses (56.1%), and respiratory therapists (43.8%). In only 36.1% of the ICUs, protocols were established to determine when a patient should begin EM. In 38.1% of the cases, the onset of EM was established by individual evaluation, and in 25.0% of the cases, it was the medical indication to start rehabilitation and EM. CONCLUSION This report shows us that EM of critically ill patients is an established practice in our ICUs like in other developed countries.
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Affiliation(s)
- Marisol Barros-Poblete
- Programa de Doctorado en Ciencias Médicas, Escuela de Graduados Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Saint-Clair Bernardes Neto
- FACISA—Faculdade de Ciências de Saúde do Trairi, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Rodolfo P. Vieira
- Evangelical University of Goias (Unievangélica), Goiás, Brazil
- Brazil University, São Paulo, Brazil
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São Paulo, Brazil
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Manuel Baz
- Área de Cuidados Intermedios, Departamento Clínico de Medicina, Facultad de Medicina, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Joan-Daniel Martí
- Cardiovascular Surgery Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Martijn A. Spruit
- Department of Research and Development, CIRO, Horn, Netherlands
- Department of Respiratory Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, NUTRIM School, Maastricht University, Maastricht, Netherlands
| | - Rodrigo Torres-Castro
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
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Tadyanemhandu C, van Aswegen H, Ntsiea V. Barriers and facilitators to implementation of early mobilisation of critically ill patients in Zimbabwean and South African public sector hospitals: a qualitative study. Disabil Rehabil 2022; 44:6699-6709. [PMID: 34461792 PMCID: PMC9183945 DOI: 10.1080/09638288.2021.1970827] [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: 01/11/2021] [Revised: 06/21/2021] [Accepted: 08/15/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Implementing early mobilisation in intensive care is challenging, and a detailed knowledge of factors that may hinder or facilitate implementation is essential for success. The study was done to explore the perceived barriers and facilitators to early mobilisation by physiotherapists in Zimbabwean and South African public sector hospital ICUs. METHODS A qualitative study was done in eight public sector hospitals from South Africa and four hospitals from Zimbabwe. Physiotherapists from the participating hospitals who had at least two years working experience in ICU were invited to participate in semi-structured, in-depth, face-to-face interviews. Purposive sampling was done. Data collected included interpretation of early mobilisation, perceived barriers, and facilitators to early mobilisation. Data analysis was done using the content analysis method. FINDINGS A total of 22 physiotherapists were interviewed. In defining the activities regarded as early mobilisation, there was diversity in relation to the specific activities and the nature of the patients in which the defined activities were suitable for. Perceived barriers which emerged included lack of professional autonomy or boundaries, motivation, and clinical skills. Perceived facilitators to early mobilisation included the availability of guidelines, good communication, adequate staff, and mobilisation equipment. CONCLUSIONS Barriers and facilitators to early mobilisation are multifactorial. There is need for multidisciplinary team collaboration and planning before implementing early mobilisation activities.Implications to rehabilitationProfessional roles/identity and or boundaries emerged to be a barrier that hinder implementation of early mobilisation if not clearly defined.Non-rotational physiotherapy coverage was highlighted to be important in facilitating good communication and teamwork and sustainability of services in ICU.Good communication channels and referrals between different disciplines should be employed in ICU to prevent delay in rendering services to ICU patients.
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Affiliation(s)
- Cathrine Tadyanemhandu
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
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Nankaku M, Ikeguchi R, Aoyama T, Kitamura G, Otagaki A, Hamada R, Yuri T, Matsuda S. A First View of the Effect of a Trial of Early Mobilization on the Muscle Strength and Activities of Daily Living in Mechanically Ventilated Patients With COVID-19. Arch Rehabil Res Clin Transl 2022; 4:100201. [PMID: 35702651 PMCID: PMC9186404 DOI: 10.1016/j.arrct.2022.100201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Design Setting Participants Interventions Main Outcome Measures Results Conclusion
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Affiliation(s)
- Manabu Nankaku
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthropedic Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan
- Corresponding author Ryosuke Ikeguchi MD, PhD, Rehabilitation Unit, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku Kyoto 606-8507, Japan.
| | - Tomoki Aoyama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Gakuto Kitamura
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Ayumi Otagaki
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Ryota Hamada
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Takuma Yuri
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
| | - Shuichi Matsuda
- Rehabilitation Unit, Kyoto University Hospital, Kyoto, Japan
- Department of Orthropedic Surgery, Faculty of Medicine, Kyoto University, Kyoto, Japan
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Vollenweider R, Manettas AI, Häni N, de Bruin ED, Knols RH. Passive motion of the lower extremities in sedated and ventilated patients in the ICU - a systematic review of early effects and replicability of Interventions. PLoS One 2022; 17:e0267255. [PMID: 35552550 PMCID: PMC9098053 DOI: 10.1371/journal.pone.0267255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 04/05/2022] [Indexed: 01/02/2023] Open
Abstract
Early mobilization, which includes active / passive motion in bed along with mobilization out of bed, is recommended to prevent the development of intensive care unit acquired-weakness (ICU-AW) for patients with critical illness on the intensive care unit. To date, the impact of passive motion of the lower extremities in sedated and ventilated patients remains unclear. The aim of the study is to systematically review and summarize the currently available randomized controlled trials in English or German language on the impact of passive motion of the lower extremities in sedated and ventilated patients ≥ 18 years in the intensive care unit on musculature, inflammation and immune system and the development of intensive care unit-acquired weakness and to evaluate the replicability of interventions and the methodological quality of included studies. A systematic literature search was performed up to 20th February 2022 in the databases Medline, Embase, Cochrane Library, CINAHL and PEDro. The description of the intervention (TIDieR checklist) and the methodological quality (Downs and Black checklist) were assessed. Five studies were included in the qualitative syntheses. On average, the studies were rated with 6.8 out of 12 points according to the TIDieR checklist. For the methodological quality an average of 19.8 out of 27 points on the Downs and Black checklist was reported. The results of included studies indicated that muscle loss may be reduced by passive manual movement, passive cycling and passive motion on a continuous passive motion-unit. In addition, positive effects were reported on the reduction of nitrosative stress and the immune response. The impact on the development of ICU-AW remains unclear. In conclusion, passive movement show a slight tendency for beneficial changes on cellular level in sedated and ventilated patients in the ICU within the first days of admission, which may indicate a reduction of muscle wasting and could prevent the development of ICU-AW. Future randomized controlled trials should use larger samples, use complete intervention description, use a comparable set of outcome measures, use rigorous methodology and examine the effect of passive motion on the development of ICU-AW.
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Affiliation(s)
- Rahel Vollenweider
- Nursing and Allied Health Profession Office, Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Anastasios I. Manettas
- Nursing and Allied Health Profession Office, Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Nathalie Häni
- Nursing and Allied Health Profession Office, Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
- OST–Eastern Swiss University of Applied Sciences, Department of Health, St. Gallen, Switzerland
- * E-mail:
| | - Ruud H. Knols
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
- Directorate of Research and Education, Physiotherapy Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
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Ahmad M, Kim K, Indorato D, Petrenko I, Diaz K, Rotatori F, Salhany R, Lakhi N. Post-COVID Care Center to Address Rehabilitation Needs in COVID-19 Survivors: A Model of Care. Am J Med Qual 2022; 37:266-271. [PMID: 34369895 PMCID: PMC9052353 DOI: 10.1097/jmq.0000000000000014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2019 pandemic surge left a large cohort of patients vulnerable to cardiopulmonary, neurological, and psychiatric complications. This post-COVID Care center was established to identify patients with disease sequalae and deliver early multidisciplinary rehabilitation services. The evaluation included comprehensive history and physicals, screening tests, labs, and imaging to determine appropriate specialist referrals. After a 6-month period, 278 unique referrals were made to address symptoms reported by 114 patients in specialities including pulmonology, cardiology, and psychiatry. This framework allowed for individualized patient treatment and monitoring of disease after the acute phase of infection. This study highlights the substantial physical and psychosocial impact a coronavirus disease 2019 infection has on patients' long-term trajectory and emphasizes the need for early targeted rehabilitation Post-COVID Care centers. As the world transitions into the chronic phase of this pandemic, this model of care will provide a framework to improve the quality of health care delivery.
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Affiliation(s)
- Maleeha Ahmad
- Richmond University Medical Center, Staten Island, NY
| | - Kangmin Kim
- Richmond University Medical Center, Staten Island, NY
| | | | | | - Keith Diaz
- Richmond University Medical Center, Staten Island, NY
| | | | | | - Nisha Lakhi
- Richmond University Medical Center, Staten Island, NY
- Department of Obstetrics and Gynecology, New York Medical College School of Medicine, Valhalla, NY
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Cordeiro ALL, Lima ADS, Oliveira CMD, Sá JPD, Guimarães ARF. Impact of early mobilization on clinical and functional outcomes in patients submitted to coronary artery bypass grafting. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2022; 12:67-72. [PMID: 35600284 PMCID: PMC9123416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/31/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Heart surgery is a feature that has grown a lot in recent years. Due to the complications that can be generated, the importance of prevention emerges, thus seeking effective protocols that generate improvement in clinical and functional outcomes to promote a shorter hospital stay and readmission. OBJECTIVE To evaluate the impact of early mobilization on clinical and functional outcomes in patients undergoing coronary artery bypass grafting. METHODOLOGY This was a prospective cohort study. Patients were evaluated preoperatively through the Medical Research Council (MRC), Functional Independence Measurement (FIM), Six-Minute Walk Test (6MWT). After the surgery they were divided into two groups: the mobilized group (MG) where patients performed bed transfer to armchair on the 1st postoperative day and ambulated on the 2nd day, and the non-mobilized group (NMG) who underwent passive kinesiotherapy in bed. At ICU discharge, mechanical ventilation (MV) time, intensive care unit stay (ICU) and mortality were compared. At hospital discharge, preoperative tests were repeated to compare with admission. RESULTS A total of 103 patients were admitted, 59 (57.3%) males, mean age 64 ± 8 years. Time of MV it was 6 ± 2 (MG) vs 10 ± 3 (NMG) hours, P = 0.02, ICU stay it was 2 ± 2 (MG) vs 4 ± 3 (NMG) days (P ≤ 0.001), length of stay hospital was 8 ± 4 (MG) vs 14 ± 5 (NMG) days (P ≤ 0.001), FIM -4 ± 2 (MG) vs -11 ± 4 (NMG) points (P ≤ 0.001) and distance traveled 37 ± 10 (MG) vs 78 ± 11 (NMG) meters (P < 0.001). CONCLUSION Early mobilization is associated with improvement in clinical outcomes such as MV time, ICU stay, hospital and functional outcomes, on the FIM scale and distance traveled.
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Affiliation(s)
- André Luiz Lisboa Cordeiro
- Doctoral Student in Medicine and Human Health, Bahian School of Medicine and Public HealthSalvador, Bahia, Brazil
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28
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The validity, reliability and feasibility of four instruments for assessing the consciousness of stroke patients in a neurological intensive care unit compared. BMC Med Res Methodol 2022; 22:102. [PMID: 35395722 PMCID: PMC8991649 DOI: 10.1186/s12874-022-01580-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 03/21/2022] [Indexed: 01/09/2023] Open
Abstract
Background Early rehabilitation is the foundation for recovery for those admitted to an intensive care unit. Appropriate assessment of consciousness is needed before any rehabilitative intervention begins. Methods This prospective study compared the validity, reliability and applicability of the sedation-agitation scale, the Richmond Agitation-Sedation Scale, the motor activity assessment scale and the Glasgow Coma Scale in a working neurological intensive care unit. Eighty-three stroke patients were assessed with the four scales by the same 3 raters acting independently: a senior physician, a senior therapist and a trainee. That generated 996 assessment records for comparison. Results Good agreement (r=0.98–0.99) was found among the sedation-agitation scale, the Richmond Agitation-Sedation Scale, the motor activity assessment scale scores, but the Glasgow Coma Scale ratings correlated less well (r=0.72–0.76) with the others. Consistent results were also found among the three raters. After stratification of the ratings by age, gender, level of consciousness and Acute Physiology and Chronic Health Evaluation score, the scales reported significant differences among the levels of consciousness and among those with different Acute Physiology and Chronic Health Evaluation results, but not with different age or gender strata. Conclusions The four instruments tested are all reliable enough and feasible for use as a tool for consciousness screening in a neurological intensive care unit.
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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.
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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]
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The Impact of Continuous Passive Motion on Heterotopic Ossification Maturation. Am J Phys Med Rehabil 2021; 100:e194-e197. [PMID: 34310347 DOI: 10.1097/phm.0000000000001852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Heterotopic ossification is the formation of pathological bone in soft tissues. It is postulated that continuous passive motion is a helpful adjuvant in the halt of the heterotopic ossification progression and the maintenance or increase of the joint mobility. The purpose of this clinical case study is to present the effectiveness of continuous passive motion. A 46-yr-old male patient experiencing right hemiparesis arrived in our rehabilitation department with limitation on passive flexion of the right hip. On x-ray of the pelvis, immature heterotopic bone formation was found. To halt this ongoing process of heterotopic bone formation, a program of continuous passive motion was implemented. In addition, risedronate was administrated. We started the continuous passive motion at 50 degrees of flexion for 30 mins that was increased to 100 degrees for 3 hrs daily. The final range of motion at the hip was: flexion 85 degrees, extension 0 degrees, internal rotation 10 degrees, external rotation 10 degrees, abduction 10 degrees, and adduction 10 degrees. Based on our results, continuous passive motion plays a role in heterotopic ossification maturation. The effectiveness of continuous passive motion implementation against HO should be further investigated for selected cases.
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Liang Z, Yip H, Sena Moore K, Ferreira T, Ji M, Signorile JF, Munro C. Self-Managed Music-Guided Exercise Intervention Improved Upper and Lower Extremity Muscle Strength for ICU Survivors-A Pilot Randomized Controlled Study. Biol Res Nurs 2021; 24:145-151. [PMID: 34738474 DOI: 10.1177/10998004211050297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ObjectiveThe objective of this study was to evaluate effects of a self-managed music-guided exercise intervention on muscle strength among intensive care unit (ICU) survivors. Methods We used a two-arm randomized-controlled trial. Following ICU discharge, eligible participants were assigned to one of two groups: music group (n = 13) or active control group (n = 13). The music group was taught to self-manage upper and lower extremity exercise movements by listening to an individualized music-guided playlist twice daily for 5 days. The active control group was provided an exercise brochure and advised to perform the same exercises at the same intervals. Dynamometers were used to measure muscle strength. T-tests and Weighted GEE models were used for testing the intervention effect between groups. Results Twenty-six subjects were enrolled. The mean age was 62.8 (SD = 13.8), 53.8% were male, 65.4% were Caucasian, and the mean APACHE severity of illness score was 59 (SD = 23.4). Reasons for ICU admission were mainly cardiac and medical. The music group showed significant improvements in handgrip, plantar flexion, leg extension, elbow flexion, and shoulder adduction strengths on left and right sides. Additionally, left and right leg extensor and left plantar flexor strengths showed significant post-differences, and small to moderately large effect sizes, between the music group and control group. Conclusion These findings suggest that a music-guided exercise intervention has the potential to improve muscle strength in ICU survivors and prevent further post-ICU deterioration in ICU survivors. Future trials should build upon these preliminary findings.
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Affiliation(s)
- Zhan Liang
- School of Nursing and Health Studies, 5452University of Miami, Coral Gables, FL, USA
| | - Hilary Yip
- Frost School of Music, 5452University of Miami, Coral Gables, FL, USA
| | - Kimberly Sena Moore
- Bower School of Music & the Arts, 3391Florida Gulf Coast University, Fort Myers, FL, USA
| | - Tanira Ferreira
- Division of Pulmonary Disease and Critical Care, Department of Medicine, University of Miami Hospital & Clinics, Miami, FL, USA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Joseph F Signorile
- Department of Kinesiology and Sport Sciences, 25802University of Miami, Coral Gables, FL, USA
| | - Cindy Munro
- School of Nursing and Health Studies, 5452University of Miami, Coral Gables, FL, USA
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Efficacy of Acupuncture Combined with Rehabilitation Training for Intensive Care Unit-Acquired Muscle Weakness: A Protocol for a Randomized, Sham-Procedure-Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3539651. [PMID: 34721629 PMCID: PMC8550834 DOI: 10.1155/2021/3539651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/22/2021] [Indexed: 01/20/2023]
Abstract
To evaluate the efficacy of acupuncture combined with rehabilitation training in patients with intensive care unit (ICU)-acquired muscle weakness (ICUAW), a single-blinded, randomized, sham-controlled clinical trial is designed for execution. In total, 56 participants with ICUAW will be randomly assigned to the treatment and control groups with 28 participants in each group. The participants will be treated with acupunctures or sham procedures at LI15, LI11, ST36, GB34, and ST31, 5 times per week for a total of 20 sessions in 4 weeks while they will receive rehabilitation training. Patients will be followed up every month for 3 months after treatment. The primary outcomes include changes in quadriceps femoris muscle area, thickness, vastus intermediate muscle thickness, subcutaneous tissue thickness, and ultrasonic intensities of the rectus femoris. The secondary outcomes consist of the modified Barthel index score and the Medical Research Council total score. Participants' mechanical ventilation, the rate of detachment at the second week, the 28-day survival rate, and the occurrence of adverse reactions will be measured, and any side effects will be reported and recorded. Patient outcomes between the treatment and control groups will be compared and statistically tested. We anticipate that the therapeutic regimen of acupuncture combined with rehabilitation training would be more effective than the rehabilitation training alone for the treatment of the ICUAW. The findings of this study could help develop a better strategy for the treatment of the ICUAW disease and explore a clinical application of an acupuncture technique. Trial registration: Chinese Clinical Trial Register ChiCTR2000038779. Registered 30 September, 2020, https://www.chictr.org.cn/showproj.aspx?proj=62284.
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Passantino A, Dalla Vecchia LA, Corrà U, Scalvini S, Pistono M, Bussotti M, Gambarin FI, Scrutinio D, La Rovere MT. The Future of Exercise-Based Cardiac Rehabilitation for Patients With Heart Failure. Front Cardiovasc Med 2021; 8:709898. [PMID: 34422933 PMCID: PMC8371325 DOI: 10.3389/fcvm.2021.709898] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 06/29/2021] [Indexed: 01/14/2023] Open
Abstract
Cardiac rehabilitation (CR) is a comprehensive program that includes exercise training, titration of medical therapy, lifestyle modification, educational support, and psychosocial assessment. All these components are safe and beneficial resulting in significant improvements in quality of life, functional capacity, mortality, and hospital readmission. Current guidelines support its use in a broad spectrum of cardiac disease. This review focuses on exercise-based CR for heart failure (HF) patients in whom CR is a recommended treatment. Exercise should be prescribed according to a personalized approach, optimizing, and tailoring the rehabilitative program to the patient's characteristics. Specific CR programs are dedicated to older patients, those with HF and preserved ejection fraction, and recipients of cardiac implantable electronic devices or left ventricular assistance device. Telemedicine may increase CR participation and overcome some of the barriers that limit its utilization.
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Affiliation(s)
- Andrea Passantino
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Bari, Italy
| | | | - Ugo Corrà
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Veruno, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS, Division of Cardiac Rehabilitation, Lumezzane, Italy
| | - Massimo Pistono
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Veruno, Italy
| | - Maurizio Bussotti
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Milan, Italy
| | - Fabiana Isabella Gambarin
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Veruno, Italy
| | - Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri Spa SB, IRCCS Division of Cardiac Rehabilitation, Bari, Italy
| | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri Spa SB, Division of Cardiac Rehabilitation, Montescano, Italy
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The Efficacy and Safety of In-Intensive Care Unit Leg-Cycle Ergometry in Critically Ill Adults. A Systematic Review and Meta-analysis. Ann Am Thorac Soc 2021; 17:1289-1307. [PMID: 32628501 DOI: 10.1513/annalsats.202001-059oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Survivors of critical illness may experience physical-function deficits after intensive care unit (ICU) discharge. In-ICU cycle ergometry may facilitate early mobilization and decrease functional impairment.Objective: We conducted a systematic review and meta-analysis to understand the effect of in-ICU leg-cycle ergometry on patient-important and clinically relevant outcomes.Data Sources: We searched eight electronic databases from inception until July 2019.Data Extraction: We included randomized controlled trials (RCTs) and nonrandomized studies of critically ill adults admitted to the ICU for ≥24 hours, comparing cycling interventions to control arms that did not receive cycling. Main outcomes included physical function, mechanical ventilation (MV) duration, length of stay (LOS), quality of life (QoL), mortality, and safety. We conducted independent duplicate-citation screening, data abstraction, and risk-of-bias assessments. We pooled RCTs using a random-effects model and calculated the risk ratio (RR), mean difference (MD), or standardized MD with 95% confidence intervals (CIs). We assessed certainty of outcomes using the Grading of Recommendations Assessment, Development, and Evaluation approach.Results: Of 6,531 citations, we included 12 RCTs and 2 nonrandomized studies (n = 926). Between the cycling and control groups, there were no differences in physical function at hospital discharge (3 RCTs; n = 225; standardized MD, 0.07 [95% CI, -0.38 to 0.53]; very low certainty), MV duration (9 RCTs; n = 676; MD, 0.01 [-1.04 to 1.07] days; moderate certainty), ICU LOS (10 RCTs; n = 511; MD, 0.23 [-1.44 to 1.89] days; moderate certainty), hospital LOS (7 RCTs; n = 393, MD -0.07 [-3.87 to 3.73] days; moderate certainty), QoL at 6 months after hospital discharge (2 RCTs; n = 103; MD, 9.13 [13.80 to 32.05] points higher; very low certainty), or hospital mortality (7 RCTs; n = 710; RR 1.09 [0.82 to 1.46]; moderate-certainty). The adverse event rate in cycling sessions was 0.16% across studies (10 studies; 5 of 3,117 sessions; very low certainty).Conclusions: Cycling initiated in the ICU is probably safe; however, we did not find any differences in physical function, MV duration, LOS, QoL, or mortality compared with those not receiving cycling. Rigorously designed RCTs are needed to improve precision and further investigate the effect of cycling on patient-important outcomes.
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Gala K, Desai V, Liu N, Omer EM, McClave SA. How to Increase Muscle Mass in Critically Ill Patients: Lessons Learned from Athletes and Bodybuilders. Curr Nutr Rep 2021; 9:369-380. [PMID: 33098051 DOI: 10.1007/s13668-020-00334-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Decades of research on nutrition and exercise on athletes and bodybuilders has yielded various strategies to promote anabolism and improve muscle health and growth. We reviewed these interventions in the context of muscle loss in critically ill patients. RECENT FINDINGS For critically ill patients, ensuring optimum protein intake is important, potentially using a whey-containing source and supplemented with vitamin D and leucine. Agents like hydroxyl β-methylbutyrate and creatine can be used to promote muscle synthesis. Polyunsaturated fatty acids stimulate muscle production as well as have anti-inflammatory properties that may be useful in critical illness. Adjuncts like oxandralone promote anabolism. Resistance training has shown mixed results in the ICU setting but needs to be explored further with specific outcomes. Critically ill patients suffer from severe proteolysis during hospitalization as well as persistent inflammation, immunosuppression, and catabolism syndrome after discharge. High protein supplementation, ergogenic aids, anti-inflammatories, and anabolic adjuncts have shown potential in alleviating muscle loss and should be used in intensive care units to optimize patient recovery.
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Affiliation(s)
- Khushboo Gala
- Department of Internal Medicine, University of Louisville, 550 S Jackson Street, 3rd Floor, Ambulatory Care Building, Louisville, KY, 40202, USA.
| | - Viral Desai
- Department of Internal Medicine, University of Louisville, 550 S Jackson Street, 3rd Floor, Ambulatory Care Building, Louisville, KY, 40202, USA
| | - Nanlong Liu
- Department of Gastroenterology and Hepatology, University of Louisville, Louisville, KY, USA
| | - Endashaw M Omer
- Department of Gastroenterology and Hepatology, University of Louisville, Louisville, KY, USA
| | - Stephen A McClave
- Department of Gastroenterology and Hepatology, University of Louisville, Louisville, KY, USA
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Bertozzi MN, Cagide S, Navarro E, Accoce M. Description of physical rehabilitation in intensive care units in Argentina: usual practice and during the COVID-19 pandemic. Online survey. Rev Bras Ter Intensiva 2021; 33:188-195. [PMID: 34231799 PMCID: PMC8275077 DOI: 10.5935/0103-507x.20210026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/09/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To describe the usual practice of mobility therapy in the adult intensive care unit for patients with and without COVID-19. Methods Online survey in which physical therapists working in an adult intensive care unit in Argentina participated. Sixteen multiple-choice or single-response questions grouped into three sections were asked. The first section addressed personal, professional and work environment data. The second section presented questions regarding usual care, and the third focused on practices under COVID-19 pandemic conditions. Results Of 351 physical therapists, 76.1% answer that they were exclusively responsible for patient mobility. The highest motor-based goal varied according to four patient scenarios: Mechanically ventilated patients, patients weaned from mechanical ventilation, patients who had never required mechanical ventilation, and patients with COVID-19 under mechanical ventilation. In the first and last scenarios, the highest goal was to optimize muscle strength, while for the other two, it was to perform activities of daily living. Finally, the greatest limitation in working with patients with COVID-19 was respiratory and/or contact isolation. Conclusion Physical therapists in Argentina reported being responsible for the mobility of patients in the intensive care unit. The highest motor-based therapeutic goals for four classic scenarios in the closed area were limited by the need for mechanical ventilation. The greatest limitation when mobilizing patients with COVID-19 was respiratory and contact isolation.
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Affiliation(s)
- Matias Nicolás Bertozzi
- Sanatorio Anchorena San Martín - Buenos Aires, Argentina.,Hospital Donación "Francisco Santojanni" - Buenos Aires, Argentina
| | - Sabrina Cagide
- Sanatorio Anchorena San Martín - Buenos Aires, Argentina.,Hospital Municipal "Dr. Bernardo Houssay" - Vicente Lopez, Argentina
| | - Emiliano Navarro
- Sanatorio Anchorena San Martín - Buenos Aires, Argentina.,Centro del Parque Cuidados Respiratorios - Buenos Aires, Argentina.,Hospital General de Agudos "Carlos G. Durand" - Buenos Aires, Argentina
| | - Matias Accoce
- Sanatorio Anchorena San Martín - Buenos Aires, Argentina.,Hospital de Quemados "Dr. Arturo Umberto Illia" - Buenos Aires, Argentina.,Universidad Abierta Interamericana - Buenos Aires, Argentina
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Goldfarb M, Semsar-kazerooni K, Morais JA, Dima D. Early Mobilization in Older Adults with Acute Cardiovascular Disease. Age Ageing 2021; 50:1166-1172. [PMID: 33247593 DOI: 10.1093/ageing/afaa253] [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] [Received: 05/31/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Early mobilization (EM) is beneficial in critical care units and in older hospitalized patients, but little is known about EM in older adults with acute cardiovascular disease. METHODS Consecutive admissions of adults ≥80 years old to a Cardiac Intensive Care Unit (CICU) prior to and following implementation of a nurse-driven EM program were reviewed. Mobility was measured using the Level of Function (LOF) Mobility Scale, which ranges from 0 (bed immobile) to 5 (able to walk >20 meters). The primary outcome was discharge home. RESULTS There were 412 patients included (N = 234, intervention; N = 178, preintervention). There was no difference in age between groups (overall 86.3 ± 4.8 years old) or sex (overall female N = 215, 52.2%). In the intervention group, functional impairment was present in 89 patients (38.0%) prehospitalization and in 209 patients (89.3%) on admission. Nearly half of patients (N = 107; 45.7%) improved their LOF by ≥1 during admission. Mobilization occurred during nearly all opportunities (838/850; 98.6%), and most mobility activities were completed (2,207/2,553; 86.4%). Adverse events were rare (5/2,207 activities [0.2% adverse event rate]) and transient. Patients in the intervention group were more likely than patients in the preintervention group to be discharged home (74.4 vs. 65.7%, P = 0.047, respectively) and had a lower rate of in-hospital death (6.4 vs. 14.6%, P = 0.006, respectively). There was no difference in mean length of hospital stay, 30-day emergency department visit or hospital re-admission. CONCLUSION EM is safe in older adults in the CICU and is associated with reduced discharge to healthcare facility and in-hospital mortality.
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Affiliation(s)
- Michael Goldfarb
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - José A Morais
- Division of Geriatric Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Diana Dima
- Department of Nursing, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Daptardar AA. Quest of Knowledge and Perceived Barriers toward Early Mobilization of Critically Ill Patients in Intensive Care Unit: A Continuing Journey! Indian J Crit Care Med 2021; 25:489-490. [PMID: 34177164 PMCID: PMC8196386 DOI: 10.5005/jp-journals-10071-23838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
How to cite this article: Daptardar AA. Quest of Knowledge and Perceived Barriers toward Early Mobilization of Critically Ill Patients in Intensive Care Unit: A Continuing Journey! Indian J Crit Care Med 2021;25(5):489-490.
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Respiratory Support Adjustments and Monitoring of Mechanically Ventilated Patients Performing Early Mobilization: A Scoping Review. Crit Care Explor 2021; 3:e0407. [PMID: 33912837 PMCID: PMC8078339 DOI: 10.1097/cce.0000000000000407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: This scoping review is aimed to summarize current knowledge on respiratory support adjustments and monitoring of metabolic and respiratory variables in mechanically ventilated adult patients performing early mobilization. Data Sources: Eight electronic databases were searched from inception to February 2021, using a predefined search strategy. Study Selection: Two blinded reviewers performed document selection by title, abstract, and full text according to the following criteria: mechanically ventilated adult patients performing any mobilization intervention, respiratory support adjustments, and/or monitoring of metabolic/respiratory real-time variables. Data Extraction: Four physiotherapists extracted relevant information using a prespecified template. Data Synthesis: From 1,208 references screened, 35 documents were selected for analysis, where 20 (57%) were published between 2016 and 2020. Respiratory support settings (ventilatory modes or respiratory variables) were reported in 21 documents (60%). Reported modes were assisted (n = 11) and assist-control (n = 9). Adjustment of variables and modes were identified in only seven documents (20%). The most frequent respiratory variable was the Fio2, and only four studies modified the level of ventilatory support. Mechanical ventilator brand/model used was not specified in 26 documents (74%). Monitoring of respiratory, metabolic, and both variables were reported in 22 documents (63%), four documents (11%) and 10 documents (29%), respectively. These variables were reported to assess the physiologic response (n = 21) or safety (n = 13). Monitored variables were mostly respiratory rate (n = 26), pulse oximetry (n = 22), and oxygen consumption (n = 9). Remarkably, no study assessed the work of breathing or effort during mobilization. Conclusions: Little information on respiratory support adjustments during mobilization of mechanically ventilated patients was identified. Monitoring of metabolic and respiratory variables is also scant. More studies on the effects of adjustments of the level/mode of ventilatory support on exercise performance and respiratory muscle activity monitoring for safe and efficient implementation of early mobilization in mechanically ventilated patients are needed.
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Chen B, Xie G, Lin Y, Chen L, Lin Z, You X, Xie X, Dong D, Zheng X, Li D, Lin W. A systematic review and meta-analysis of the effects of early mobilization therapy in patients after cardiac surgery. Medicine (Baltimore) 2021; 100:e25314. [PMID: 33847630 PMCID: PMC8051976 DOI: 10.1097/md.0000000000025314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Prolonged hospitalization and immobility of critical care patients elevate the risk of long-term physical and cognitive impairments. However, the therapeutic effects of early mobilization have been difficult to interpret due to variations in study populations, interventions, and outcome measures. We conducted a meta-analysis to assess the effects of early mobilization therapy on cardiac surgery patients in the intensive care unit (ICU). METHODS PubMed, Excerpta Medica database (EMBASE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), and the Cochrane Library were comprehensively searched from their inception to September 2018. Randomized controlled trials were included if patients were adults (≥18 years) admitted to any ICU for cardiac surgery due to cardiovascular disease and who were treated with experimental physiotherapy initiated in the ICU (pre, post, or peri-operative). Data were extracted by 2 reviewers independently using a pre-constructed data extraction form. Length of ICU and hospital stay was evaluated as the primary outcomes. Physical function and adverse events were assessed as the secondary outcomes. Review Manager 5.3 (RevMan 5.3) was used for statistical analysis. For all dichotomous variables, relative risks or odds ratios with 95% confidence intervals (CI) were presented. For all continuous variables, mean differences (MDs) or standard MDs with 95% CIs were calculated. RESULTS The 5 studies with a total of 652 patients were included in the data synthesis final meta-analysis. While a slight favorable effect was detected in 3 out of the 5 studies, the overall effects were not significant, even after adjusting for heterogeneity. CONCLUSIONS This population-specific evaluation of the efficacy of early mobilization to reduce hospitalization duration suggests that intervention may not universally justify the labor barriers and resource costs in patients undergoing non-emergency cardiac surgery. PROSPERO RESEARCH REGISTRATION IDENTIFYING NUMBER CRD42019135338.
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Affiliation(s)
- Bin Chen
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
- National Clinical Research Base of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province
| | - Guanli Xie
- Yunnan University of Traditional Chinese Medicine, Kunming 650500, Yunnan Province, China
| | - Yuan Lin
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Lianghua Chen
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Zhichen Lin
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Xiaofang You
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Xuemin Xie
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Danyu Dong
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Xinyi Zheng
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Dong Li
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
| | - Wanqing Lin
- The Affiliated People's Hospital of Fujian University of Traditional Chinese Medicine
- National Clinical Research Base of Traditional Chinese Medicine, Fuzhou 350004, Fujian Province
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Downer B, Pritchard K, Thomas KS, Ottenbacher K. Improvement in Activities of Daily Living during a Nursing Home Stay and One-Year Mortality among Older Adults with Sepsis. J Am Geriatr Soc 2021; 69:938-945. [PMID: 33155268 PMCID: PMC8049879 DOI: 10.1111/jgs.16915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVE To describe the recovery of activities of daily living (ADLs) during a skilled nursing facility (SNF) stay and the association with 1-year mortality after SNF discharge among Medicare beneficiaries treated in intensive care for sepsis. DESIGN Retrospective cohort study. SETTING Skilled nursing facilities in the United States. PARTICIPANTS Medicare fee-for-service beneficiaries admitted to an SNF within 3 days of discharge from a hospitalization that included an intensive care unit (ICU) stay for sepsis between January 1, 2013, and September 30, 2015 (N = 59,383). MEASUREMENTS Data from the Minimum Data Set (MDS) were used to calculate a total score for seven ADLs. Improvement was determined by comparing the total ADL scores from the first and last MDS assessments of the SNF stay. Proportional hazard models were used to estimate the association between improvement in ADL function and 1-year mortality after SNF discharge. RESULTS Approximately 58% of SNF residents had any improvement in ADL function. Residents who had improvement in ADL function had 0.72 (95% confidence interval (CI) = 0.69-0.74) lower risk for mortality following SNF discharge than residents who did not improve. Residents who improved 1-3 points (hazard ratio (HR) = 0.82, 95% CI = 0.79-0.84) and four or more points (HR = 0.57, 95% CI = 0.55-0.60) in ADL function had significantly lower mortality risk than residents who did not improve. CONCLUSION Older adults treated in an ICU with sepsis can improve in ADL function during an SNF stay. This improvement is associated with lower 1-year mortality risk after SNF discharge. These findings provide evidence that ADL recovery during an SNF stay is associated with better health outcomes for older adults who have survived an ICU stay for sepsis.
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Affiliation(s)
- Brian Downer
- University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston, TX, US
- University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX, US
| | - Kevin Pritchard
- University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston, TX, US
| | - Kali S. Thomas
- Brown University, School of Public Health, Providence, RI, US
- United States Department of Veterans Affairs Medical Center, Providence, RI, US
| | - Kenneth Ottenbacher
- University of Texas Medical Branch, Division of Rehabilitation Sciences, Galveston, TX, US
- University of Texas Medical Branch, Sealy Center on Aging, Galveston, TX, US
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[S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version]. Med Klin Intensivmed Notfmed 2021; 115:37-109. [PMID: 32356041 DOI: 10.1007/s00063-020-00685-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Goodwin VA, Allan L, Bethel A, Cowley A, Cross JL, Day J, Drummond A, Hall AJ, Howard M, Morley N, Thompson Coon J, Lamb SE. Rehabilitation to enable recovery from COVID-19: a rapid systematic review. Physiotherapy 2021; 111:4-22. [PMID: 33637294 PMCID: PMC7902208 DOI: 10.1016/j.physio.2021.01.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 12/26/2022]
Abstract
Objectives To establish the evidence for rehabilitation interventions tested in populations of patients admitted to ICU and critical care with severe respiratory illness, and consider whether the evidence is generalizable to patients with COVID-19. Methods The authors undertook a rapid systematic review. Medline (via OvidSP), CINAHL Complete (via EBSCOhost), Cochrane Library, Cochrane Database of Systematic Reviews and CENTRAL (via Wiley), Epistemonikos (via Epistemonikos.org), PEDro (via pedro.org.au) and OTseeker (via otseeker.com) searched to 7 May 2020. The authors included systematic reviews, RCTs and qualitative studies involving adults with respiratory illness requiring intensive care who received rehabilitation to enhance or restore resulting physical impairments or function. Data were extracted by one author and checked by a second. TIDier was used to guide intervention descriptions. Study quality was assessed using Critical Skills Appraisal Programme (CASP) tools. Results Six thousand nine hundred and three titles and abstracts were screened; 24 systematic reviews, 11 RCTs and eight qualitative studies were included. Progressive exercise programmes, early mobilisation and multicomponent interventions delivered in ICU can improve functional independence. Nutritional supplementation in addition to rehabilitation in post-ICU hospital settings may improve performance of activities of daily living. The evidence for rehabilitation after discharge from hospital following an ICU admission is inconclusive. Those receiving rehabilitation valued it, engendering hope and confidence. Conclusions Exercise, early mobilisation and multicomponent programmes may improve recovery following ICU admission for severe respiratory illness that could be generalizable to those with COVID-19. Rehabilitation interventions can bring hope and confidence to individuals but there is a need for an individualised approach and the use of behaviour change strategies. Further research is needed in post-ICU settings and with those who have COVID-19.
Registration: Open Science Framework https://osf.io/prc2y
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Louvaris Z, Langer D. Moving towards a better identification and management of frailty in ICU survivors. Thorax 2021; 76:322-323. [PMID: 33574122 DOI: 10.1136/thoraxjnl-2020-216530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Zafeiris Louvaris
- Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium .,Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE department CHROMETA, Leuven, Belgium
| | - Daniel Langer
- Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium.,Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE department CHROMETA, Leuven, Belgium
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Tadyanemhandu C, van Aswegen H, Ntsiea V. Organizational structures and early mobilization practices in South African public sector intensive care units-A cross-sectional study. J Eval Clin Pract 2021; 27:42-52. [PMID: 32141685 PMCID: PMC7483254 DOI: 10.1111/jep.13378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/15/2020] [Accepted: 02/03/2020] [Indexed: 12/12/2022]
Abstract
RATIONALE Understanding current early mobilization practice of patients in intensive care unit (ICU) is critical to the design and implementation of strategies to facilitate its application in a diverse population of critically ill patients encountered in public sector hospitals. AIM To evaluate the organizational structures of South African public sector hospital ICUs and to describe early mobilization practices in these units. METHODS A cross-sectional survey was done in participating public hospitals from eight provinces in South Africa. Convenience sampling was done. Data collected included hospital and ICU structure, adult patient demographic and clinical data, and mobilization activities done in ICU over the previous 24 hours prior to the day of the survey. RESULTS A total of 29 ICUs from 13 participating hospitals were surveyed resulting in 205 patient records. Majority of the surveyed ICUs were "open" type (n = 16; 55.2%). A standardized sedation scoring system was used in 18 units (62.1%) and only two units (6.9%) had an early mobilization protocol in place. Mean age of the patients surveyed was 43.5 (±17.7) years and 148 (72.2%) patients were on mechanical ventilation. Primary reasons for admission to ICU included traumatic injury (n = 86; 42%) and postoperative care (n = 33; 16.1%). Mobilization activities performed in the previous 24 hours included turning the patient in bed (n = 88; 42.9%), marching on the spot (n = 9; 4.4%) and walking (n = 10; 4.9%). Out-of-bed mobilization was done in only 40 (19.5%) patients. The most common barriers to early mobilization included patient unresponsiveness (n = 50; 24.4%) and hemodynamic instability (n = 42; 20.5%). The type of ventilation was found to have a significant positive relationship with out-of-bed patient mobilization (P = .000). CONCLUSIONS A small proportion of patients attained their highest level of mobilization in ICU. The type of ventilation influenced early mobilization practices in public sector ICUs in South Africa.
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Affiliation(s)
- Cathrine Tadyanemhandu
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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47
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Evaluating the Benefits of Early Intensive Rehabilitation for Patients With Sepsis in the Medical Intensive Care Unit: A Retrospective Study. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2021. [DOI: 10.1097/jat.0000000000000160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Menges D, Seiler B, Tomonaga Y, Schwenkglenks M, Puhan MA, Yebyo HG. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Crit Care 2021; 25:16. [PMID: 33407707 PMCID: PMC7789482 DOI: 10.1186/s13054-020-03446-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/18/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This systematic review and meta-analysis aimed to determine the effectiveness of systematic early mobilization in improving muscle strength and physical function in mechanically ventilated intensive care unit (ICU) patients. METHODS We conducted a two-stage systematic literature search in MEDLINE, EMBASE and the Cochrane Library until January 2019 for randomized controlled trials (RCTs) examining the effects of early mobilization initiated within 7 days after ICU admission compared with late mobilization, standard early mobilization or no mobilization. Priority outcomes were Medical Research Council Sum Score (MRC-SS), incidence of ICU-acquired weakness (ICUAW), 6-min walk test (6MWT), proportion of patients reaching independence, time needed until walking, SF-36 Physical Function Domain Score (PFS) and SF-36 Physical Health Component Score (PCS). Meta-analysis was conducted where sufficient comparable evidence was available. We evaluated the certainty of evidence according to the GRADE approach. RESULTS We identified 12 eligible RCTs contributing data from 1304 participants. Two RCTs were categorized as comparing systematic early with late mobilization, nine with standard early mobilization and one with no mobilization. We found evidence for a benefit of systematic early mobilization compared to late mobilization for SF-36 PFS (MD 12.3; 95% CI 3.9-20.8) and PCS (MD 3.4; 95% CI 0.01-6.8), as well as on the proportion of patients reaching independence and the time needed to walking, but not for incidence of ICUAW (RR 0.62; 95% CI 0.38-1.03) or MRC-SS. For systematic early compared to standard early mobilization, we found no statistically significant benefit on MRC-SS (MD 5.8; 95% CI - 1.4 to 13.0), incidence of ICUAW (RR 0.90; 95% CI 0.63-1.27), SF-36 PFS (MD 8.1; 95% CI - 15.3 to 31.4) or PCS (MD - 2.4; 95% CI - 6.1 to 1.3) or other priority outcomes except for change in 6MWT from baseline. Generally, effects appeared stronger for systematic early compared to late mobilization than to standard early mobilization. We judged the certainty of evidence for all outcomes as very low to low. CONCLUSION The evidence regarding a benefit of systematic early mobilization remained inconclusive. However, our findings indicate that the larger the difference in the timing between the intervention and the comparator, the more likely an RCT is to find a benefit for early mobilization. STUDY REGISTRATION PROSPERO (CRD42019122555).
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Affiliation(s)
- Dominik Menges
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland.
| | - Bianca Seiler
- Faculty of Medicine (MeF), University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland
| | - Yuki Tomonaga
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Matthias Schwenkglenks
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Milo A Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Henock G Yebyo
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
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An Explanatory Model for the Relationship Between Physical Therapists' Self-perceptions of Value and Care Prioritization Decisions in the Acute Hospital. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit. Crit Care Res Pract 2020; 2020:7840743. [PMID: 33294221 PMCID: PMC7714600 DOI: 10.1155/2020/7840743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Patients admitted to the intensive care unit (ICU) are generally confined to bed leading to limited mobility that may have detrimental effects on different body systems. Early mobilization prevents or reduces these effects and improves outcomes in patients following critical illness. The purpose of this review is to summarize different aspects of early mobilization in intensive care. Methods Electronic databases of PubMed, Google Scholar, ScienceDirect, and Scopus were searched using a combination of keywords. Full-text articles meeting the inclusion criteria were selected. Results Fifty-six studies on various aspects such as the effectiveness of early mobilization in various intensive care units, newer techniques in early mobilization, outcome measures for physical function in the intensive care unit, safety, and practice and barriers to early mobilization were included. Conclusion: Early mobilization is found to have positive effects on various outcomes in patients with or without mechanical ventilation. The newer techniques can be used to facilitate early mobilization. Scoring systems—specific to the ICU—are available and should be used to quantify patients' status at different intervals of time. Early mobilization is not commonly practiced in many countries. Various barriers to early mobilization have been identified, and different strategies can be used to overcome them.
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