1
|
Söderberg A, Karlsson V, Fagevik Olsén M, Thelandersson A, Johansson A. Patient as active partner - clue to successful early mobilization in intensive care. Physiother Theory Pract 2024; 40:2298-2308. [PMID: 37489585 DOI: 10.1080/09593985.2023.2239891] [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: 04/29/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The evidence for the benefits of early mobilization in intensive care is growing. Early mobilization differs from most other interventions in intensive care since the patient's participation is requested. What kind of challenges this entails for the intensive care clinicians, and what is crucial in successful early mobilization from their perspective, is sparsely explored and was therefore the purpose of this study. METHODS Semi-structured interviews were held with 17 intensive care clinicians, seven nurses, five assistant nurses and five physiotherapists. The interviews were analyzed with a phenomenographic methodology. FINDINGS Four descriptive categories emerged: 1) Taking responsibility; 2) Taking the patient's perspective; 3) Time or not time to mobilize; and 4) The "know-how" of early mobilization. Early mobilization was perceived as an important and crucial part of intensive care. It includes positioning and sensory stimulation, which could be used to re-orientate the patient and prevent delirium. The patients' experiences were considered individual with a mix of strong emotions. Despite the stated significance of early mobilization, different conceptions were expressed about the right time, some of them based on concerns for the patient, and some due to safety concerns. In the optimal active mobilization to upright positions there was an emphasis on careful preparation and patient involvement, including negotiation and active participation. CONCLUSIONS The importance of early mobilization is indisputable. Successful early mobilization is achieved by applying a person-centered approach, involving the patient as an active partner. Early mobilization comprises positioning and sensory stimulation and should be included in the daily planning of patient care.
Collapse
Affiliation(s)
- Annika Söderberg
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Arvid Wallgrens Backe, University of Gothenburg, Gothenburg, SE, Sweden
- Department of Physiotherapy, Skaraborg Hospital, Skövde, SE, Sweden
| | | | - Monika Fagevik Olsén
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Arvid Wallgrens Backe, University of Gothenburg, Gothenburg, SE, Sweden
| | | | - Anita Johansson
- Research and Development Centre, Skaraborg Hospital, Skövde, SE, Sweden
| |
Collapse
|
2
|
O'Grady HK, Ball I, Berney S, Burns KEA, Cook DJ, Fox-Robichaud A, Herridge MS, Karachi T, Mathur S, Reid JC, Rochwerg B, Rollinson T, Rudkowski JC, Bosch J, Turkstra LS, KhoPT ME. Characterizing usual-care physical rehabilitation in Canadian intensive care unit patients: a secondary analysis of the Canadian multicentre Critical Care Cycling to Improve Lower Extremity Strength pilot randomized controlled trial. Can J Anaesth 2024:10.1007/s12630-024-02838-7. [PMID: 39317833 DOI: 10.1007/s12630-024-02838-7] [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: 10/30/2023] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 09/26/2024] Open
Abstract
PURPOSE Physical rehabilitation (PR) in the intensive care unit (ICU) may improve outcomes for survivors but clinical trial results have been discordant. We hypothesized that discordant results may reflect treatment heterogeneity received by "usual care" comparator groups in PR studies. Usual-care PR is typically underspecified, which is a barrier to comparing results across treatment studies. The primary objective of the present study was to describe the usual-care PR received by critically ill patients enrolled in the Canadian multicentre Critical Care Cycling to Improve Lower Extremity Strength (CYCLE) pilot randomized controlled trial (RCT) of PR. Other objectives were to help contextualize current research and provide data for international comparison. METHODS In this secondary analysis of the CYCLE pilot RCT, patients were randomized to in-bed cycling and usual-care PR or usual-care PR alone. Physiotherapists documented usual-care PR including therapy received, type of activity, duration, adverse events and consequences, reasons for no PR, and concurrent relevant medical interventions. We characterized usual care using descriptive statistics at the cohort and patient levels. RESULTS Across seven Canadian centres, 30 patients were randomized to usual-care PR. The median [interquartile range (IQR)] ICU stay was 10 [9-24] days and patients received PR on a median [IQR] of 5 [3-9] days for 23 [17-30] min per day. Eighteen patients (60%) stood, marched, or walked during usual care. Transient adverse events occurred in three patients on 1.5% (3/198) of days and none prompted session termination. CONCLUSIONS In the usual-care arm of the CYCLE pilot RCT, PR was delivered on half of ICU days and over half of patients stood, marched, or walked. Adverse events during usual-care PR were uncommon. STUDY REGISTRATION ClinicalTrials.gov ( NCT02377830 ); first posted 4 March 2015.
Collapse
Affiliation(s)
- Heather K O'Grady
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ian Ball
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Sue Berney
- Physiotherapy Clinic, Austin Health, Heidelberg, VIC, Australia
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Karen E A Burns
- Li Sha King Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Margaret S Herridge
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Timothy Karachi
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada
| | - Julie C Reid
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Bram Rochwerg
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Thomas Rollinson
- Physiotherapy Clinic, Austin Health, Heidelberg, VIC, Australia
- Department of Physiotherapy, Melbourne School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia
| | - Jill C Rudkowski
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Jackie Bosch
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lyn S Turkstra
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michelle E KhoPT
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
- Institute of Applied Health Sciences, 1400 Main St. W., Hamilton, ON, L8S 1C7, Canada.
| |
Collapse
|
3
|
Aljohani HY, Alammar S, Alnawmasi S, Alfawzan R, Alotaibi N, Mumenah N, Alruwaili A, Algrani SS, Alotaibi TF, Alqahtani MK, Alqahtani MM, Alanazi AM, Ismaeil T, Almalki S, Alotaibi J. Perceived Barriers of Clinical Roles Towards Intensive Care Unit Mobility. Rehabil Res Pract 2024; 2024:5551184. [PMID: 39286774 PMCID: PMC11405107 DOI: 10.1155/2024/5551184] [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: 07/19/2023] [Revised: 07/22/2024] [Accepted: 08/19/2024] [Indexed: 09/19/2024] Open
Abstract
Background: There is overwhelming evidence of improved patient outcomes as a result of early mobilization in the intensive care unit (ICU). However, several barriers of ICU mobility remain understated with reference to clinical roles. The purpose of this study is to investigate the perceived barriers of early mobility of critically ill patients among ICU healthcare providers. Methods: In this cross-sectional study, the Mobilization Attitudes and Beliefs Survey (PMABS-ICU) was administered to ICU healthcare providers using an online survey. The study investigated barriers related to knowledge, attitudes, and behaviors regarding ICU mobility practices. These barriers were compared among different ICU clinical roles. Results: The survey yielded a total number of 214 healthcare providers with 41% female and 59% male. Respiratory therapists reported the highest perceived barriers to ICU mobility (M 39, IQR 36, 43) % compared to physical therapists (who reported the lowest barriers), occupational therapists, nurses, and physicians (p ≤ 0.05). ICU healthcare providers' behavior towards ICU mobility such as perceived benefits and safety is ranked as the primary barrier (M 49, IQR 42, 52) %. Professional experience did not significantly vary among all groups. Conclusion: Our findings highlight that ICU healthcare providers' perceptions, including both potential benefits and safety concerns regarding mobility, are significant barriers to implement mobility practices. ICU mobility barriers should be tackled by providing education and training. A focused effort to include RTs and nurses could advance interdisciplinary ICU mobility practice and reduce associated barriers.
Collapse
Affiliation(s)
- Hassan Y Aljohani
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Shahad Alammar
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Shoug Alnawmasi
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Riham Alfawzan
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Nouf Alotaibi
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Noora Mumenah
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Arwa Alruwaili
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Saleh S Algrani
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Tareq F Alotaibi
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Mobarak K Alqahtani
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Mohammed M Alqahtani
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Abdullah M Alanazi
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Taha Ismaeil
- Department of Respiratory Therapy King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) & King Abdullah International Medical Research Centre (KAIMRC), Riyadh, Saudi Arabia
| | - Sarah Almalki
- Department of Physical Therapy Asir Rehabilitation Centre Asir Central Hospital, Abha, Saudi Arabia
| | - Jassas Alotaibi
- Physical Therapy Department King Fahad Medical Complex, Dhahran, Saudi Arabia
| |
Collapse
|
4
|
Xu J, Huang X, Karn SK, Feng S, Dong Q, Li X, Ma L, Zhu X. Benefits of early mobilization after atrial fibrillation ablation in geriatrics over 75 years old: A retrospective comparative study. Geriatr Nurs 2024; 59:507-515. [PMID: 39146641 DOI: 10.1016/j.gerinurse.2024.08.006] [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: 03/07/2024] [Revised: 07/14/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Despite early mobilization has been proposed as an effective intervention to improve prognosis of patients in intensive care unit and other clinical settings, the benefits of it in patients with atrial fibrillation undergoing catheter ablation is still unknow. METHOD 273 geriatric patients with atrial fibrillation underwent catheter ablation in our center were included in this retrospective cohort study, with 137 in early mobilization group and 136 in routine care group. RESULT After in-hospital observation and 90-day follow-up, we found though patients undergoing early mobilization didn't suffer more post-procedural complications, early mobilization didn't either shorten or extend the length of hospital stay. The average score of EQ-5D visual analogue scale and EHRA symptom scale were significantly improved and less unscheduled outpatient visits were recorded in early mobilization group during 90-day follow-up. CONCLUSION Early mobilization could be a safe and favorable intervention for patients underwent catheter ablation.
Collapse
Affiliation(s)
- Jiangmei Xu
- Department of Nursery, Shanghai Tenth People's Hospital, School of medicine, Tongji University, Shanghai, China; School of medicine, Tongji University, Shanghai, China
| | - Xiangdong Huang
- Department of Nursery, Shanghai Tenth People's Hospital, School of medicine, Tongji University, Shanghai, China; School of medicine, Tongji University, Shanghai, China
| | - Shailendra Kumar Karn
- Department of Cardiology, Shanghai Tenth People's Hospital, School of medicine, Tongji University, Shanghai, China
| | - Shiyu Feng
- School of medicine, Tongji University, Shanghai, China
| | - Qiong Dong
- Department of Nursery, Shanghai Tenth People's Hospital, School of medicine, Tongji University, Shanghai, China
| | - Xiang Li
- Department of Nursery, Shanghai Tenth People's Hospital, School of medicine, Tongji University, Shanghai, China; Department of Cardiology, Shanghai Tenth People's Hospital, School of medicine, Tongji University, Shanghai, China
| | - Li Ma
- Department of Nursery, Shanghai Tenth People's Hospital, School of medicine, Tongji University, Shanghai, China
| | - Xiaoping Zhu
- Department of Nursery, Shanghai Tenth People's Hospital, School of medicine, Tongji University, Shanghai, China; School of medicine, Tongji University, Shanghai, China.
| |
Collapse
|
5
|
Honda Y, Shin JH, Kunisawa S, Fushimi K, Imanaka Y. Impact of a financial incentive on early rehabilitation and outcomes in ICU patients: a retrospective database study in Japan. BMJ Qual Saf 2024:bmjqs-2024-017081. [PMID: 39174335 DOI: 10.1136/bmjqs-2024-017081] [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: 01/04/2024] [Accepted: 08/12/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Early mobilisation of intensive care unit (ICU) patients has been recommended in clinical practice guidelines. Therefore, the Japanese universal health insurance system introduced an additional fee for early mobilisation and/or rehabilitation, which can be claimed by hospitals when starting rehabilitation of ICU patients within 48 hours after their ICU admission. However, the effect of this fee is unknown. OBJECTIVE To measure the proportion of ICU patients who received early rehabilitation and the impact on length of ICU stay, the length of hospital stay and discharged to home after the introduction of the financial incentive (additional fee for early mobilisation and/or rehabilitation). DESIGN/METHODS We included patients who were admitted to ICU within 2 days of hospitalisation between April 2016 and January 2020. We conducted interrupted time series analyses to assess the effects of the introduction of the financial incentive. RESULTS The proportion of patients who received early rehabilitation immediately increased after the introduction of the financial incentive (rate ratio (RR) 1.293, 95% CI 1.240 to 1.349). The RR for proportion of patients received early rehabilitation was 1.008 (95% CI 1.005 to 1.011) in the period after the introduction of the financial incentive compared with period before its introduction. There was no statistically significant change in the mean length of ICU stay, the mean length of hospital stay and the proportion of patients who were discharged to home. CONCLUSION After the introduction of the financial incentive, the proportion of ICU patients who received early rehabilitation increased. However, the effects of the financial incentive on the length of ICU stay, the length of hospital stay and the proportion of patients who were discharged to home were limited.
Collapse
Affiliation(s)
- Yudai Honda
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
- Department of Health Security System, Kyoto University Graduate School of Medicine, Centre for Health Security, Kyoto, Japan
| |
Collapse
|
6
|
Siesage K, Schandl A, Johansson M, Nygren-Bonnier M, Karlsson E, Joelsson-Alm E. Mobilisation of post-ICU patients - a crucial teamwork between physiotherapists and nurses at surgical wards: a qualitative study. Disabil Rehabil 2024:1-7. [PMID: 39155773 DOI: 10.1080/09638288.2024.2392036] [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: 01/10/2024] [Revised: 08/03/2024] [Accepted: 08/09/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE To describe experiences of the ward nurse in relation to extended physiotherapy and mobilising of post-ICU patients. METHODS Individual semi-structured interviews were conducted with 17 registered nurses working on surgical wards in a Swedish regional hospital. Qualitative content analysis was used to analyse the data. The study was reported according to the consolidated criteria for reporting qualitative research (COREQ). RESULTS The study findings are presented in three categories: challenges to mobilising post-ICU patients, shared responsibility facilitates mobilisation, and extended physiotherapy is beneficial for patients' wellbeing. Nurses stated that they lacked knowledge and skills to perform the safe mobilisation of post-ICU patients due to their complex medical history and needs. Collaboration with physiotherapists was perceived to facilitate mobilisation and to be beneficial for patients' wellbeing outcome. CONCLUSIONS The study indicates that post-ICU patients are at risk of remaining immobilised because ward nurses find mobilisation too complex to conduct without support from physiotherapists. Shared responsibility through multi-professional teamwork regarding patient rehabilitation is perceived as contributing the knowledge required to achieve safe mobilisation that enhances autonomy and physical ability in post-ICU patients.
Collapse
Affiliation(s)
- Katinka Siesage
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Anna Schandl
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Matheo Johansson
- Department of Orthopaedics and Rehabilitation, Unit of Occupational and Physical Therapy, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Function Allied Health Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Emelie Karlsson
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Back in Motion Research Group, Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
7
|
Schaller SJ, Scheffenbichler FT, Bein T, Blobner M, Grunow JJ, Hamsen U, Hermes C, Kaltwasser A, Lewald H, Nydahl P, Reißhauer A, Renzewitz L, Siemon K, Staudinger T, Ullrich R, Weber-Carstens S, Wrigge H, Zergiebel D, Coldewey SM. Guideline on positioning and early mobilisation in the critically ill by an expert panel. Intensive Care Med 2024; 50:1211-1227. [PMID: 39073582 DOI: 10.1007/s00134-024-07532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/15/2024] [Indexed: 07/30/2024]
Abstract
A scientific panel was created consisting of 23 interdisciplinary and interprofessional experts in intensive care medicine, physiotherapy, nursing care, surgery, rehabilitative medicine, and pneumology delegated from scientific societies together with a patient representative and a delegate from the Association of the Scientific Medical Societies who advised methodological implementation. The guideline was created according to the German Association of the Scientific Medical Societies (AWMF), based on The Appraisal of Guidelines for Research and Evaluation (AGREE) II. The topics of (early) mobilisation, neuromuscular electrical stimulation, assist devices for mobilisation, and positioning, including prone positioning, were identified as areas to be addressed and assigned to specialist expert groups, taking conflicts of interest into account. The panel formulated PICO questions (addressing the population, intervention, comparison or control group as well as the resulting outcomes), conducted a systematic literature review with abstract screening and full-text analysis and created summary tables. This was followed by grading the evidence according to the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence and a risk of bias assessment. The recommendations were finalized according to GRADE and voted using an online Delphi process followed by a final hybrid consensus conference. The German long version of the guideline was approved by the professional associations. For this English version an update of the systematic review was conducted until April 2024 and recommendation adapted based on new evidence in systematic reviews and randomized controlled trials. In total, 46 recommendations were developed and research gaps addressed.
Collapse
Affiliation(s)
- Stefan J Schaller
- Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
| | | | | | - Manfred Blobner
- Department of Anaesthesiology and Intensive Care Medicine, Ulm University, Ulm, Germany
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Julius J Grunow
- Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Uwe Hamsen
- Ruhr University Bochum, Bochum, Germany
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany
| | - Carsten Hermes
- Hochschule für Angewandte Wissenschaften Hamburg (HAW Hamburg), Hamburg, Germany
- Akkon-Hochschule für Humanwissenschaften, Berlin, Germany
| | - Arnold Kaltwasser
- Academy of the District Hospitals Reutlingen, Kreiskliniken Reutlingen, Reutlingen, Germany
| | - Heidrun Lewald
- Department of Anaesthesiology and Intensive Care Medicine, School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter Nydahl
- University Hospital of Schleswig-Holstein, Kiel, Germany
- Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria
| | - Anett Reißhauer
- Department of Rehabilitation Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Leonie Renzewitz
- Department of Physiotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Karsten Siemon
- Department of Pneumology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Germany
| | - Thomas Staudinger
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Roman Ullrich
- Department of Anaesthesia, General Intensive Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
- Department of Anaesthesiology and Intensive Care Medicine, AUVA Trauma Center Vienna, Vienna, Austria
| | - Steffen Weber-Carstens
- Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Hermann Wrigge
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital, Halle, Germany
- Medical Faculty, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | | | - Sina M Coldewey
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
- Septomics Research Center, Jena University Hospital, Jena, Germany.
| |
Collapse
|
8
|
Twose P, Peirce S, Maisey J, Jones L, Nunn J. Ventilator-tube holder for mobilising patients with a tracheostomy: A pilot usability study (TrachVest). Aust Crit Care 2024:S1036-7314(24)00113-9. [PMID: 38960743 DOI: 10.1016/j.aucc.2024.05.014] [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: 03/15/2024] [Revised: 05/09/2024] [Accepted: 05/31/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION Patients in intensive care may have a tracheostomy and be dependent on a respiratory ventilator while yet conscious and able to mobilise. Early rehabilitation is known to be key to patient recovery. However, for these patients, therapy staff members are required to manage the ventilator tubing in addition to other patient-connected equipment whilst focussing on patient mobility and progress. A technical garment (TrachVest) was designed to hold the ventilator tubing securely during these therapeutic mobilisations. METHODS We conducted a mixed-methods study to evaluate the use of this garment in an intensive care unit setting. The aim was to determine potential effects on patient safety, its potential benefits, and usability. Research methods included direct observations, user questionnaires (quantitative and qualitative), and staff focus groups. RESULTS A total of 14 therapy sessions with the garment were observed, involving nine patients and 10 staff. Eleven staff members participated in two focus groups, including two previously involved in the therapy sessions. Therapy sessions consisted of a range of activities including sitting on the edge of the bed, transferring from bed to chair (including use of hoists), and mobilising with walking aids. Overall, staff members felt that the garment was easy to use and would likely improve patient safety during mobilisations. The main benefits were staff reassurance, allowing them to focus on therapy, and in potentially reducing the number of staff members needed for particular activities. Patient characteristics were found to be influential on the perceived utility, and TrachVest may have greater benefit for patients who have greater physical function (e.g., able to actively participate in rehabilitation) and can mobilise at least from bed to chair. Experience of using the TrachVest and of patient capabilities was thought to be key to knowing when it would be most useful. CONCLUSION Within this pilot usability study, participants, both staff and patients, reported that the TrachVest garment designed to support ventilator tubing during rehabilitation to be highly useable and beneficial to supporting rehabilitation in this patient group.
Collapse
Affiliation(s)
- Paul Twose
- Physiotherapy Department, University Hospital of Wales, Cardiff, CF14 4XW, UK; School of Healthcare Sciences, Cardiff University, Cardiff CF144XN, UK.
| | - Susan Peirce
- Cedar, Cardiff Medicentre, Heath Park, CF14 4UJ, UK.
| | - John Maisey
- Mechanical Section, Clinical Engineering, Medical Physics Corridor, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, UK.
| | - Laura Jones
- Physiotherapy Department, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| | - Jason Nunn
- Physiotherapy Department, University Hospital of Wales, Cardiff, CF14 4XW, UK.
| |
Collapse
|
9
|
Ross P, Sheldrake J, Ilic D, Watterson J, Berkovic D, Pilcher D, Udy A, Hodgson CL. An exploration of intensive care nurses' perceptions of workload in providing extracorporeal membrane oxygenation (ECMO) support: A descriptive qualitative study. Aust Crit Care 2024; 37:585-591. [PMID: 38355389 DOI: 10.1016/j.aucc.2023.12.002] [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: 08/13/2023] [Revised: 11/16/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND There is increasing use of extracorporeal membrane oxygenation (ECMO) in intensive care, where nurses provide the majority of the required ongoing care of cannulas, circuit, and console. Limited evidence currently exists that details nursing perspectives, experiences, and challenges with workload in the provision of ECMO care. OBJECTIVE The objective of this study was to investigate intensive care nurses' perceptions of workload in providing specialist ECMO therapy and care in a high-volume ECMO centre. METHODS The study used a qualitative descriptive methodology through semistructured interviews. Data were analysed using an inductive thematic analysis approach following Braun and Clarke's iterative process. This study was conducted in an intensive care unit within an Australian public, quaternary, university-affiliated hospital, which provides specialist state-wide service for ECMO. FINDINGS Thirty ECMO-specialist trained intensive care nurses were interviewed. This study identified three key themes: (i) opportunity; (ii) knowledge and responsibilities; and (iii) systems and structures impacting on intensive care nurses' workload in providing ECMO supportive therapy. CONCLUSIONS Intensive care nurses require advanced clinical and critical thinking skills. Intensive care nurses are motivated and engaged to learn and acquire ECMO skills and competency as part of their ongoing professional development. Providing bedside ECMO management requires constant monitoring and surveillance from nurses to care for the one of the most critically unwell patient populations in the intensive care unit setting. As such, ECMO nursing services require a suitably trained and educated workforce of intensive care trained nurses. ECMO services provide clinical development opportunities for nurses, increase their scope of practice, and create advanced practice-specialist roles.
Collapse
Affiliation(s)
- Paul Ross
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC, 3004, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia.
| | - Jayne Sheldrake
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Dragan Ilic
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia.
| | - Jason Watterson
- Department of Intensive Care, Frankston Hospital, Peninsula Health, Frankston, VIC, 3199, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia.
| | - Danielle Berkovic
- School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia.
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC, 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia.
| | - Andrew Udy
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC, 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia.
| | - Carol L Hodgson
- Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC, 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, VIC, Australia.
| |
Collapse
|
10
|
Onishi Y, Murai Y, Nakajima E. Framework to elicit consent from lightly sedated mechanically ventilated intensive care patients in nursing practice. Jpn J Nurs Sci 2024; 21:e12601. [PMID: 38698302 DOI: 10.1111/jjns.12601] [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: 01/04/2024] [Revised: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024]
Abstract
AIM The study aimed to ascertain a framework of nursing practices to elicit consent from lightly sedated ventilated patients. METHODS Study participants were nurses working in intensive care and critical care wards, whose observations and semi-structured interviews were assessed using a modified grounded theory approach. RESULTS A total of 15 concepts were generated, from which three categories and three subcategories were generated. Category 1: Nurses taking the lead in providing assistance by sharing signs of change while continuing the invasive treatment, working to maintain the patient's life, alleviation of pain, promotion of awareness of the current situation, and acclimating them to the treatment environment as the basis for building a relationship between patients and nurses. Category 2: Searching for points of agreement and reaching a compromise involves the nurse drawing out the patient's thoughts, hopes, and expectations, and transforming the relationship into a patient-centered one by sharing goals with the patient in order to achieve them. Category 3: Organizing collaboration within care supported the patient's ability to move safely while maintaining the patient's pace to achieve shared goals, and guided the patient's independent actions. CONCLUSIONS Even when patients recover from an acute life-threatening situation, their physical sensations remain vague and their functional decline continues. Rather than simply eliciting consent from patients, the structure of nursing practice to elicit such response from patients involves drawing out the patient's thoughts, hopes, and expectations, as well as guiding the patient toward goals that they have created together with the nurse and utilizing the patient's strengths to achieve these goals.
Collapse
Affiliation(s)
- Yoko Onishi
- Faculty of Nursing, Ishikawa Prefectural Nursing University, Kahoku, Japan
| | - Yoshiko Murai
- Faculty of Nursing, Ishikawa Prefectural Nursing University (Retired), Kahoku, Japan
| | - Emiko Nakajima
- Department of Nursing, Faculty of Health Sciences, Kyorin University, Tokyo, Japan
| |
Collapse
|
11
|
Kho ME, Berney S, Pastva AM, Kelly L, Reid JC, Burns KEA, Seely AJ, D'Aragon F, Rochwerg B, Ball I, Fox-Robichaud AE, Karachi T, Lamontagne F, Archambault PM, Tsang JL, Duan EH, Muscedere J, Verceles AC, Serri K, English SW, Reeve BK, Mehta S, Rudkowski JC, Heels-Ansdell D, O'Grady HK, Strong G, Obrovac K, Ajami D, Camposilvan L, Tarride JE, Thabane L, Herridge MS, Cook DJ. Early In-Bed Cycle Ergometry in Mechanically Ventilated Patients. NEJM EVIDENCE 2024; 3:EVIDoa2400137. [PMID: 38865147 DOI: 10.1056/evidoa2400137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
BACKGROUND Critical illness requiring invasive mechanical ventilation can precipitate important functional disability, contributing to multidimensional morbidity following admission to an intensive care unit (ICU). Early in-bed cycle ergometry added to usual physiotherapy may mitigate ICU-acquired physical function impairment. METHODS We randomly assigned 360 adult ICU patients undergoing invasive mechanical ventilation to receive 30 minutes of early in-bed Cycling + Usual physiotherapy (n=178) or Usual physiotherapy alone (n=182). The primary outcome was the Physical Function ICU Test-scored (PFIT-s) at 3 days after discharge from the ICU (the score ranges from 0 to 10, with higher scores indicating better function). RESULTS Cycling began within a median (interquartile range) of 2 (1 to 3) days of starting mechanical ventilation; patients received 3 (2 to 5) cycling sessions for a mean (±standard deviation) of 27.2 ± 6.6 minutes. In both groups, patients started Usual physiotherapy within 2 (2 to 4) days of mechanical ventilation and received 4 (2 to 7) Usual physiotherapy sessions. The duration of Usual physiotherapy was 23.7 ± 15.1 minutes in the Cycling + Usual physiotherapy group and 29.1 ± 13.2 minutes in the Usual physiotherapy group. No serious adverse events occurred in either group. Among survivors, the PFIT-s at 3 days after discharge from the ICU was 7.7 ± 1.7 in the Cycling + Usual physiotherapy group and 7.5 ± 1.7 in the Usual physiotherapy group (absolute difference, 0.23 points; 95% confidence interval, -0.19 to 0.65; P=0.29). CONCLUSIONS Among adults receiving mechanical ventilation in the ICU, adding early in-bed Cycling to usual physiotherapy did not improve physical function at 3 days after discharge from the ICU compared with Usual physiotherapy alone. Cycling did not cause any serious adverse events. (Funded by the Canadian Institutes of Health Research and others; ClinicalTrials.gov numbers, NCT03471247 [full randomized clinical trial] and NCT02377830 [CYCLE Vanguard 46-patient internal pilot].).
Collapse
Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Susan Berney
- Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, VIC, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia
| | - Amy M Pastva
- Department of Orthopedic Surgery, Physical Therapy Division, Duke University School of Medicine, Durham, NC
| | - Laurel Kelly
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Julie C Reid
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, Unity Health Toronto-St. Michael's Hospital, Toronto
| | - Andrew J Seely
- Department of Surgery, University of Ottawa, Ottawa
- Critical Care Medicine, Ottawa Hospital Research Institute, Ottawa
| | - Frédérick D'Aragon
- Department of Anesthesiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Bram Rochwerg
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Ian Ball
- Department of Medicine, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Alison E Fox-Robichaud
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Tim Karachi
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Francois Lamontagne
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Département de Médecine, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patrick M Archambault
- Centre de Recherche Intégrée pour un Système Apprenant en Santé et Services Sociaux, Centre Intégré de Santé et Services Sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
| | - Jennifer L Tsang
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Niagara Health Knowledge Institute, Niagara Health, St. Catharines, ON, Canada
| | - Erick H Duan
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - John Muscedere
- Queen's University, Kingston, ON, Canada
- Department of Critical Care Medicine, Kingston, ON, Canada
| | - Avelino C Verceles
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Maryland, Baltimore
| | - Karim Serri
- Critical Care Division, Department of Medicine, Centre de Recherche de l'Hôpital du Sacré-Cœur de Montréal, Hôpital Sacré-Coeur de Montréal, Faculté de Médecine, Université de Montréal, Montreal
| | - Shane W English
- Department of Medicine (Critical Care), University of Ottawa, Ottawa
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa
| | - Brenda K Reeve
- Department of Medicine, Brantford General Hospital, Brantford, ON, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto
- Department of Medicine, Sinai Health System, Toronto
| | - Jill C Rudkowski
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Heather K O'Grady
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Geoff Strong
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kristy Obrovac
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Daana Ajami
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Laura Camposilvan
- Physiotherapy Department, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Center for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joe's, Hamilton, ON, Canada
| | - Margaret S Herridge
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, Toronto General Research Institute, Institute of Medical Science, University Health Network, University of Toronto, Toronto
| | - Deborah J Cook
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact (HEI), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
12
|
Dunn H, da Costa Ferreira Oberfrank N, Krupp A. Preimplementation of Critical Care Early Mobility Clinical Decision Support: A Content Validation Study. Comput Inform Nurs 2024; 42:463-469. [PMID: 38512354 DOI: 10.1097/cin.0000000000001121] [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: 03/23/2024]
Abstract
Early mobility is a form of critical care rehabilitation ranging from in-bed exercise to ambulation and is known to limit post-intensive-care functional decline. Multiple barriers prevent widespread early mobility implementation. Clinical decision support systems can optimize the decision-making process and overcome barriers to care. However, critical care early mobility clinical decision support does not exist. Our objective was to develop and establish the content validation of the operational definitions for a novel critical care early mobility assessment instrument. Content validation was conducted in two steps: (1) development of operational definitions by the research team and (2) content validation with 10 nurse experts. Quality assessment and suitability of the operational definitions for 30 items, across four safety domains, were assessed using a 7 point-Likert scale. Item content validity index scores ranged from 0.6 to 0.1 after the first validation round. Domains containing items with item content validity index scores less than the lower limit of 0.78 were modified for clarity of language. Item content validity index scores ranged from 0.8 to 1.0, and the scale-level content validity index was 0.93 after the second content validation round. Excellent content validity of the operational definitions was achieved. This is the first methodological step in a larger project to develop clinical decision support for critical care early mobility.
Collapse
Affiliation(s)
- Heather Dunn
- Author Affiliation: College of Nursing, University of Iowa, Iowa City
| | | | | |
Collapse
|
13
|
El Kaim A, Serra M, De Noray H, Lallemant A, Gobatto C, Degos V, Carpentier A, Riche M, Apra C. Safety and practicality study of using an exoskeleton in acute neurosurgery patients. Acta Neurochir (Wien) 2024; 166:221. [PMID: 38763932 DOI: 10.1007/s00701-024-06112-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/01/2024] [Indexed: 05/21/2024]
Abstract
INTRODUCTION Early mobilization is key in neurologically impaired persons, limiting complications and improving long-term recovery. Self-balanced exoskeletons are used in rehabilitation departments to help patients stand and walk. We report the first case series of exoskeleton use in acute neurosurgery and intensive care patients, evaluating safety, clinical feasibility and patients' satisfaction. METHODS We report a retrospective observational study including individuals hospitalized in the neurosurgical intensive care and neurosurgery departments. We included patients with a medical prescription for an exoskeleton session, and who met no contraindication. Patients benefited from standing sessions using a self-balanced exoskeleton (Atalante, Wandercraft, France). Patients and sessions data were collected. Safety, feasibility and adherence were evaluated. RESULTS Seventeen patients were scheduled for 70 standing sessions, of which 27 (39%) were completed. They were typically hospitalized for intracranial hemorrhage (74%) and presented with unilateral motor impairments, able to stand but with very insufficient weight shifting to the hemiplegic limb, requiring support (MRC 36.2 ± 3.70, SPB 2.0 ± 1.3, SPD 0.7 ± 0.5). The average duration of standing sessions was 16 ± 9 min. The only side effect was orthostatic hypotension (18.5%), which resolved with returning to seating position. The most frequent reason for not completing a session was understaffing (75%). All patients were satisfied and expressed a desire to repeat it. CONCLUSIONS Physiotherapy using the exoskeleton is safe and feasible in the acute neurosurgery setting, although it requires adaptation from the staff to organize the sessions. An efficacy study is ongoing to evaluate the benefits for the patients.
Collapse
Affiliation(s)
- Audrey El Kaim
- Neurosurgery Department, Pitié Salpêtrière Hospital, Paris, France
- Institute of Myology, Pitié Salpêtrière Hospital, Paris, France
| | - Manon Serra
- Brain Machine Interface Clinical Research Group, Sorbonne University, Paris, France
- Physical and Rehabilitation Medicine Unit, Pitié Salpêtrière Hospital, Paris, France
- Department of Anesthesia, Critical Care and Perioperative Care, Pitié Salpêtrière Hospital, Paris, France
| | - Henri De Noray
- Neurosurgery Department, Pitié Salpêtrière Hospital, Paris, France
- Department of Anesthesia, Critical Care and Perioperative Care, Pitié Salpêtrière Hospital, Paris, France
| | - Audrey Lallemant
- Neurosurgery Department, Pitié Salpêtrière Hospital, Paris, France
- Department of Anesthesia, Critical Care and Perioperative Care, Pitié Salpêtrière Hospital, Paris, France
| | - Corentin Gobatto
- Neurosurgery Department, Pitié Salpêtrière Hospital, Paris, France
- Department of Anesthesia, Critical Care and Perioperative Care, Pitié Salpêtrière Hospital, Paris, France
| | - Vincent Degos
- Department of Anesthesia, Critical Care and Perioperative Care, Pitié Salpêtrière Hospital, Paris, France
- Sorbonne Université, Paris, France
- Université de Paris, NeuroDiderot, Inserm, 75019, Paris, France
- PremUP, 75006, Paris, France
| | - Alexandre Carpentier
- Neurosurgery Department, Pitié Salpêtrière Hospital, Paris, France
- Brain Machine Interface Clinical Research Group, Sorbonne University, Paris, France
- Sorbonne Université, Paris, France
| | - Maximilien Riche
- Neurosurgery Department, Pitié Salpêtrière Hospital, Paris, France
- Brain Machine Interface Clinical Research Group, Sorbonne University, Paris, France
- Sorbonne Université, Paris, France
| | - Caroline Apra
- Neurosurgery Department, Pitié Salpêtrière Hospital, Paris, France.
- Neurosurgery Department, Henri Mondor Hospital, Créteil, France.
- Université Paris Est Créteil Val de Marne, Créteil, France.
- Mondor Institute of Biomedical Research, INSERM U955, Créteil, France.
| |
Collapse
|
14
|
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.
Collapse
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
| | | | | | | |
Collapse
|
15
|
Nickels M, Erwin K, McMurray G, Talbot R, Strong M, Krishnan A, van Haren FMP, Bissett B. Feasibility, safety, and patient acceptability of electronic inspiratory muscle training in patients who require prolonged mechanical ventilation in the intensive care unit: A dual-centre observational study. Aust Crit Care 2024; 37:448-454. [PMID: 37321882 DOI: 10.1016/j.aucc.2023.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Inspiratory muscle training (IMT) is an intervention that can be used to rehabilitate the respiratory muscle deconditioning experienced by patients with critical illness, requiring prolonged mechanical ventilation. Clinicians are currently using mechanical threshold IMT devices that have limited resistance ranges. OBJECTIVES The objective of this study was to evaluate the safety, feasibility, and acceptability of using an electronic device to facilitate IMT with participants requiring prolonged mechanical ventilation. METHOD A dual-centre observational cohort study, with convenience sampling, was conducted at two tertiary intensive care units. Daily training supervised by intensive care unit physiotherapists was completed with the electronic IMT device. A priori definitions for feasibility, safety, and acceptability were determined. Feasibility was defined as more than 80% of planned sessions completed. Safety was defined as no major adverse events and less than 3% minor adverse event rate, and acceptability was evaluated following the acceptability of intervention framework principles. RESULTS Forty participants completed 197 electronic IMT treatment sessions. Electronic IMT was feasible, with 81% of planned sessions completed. There were 10% minor adverse events and no major adverse events. All the minor adverse events were transient without clinical consequences. All the participants who recalled completing electronic IMT sessions reported that the training was acceptable. Acceptability was demonstrated; over 85% of participants reported that electronic IMT was either helpful or beneficial and that electronic IMT assisted their recovery. CONCLUSION Electronic IMT is feasible and acceptable to complete with critically ill participants who require prolonged mechanical ventilation. As all minor adverse events were transient without clinical consequences, electronic IMT can be considered a relatively safe intervention with patients who require prolonged mechanical ventilation.
Collapse
Affiliation(s)
- Marc Nickels
- Department of Physiotherapy, Ipswich Hospital, Brisbane, Australia; Discipline of Physiotherapy, University of Canberra, Australia
| | - Katie Erwin
- Physiotherapy Department, Canberra Hospital, Australia
| | - Grant McMurray
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Richie Talbot
- Discipline of Physiotherapy, University of Canberra, Australia
| | - Mark Strong
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Anand Krishnan
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Australia
| | - Frank M P van Haren
- Intensive Care Unit, St George Hospital, Sydney, Australia; College of Health and Medicine, Australian National University, Canberra, Australia
| | - Bernie Bissett
- Physiotherapy Department, Canberra Hospital, Australia; Discipline of Physiotherapy, University of Canberra, Australia.
| |
Collapse
|
16
|
van Galen DJM, Meinders Q, Halfwerk FR, Arens J. ECMOve: A Mobilization Device for Extracorporeal Membrane Oxygenation Patients. ASAIO J 2024; 70:377-386. [PMID: 38324706 PMCID: PMC11057491 DOI: 10.1097/mat.0000000000002153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a temporary lifesaving treatment for critically ill patients with severe respiratory or cardiac failure. Studies demonstrated the feasibility of in-hospital mobilizing during and after ECMO treatment preventing neuromuscular weakness and impaired physical functioning. Despite more compact mobile ECMO devices, implementation of ambulatory ECMO remains labor-intensive, complex, and challenging. It requires a large multidisciplinary team to carry equipment, monitor and physically support the patient, and to provide a back-up wheelchair in case of fatigue. Moreover, there is no adequate solution to ensure the stability of the patient's cannula and circuit management during ambulation. We developed a system contributing to improvement and innovation of current ambulatory ECMO patient programs. Our modular cart-in-cart system carries necessary ECMO equipment, features an extendable walking frame, and contains a folding seat for patient transport. An adjustable shoulder brace with lockable tubing-connectors enables safe fixation of the blood tubing. ECMOve provides safety, support, and accessibility while performing ambulatory ECMO for both patient and caregiver. Prototype evaluation in a simulated intensive care unit showed feasibility of our design, but needs to be evaluated in clinical care.
Collapse
Affiliation(s)
- Danny J. M. van Galen
- From the Faculty of Engineering Technologies, Department of Biomechanical Engineering, Engineering Organ Support Technologies, University of Twente, Enschede, the Netherlands
| | - Quint Meinders
- From the Faculty of Engineering Technologies, Department of Biomechanical Engineering, Engineering Organ Support Technologies, University of Twente, Enschede, the Netherlands
| | - Frank R. Halfwerk
- From the Faculty of Engineering Technologies, Department of Biomechanical Engineering, Engineering Organ Support Technologies, University of Twente, Enschede, the Netherlands
- Department of Cardiothoracic Surgery, Thorax Centrum Twente, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jutta Arens
- From the Faculty of Engineering Technologies, Department of Biomechanical Engineering, Engineering Organ Support Technologies, University of Twente, Enschede, the Netherlands
| |
Collapse
|
17
|
Paton M, Chan S, Serpa Neto A, Tipping CJ, Stratton A, Lane R, Romero L, Broadley T, Hodgson CL. Association of active mobilisation variables with adverse events and mortality in patients requiring mechanical ventilation in the intensive care unit: a systematic review and meta-analysis. THE LANCET. RESPIRATORY MEDICINE 2024; 12:386-398. [PMID: 38513675 DOI: 10.1016/s2213-2600(24)00011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/07/2024] [Accepted: 01/17/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Mobilisation during critical illness is now included in multiple clinical practice guidelines. However, a large, randomised trial and systematic review have recently identified an increased probability of adverse events and mortality in patients who received early active mobilisation in the intensive care unit (ICU). We aimed to determine the effects of mobilisation compared with usual care on adverse events and mortality in an acute ICU setting. In subgroup analyses, we specifically aimed to investigate possible sources of harm, including the timing and duration of mobilisation achieved, ventilation status, and admission diagnosis. METHODS In this systematic review with frequentist and Bayesian analyses, we searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, SCOPUS, Web of Science, and PEDro electronic databases, as well as clinical trial registries (ICTRP and ClinicalTrials.gov), from inception to March 16, 2023, without language restrictions. Eligible studies were randomised controlled trials that examined active mobilisation compared with either no mobilisation or mobilisation commencing later, or at a lower frequency or intensity, in adults who were critically ill during or after a period of mechanical ventilation in an acute ICU setting. Two authors independently screened reports, extracted data, and assessed the risk of bias using the Cochrane risk-of-bias tool (version 1). The primary outcome was the number of adverse events that occurred during the implementation of mobilisation, with the effect of mobilisation on mortality being the secondary outcome. Risk ratios (RRs) with 95% CIs were calculated in R (version 4.0.3) using random-effects modelling, with Bayesian analysis completed to calculate the probability of treatment harm (ie, RR >1). Subgroup analyses were completed to investigate the association of various factors of mobilisation on adverse events and mortality: duration of mobilisation (longer [≥20 min per day] vs shorter [<20 min per day]), timing of commencement (early [≤72 h from ICU admission] vs late [>72 h from ICU admission]), ventilation status at commencement (all patients mechanically ventilated vs all patients extubated), and ICU admission diagnosis (surgical vs medical). This study was registered with PROSPERO, CRD42022369272. FINDINGS After title and abstract screening of 14 440 studies and review of 466 full texts, 67 trials with 7004 participants met inclusion criteria, with 59 trials contributing to the meta-analysis. Of the 67 included studies, 15 (22%) did not mention adverse events and 13 (19%) reported no adverse events occurring across the trial period. Overall, we found no effect of mobilisation compared with usual care on the occurrence of adverse events (RR 1·09 [95% CI 0·69-1·74], p=0·71; I2 91%; 32 731 events, 20 studies; very low certainty), with a 2·96% occurrence rate (693 events in 23 395 intervention sessions; 25 studies). Mobilisation did not have any effect on mortality (RR 0·98 [95% CI 0·87-1·12], p=0·81; I2 0%; n=6218, 58 studies; moderate certainty). Subgroup analysis was hindered by the large amount of data that could not be allocated and analysed, making the results hypothesis generating only. INTERPRETATION Implementation of mobilisation in the ICU was associated with a less than 3% chance of an adverse event occurring and was not found to increase adverse events or mortality overall, providing reassurance for clinicians about the safety of performing this intervention. Subgroup analyses did not clearly identify any specific variable of mobilisation implementation that increased harm. FUNDING None.
Collapse
Affiliation(s)
- Michelle Paton
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Physiotherapy, Monash Health, Clayton, VIC, Australia
| | - Sarah Chan
- Department of Physiotherapy, Monash Health, Clayton, VIC, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Claire J Tipping
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
| | - Anne Stratton
- Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca Lane
- School of Health Sciences, Swinburne University, Hawthorn, VIC, Australia
| | - Lorena Romero
- Ian Potter Library, Alfred Health, Melbourne, VIC, Australia
| | - Tessa Broadley
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia; Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia.
| |
Collapse
|
18
|
Woodbridge HR, McCarthy CJ, Jones M, Willis M, Antcliffe DB, Alexander CM, Gordon AC. Assessing the safety of physical rehabilitation in critically ill patients: a Delphi study. Crit Care 2024; 28:144. [PMID: 38689372 PMCID: PMC11061934 DOI: 10.1186/s13054-024-04919-x] [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: 12/03/2023] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Physical rehabilitation of critically ill patients is implemented to improve physical outcomes from an intensive care stay. However, before rehabilitation is implemented, a risk assessment is essential, based on robust safety data. To develop this information, a uniform definition of relevant adverse events is required. The assessment of cardiovascular stability is particularly relevant before physical activity as there is uncertainty over when it is safe to start rehabilitation with patients receiving vasoactive drugs. METHODS A three-stage Delphi study was carried out to (a) define adverse events for a general ICU cohort, and (b) to define which risks should be assessed before physical rehabilitation of patients receiving vasoactive drugs. An international group of intensive care clinicians and clinician researchers took part. Former ICU patients and their family members/carers were involved in generating consensus for the definition of adverse events. Round one was an open round where participants gave their suggestions of what to include. In round two, participants rated their agreements with these suggestions using a five-point Likert scale; a 70% consensus agreement threshold was used. Round three was used to re-rate suggestions that had not reached consensus, whilst viewing anonymous feedback of participant ratings from round two. RESULTS Twenty-four multi-professional ICU clinicians and clinician researchers from 10 countries across five continents were recruited. Average duration of ICU experience was 18 years (standard deviation 8) and 61% had publications related to ICU rehabilitation. For the adverse event definition, five former ICU patients and one patient relative were recruited. The Delphi process had a 97% response rate. Firstly, 54 adverse events reached consensus; an adverse event tool was created and informed by these events. Secondly, 50 risk factors requiring assessment before physical rehabilitation of patients receiving vasoactive drugs reached consensus. A second tool was created, informed by these suggestions. CONCLUSIONS The adverse event tool can be used in studies of physical rehabilitation to ensure uniform measurement of safety. The risk assessment tool can be used to inform clinical practise when risk assessing when to start rehabilitation with patients receiving vasoactive drugs. Trial registration This study protocol was retrospectively registered on https://www.researchregistry.com/ (researchregistry2991).
Collapse
Affiliation(s)
- Huw R Woodbridge
- Imperial College Healthcare NHS Trust, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | | | | | | | - David B Antcliffe
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline M Alexander
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anthony C Gordon
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
19
|
Miles M, Davenport P, Mathur S, Goligher EC, Rozenberg D, Reid WD. Intermittent neck flexion induces greater sternocleidomastoid deoxygenation than inspiratory threshold loading. Eur J Appl Physiol 2024; 124:1151-1161. [PMID: 37923886 DOI: 10.1007/s00421-023-05338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/08/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE To compare deoxygenation of the sternocleidomastoid, scalenes, and diaphragm/intercostals (Dia/IC) during submaximal intermittent neck flexion (INF) versus submaximal inspiratory threshold loading (ITL) in healthy adults. METHODS Fourteen participants performed a randomized, cross-over, repeated measures design. After evaluation of maximal inspiratory pressures (MIP) and maximum voluntary contraction (MVC) for isometric neck flexion, participants were randomly assigned to submaximal ITL or INF until task failure. At least 2 days later, they performed the submaximal exercises in the opposite order. ITL or INF targeted 50 ± 5% of the MIP or MVC, respectively, until task failure. Near-infrared spectroscopy (NIRS) was applied to evaluate changes of deoxy-hemoglobin (ΔHHb), oxy-hemoglobin (ΔO2Hb), total hemoglobin (ΔtHb), and tissue saturation of oxygen (StO2) of the sternocleidomastoid, scalenes, and Dia/IC. Breathlessness and perceived exertion were evaluated using Borg scales. RESULTS Initially during INF, sternocleidomastoid HHb slope was greatest compared to the scalenes and Dia/IC. At isotime (6.5-7 min), ΔtHb (a marker of blood volume) and ΔO2Hb of the sternocleidomastoid were higher during INF than ITL. Sternocleidomastoid HHb, O2Hb, and tHb during INF also increased at quartile and task failure timepoints. In contrast, scalene ΔO2Hb was higher during ITL than INF at isotime. Further, Dia/IC O2Hb and tHb increased during ITL at the third quartile and at task failure. Borg scores were lower at task failure during INF compared to ITL. CONCLUSION Intermittent INF induces significant metabolic activity of the sternocleidomastoid and a lower perception of effort, which may provide an alternative inspiratory muscle training approach for mechanically ventilated patients.
Collapse
Affiliation(s)
- Melissa Miles
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Paul Davenport
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Sunita Mathur
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queens University, Kingston, ON, Canada
| | - Ewan C Goligher
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Dmitry Rozenberg
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - W Darlene Reid
- Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
- KITE Research Institute-Toronto Rehab, University Health Network, Toronto, ON, Canada.
| |
Collapse
|
20
|
Warmbein A, Hübner L, Rathgeber I, Mehler-Klamt AC, Huber J, Schroeder I, Scharf C, Gutmann M, Biebl J, Manz K, Kraft E, Eberl I, Zoller M, Fischer U. Robot-assisted early mobilization for intensive care unit patients: Feasibility and first-time clinical use. Int J Nurs Stud 2024; 152:104702. [PMID: 38350342 DOI: 10.1016/j.ijnurstu.2024.104702] [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: 03/21/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Early mobilization is only carried out to a limited extent in the intensive care unit. To address this issue, the robotic assistance system VEMOTION® was developed to facilitate (early) mobilization measures more easily. This paper describes the first integration of robotic assistance systems in acute clinical intensive care units. OBJECTIVE Feasibility test of robotic assistance in early mobilization of intensive care patients in routine clinical practice. SETTING Two intensive care units guided by anesthesiology at a German university hospital. PARTICIPANTS Patients who underwent elective surgery with postoperative treatment in the intensive care unit and had an estimated ventilation time over 48 h. METHODS Participants underwent robot-assisted mobilization, scheduled for twenty-minute sessions twice a day, ten times or one week, conducted by nursing staff under actual operational conditions on the units. No randomization or blinding took place. We assessed data regarding feasible cutoff points (in brackets): the possibility of enrollment (x ≥ 50 %), duration (pre- and post-setup (x ≤ 25 min), therapy duration (x = 20 min), and intervention-related parameters (number of mobilizing professionals (x ≤ 2), intensity of training, events that led to adverse events, errors or discontinuation). Mobilizing professionals rated each mobilization regarding their physical stress (x ≤ 3) and feasibility (x ≥ 4) on a 7 Point Likert Scale. An estimated sample size of at least twenty patients was calculated. We analyzed the data descriptively. RESULTS Within 6 months, we screened thirty-two patients for enrollment. 23 patients were included in the study and 16 underwent mobilization using robotic assistance, 7 dropped out (enrollment eligibility = 69 %). On average, 1.9 nurses were involved per therapy unit. Participants received 5.6 robot-assisted mobilizations in mean. Pre- and post-setup had a mean duration of 18 min, therapy a mean of 21 min. The robot-assisted mobilization was started after a median of 18 h after admission to the intensive care unit. We documented two adverse events (pain), twelve errors in handling, and seven unexpected events that led to interruptions or discontinuation. No serious adverse events occurred. The mobilizing nurses rated their physical stress as low (mean 2.0 ± 1.3) and the intervention as feasible (mean 5.3 ± 1.6). CONCLUSIONS Robot-assisted mobilization was feasible, but specific safety measures should be implemented to prevent errors. Robotic-assisted mobilization requires process adjustments and consideration of unit staffing levels, as the intervention does not save staff resources or time. REGISTRATION clinicaltrials.org TRN: NCT05071248; Date: 2021/10/08; URL https://clinicaltrials.gov/ct2/show/NCT05071248. TWEETABLE ABSTRACT Robot-assisted early mobilization in intensive care patients is feasible and no adverse event occurred.
Collapse
Affiliation(s)
- Angelika Warmbein
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany.
| | - Lucas Hübner
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Ivanka Rathgeber
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany
| | - Amrei Christin Mehler-Klamt
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Jana Huber
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Ines Schroeder
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Christina Scharf
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Marcus Gutmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Johanna Biebl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Kirsi Manz
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Inge Eberl
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Michael Zoller
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Uli Fischer
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany
| |
Collapse
|
21
|
Yasumura D, Katsukawa H, Matsuo R, Kawano R, Taito S, Liu K, Hodgson C. Feasibility and Inter-rater Reliability of the Japanese Version of the Intensive Care Unit Mobility Scale. Cureus 2024; 16:e59135. [PMID: 38803745 PMCID: PMC11129613 DOI: 10.7759/cureus.59135] [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] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose The purpose of this study was to verify the feasibility and inter-rater reliability of the Japanese version of the Intensive Care Unit Mobility Scale (IMS). Methods A prospective observational study was conducted at two intensive care units (ICUs) in Japan. The feasibility of the Japanese version of the IMS was assessed by 25 ICU staff (12 physical therapists and 13 nurses) using a 10-item questionnaire. Inter-rater reliability was assessed by two experienced physical therapists and two experienced nurses working with 100 ICU patients using the Japanese version of the IMS. Results In the questionnaire survey assessing feasibility, a high agreement rate was shown in 8 out of the 10 questions. All respondents could complete the IMS evaluation, and most respondents were able to complete the scoring of the IMS in a short time. The inter-rater reliability of the Japanese version of the IMS on the first day of physical therapy for ICU patients was 0.966 (95% CI: 9.94-9.99) for the weighted kappa coefficient and 0.985 (95% CI: 9.97-9.99) on the ICU discharge date assessment. The weighted κ coefficient showed an "almost perfect agreement" of 0.8 or higher. Conclusion The Japanese version of the IMS is a feasible tool with strong inter-rater reliability for the measurement of physical activity in ICU patients.
Collapse
Affiliation(s)
| | - Hajime Katsukawa
- Department of Academic Research, Japanese Society for Early Mobilization, Tokyo, JPN
| | - Ryu Matsuo
- Healthcare Administration and Management, Kyushu University, Fukuoka, JPN
| | - Reo Kawano
- Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, Aichi, JPN
| | - Shunsuke Taito
- Department of Rehabilitation, Hiroshima University Hospital, Hiroshima, JPN
| | - Keibun Liu
- Department of Academic Research, Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, JPN
| | - Carol Hodgson
- Critical Care, Monash University, Monash, AUS
- Intensive Care Unit, Alfred Hospital, Melbourn, AUS
| |
Collapse
|
22
|
Ji HM, Won YH. Early Mobilization and Rehabilitation of Critically-Ill Patients. Tuberc Respir Dis (Seoul) 2024; 87:115-122. [PMID: 38228092 PMCID: PMC10990608 DOI: 10.4046/trd.2023.0144] [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: 09/12/2023] [Revised: 11/30/2023] [Accepted: 12/18/2023] [Indexed: 01/18/2024] Open
Abstract
Post-intensive care unit (ICU) syndrome may occur after ICU treatment and includes ICU-acquired weakness (ICU-AW), cognitive decline, and mental problems. ICU-AW is muscle weakness in patients treated in the ICU and is affected by the period of mechanical ventilation. Diaphragmatic weakness may also occur because of respiratory muscle unloading using mechanical ventilators. ICU-AW is an independent predictor of mortality and is associated with longer duration of mechanical ventilation and hospital stay. Diaphragm weakness is also associated with poor outcomes. Therefore, pulmonary rehabilitation with early mobilization and respiratory muscle training is necessary in the ICU after appropriate patient screening and evaluation and can improve ICU-related muscle weakness and functional deterioration.
Collapse
Affiliation(s)
- Hye Min Ji
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Yu Hui Won
- Department of Physical Medicine and Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Jeonbuk National University–Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| |
Collapse
|
23
|
Singam A. Mobilizing Progress: A Comprehensive Review of the Efficacy of Early Mobilization Therapy in the Intensive Care Unit. Cureus 2024; 16:e57595. [PMID: 38707138 PMCID: PMC11069628 DOI: 10.7759/cureus.57595] [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: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Early mobilization therapy has emerged as a crucial aspect of intensive care unit (ICU) management, aiming to counteract the detrimental effects of prolonged immobility in critically ill patients. This comprehensive review examines the efficacy of early mobilization therapy in the ICU setting, synthesizing evidence from clinical trials, meta-analyses, and guidelines. Key findings indicate that early mobilization is associated with numerous benefits, including reduced muscle weakness, a shorter duration of mechanical ventilation, decreased ICU and hospital length of stay, and improved functional outcomes. However, safety concerns, staffing limitations, and patient-specific considerations pose significant barriers to widespread adoption. Despite these challenges, early mobilization is important for improving ICU patient outcomes. This review underscores the critical need for continued research and implementation efforts to optimize early mobilization protocols, address remaining challenges, and expand access to this beneficial therapy. By working collaboratively to overcome barriers and prioritize early mobilization, healthcare providers can enhance the quality of care and improve outcomes for critically ill patients in the ICU.
Collapse
Affiliation(s)
- Amol Singam
- Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
24
|
Liu K, Tronstad O, Flaws D, Churchill L, Jones AYM, Nakamura K, Fraser JF. From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome. J Intensive Care 2024; 12:11. [PMID: 38424645 PMCID: PMC10902959 DOI: 10.1186/s40560-024-00724-4] [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: 10/18/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Care Syndrome (PICS) is a complex constellation of physical, cognitive, and mental dysfunctions that severely impact patients' lives after hospital discharge. This review provides a comprehensive and multi-dimensional summary of the current evidence and practice of exercise therapy (ET) during and after an ICU admission to prevent and manage the various domains of PICS. The review aims to elucidate the evidence of the mechanisms and effects of ET in ICU rehabilitation and highlight that suboptimal clinical and functional outcomes of ICU patients is a growing public health concern that needs to be urgently addressed. MAIN BODY This review commences with a brief overview of the current relationship between PICS and ET, describing the latest research on this topic. It subsequently summarises the use of ET in ICU, hospital wards, and post-hospital discharge, illuminating the problematic transition between these settings. The following chapters focus on the effects of ET on physical, cognitive, and mental function, detailing the multi-faceted biological and pathophysiological mechanisms of dysfunctions and the benefits of ET in all three domains. This is followed by a chapter focusing on co-interventions and how to maximise and enhance the effect of ET, outlining practical strategies for how to optimise the effectiveness of ET. The review next describes several emerging technologies that have been introduced/suggested to augment and support the provision of ET during and after ICU admission. Lastly, the review discusses future research directions. CONCLUSION PICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients' quality of survival and helping them return to their normal lives after hospital discharge.
Collapse
Affiliation(s)
- Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia.
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia.
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan.
| | - Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Science, Queensland University of Technology, Brisbane, Australia
| | - Luke Churchill
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Alice Y M Jones
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, Kanagawa, Japan
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- Queensland University of Technology, Brisbane, Australia
- St. Andrews War Memorial Hospital, Brisbane, Australia
| |
Collapse
|
25
|
Seth B, Oakman B, Needham DM. Physical rehabilitation while awake, intubated and proned for COVID-19-associated severe acute respiratory distress syndrome. BMJ Case Rep 2024; 17:e251772. [PMID: 38373808 PMCID: PMC10882455 DOI: 10.1136/bcr-2022-251772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
This case study demonstrates the implementation of evidence-based guidelines in the intensive care unit setting, including light sedation and early physical rehabilitation while receiving prone positioning and lung protective mechanical ventilation for severe acute respiratory distress syndrome from SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Bhavna Seth
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Brittany Oakman
- Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dale M Needham
- Pulmonary and Critical Care Medicine/Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
26
|
Eggmann S, Nydahl P, Gosselink R, Bissett B. We need to talk about adverse events during physical rehabilitation in critical care trials. EClinicalMedicine 2024; 68:102439. [PMID: 38328754 PMCID: PMC10847053 DOI: 10.1016/j.eclinm.2024.102439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
- Sabrina Eggmann
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Peter Nydahl
- Nursing Research, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Rik Gosselink
- Department of Rehabilitation Sciences, Faculty of Movement and Rehabilitation Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Bernie Bissett
- Faculty of Health, University of Canberra, Australia
- Canberra Health Services, Canberra, Australia
| |
Collapse
|
27
|
Ballesteros-Reviriego G, Daniel Martí J, Planas-Pascual B. Response to "Do we actively and early mobilize patients admitted to an intensive care unit during mechanical ventilation?". ENFERMERIA INTENSIVA 2024; 35:74-75. [PMID: 37949757 DOI: 10.1016/j.enfie.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/30/2023] [Accepted: 06/09/2023] [Indexed: 11/12/2023]
Affiliation(s)
- G Ballesteros-Reviriego
- Hospital Universitari Vall Hebron, Barcelona, Spain; Grupo de Trabajo de Rehabilitación Precoz, Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Spain
| | - J Daniel Martí
- Grupo de Trabajo de Rehabilitación Precoz, Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Spain; Hospital Clínic de Barcelona, Barcelona, Spain
| | - B Planas-Pascual
- Hospital Universitari Vall Hebron, Barcelona, Spain; Grupo de Trabajo de Rehabilitación Precoz, Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Spain.
| |
Collapse
|
28
|
Mazwi N, Lissak I, Wongtangman K, Platzbecker K, Albrecht L, Teja B, Xu X, Morteo NM, Sparling T, Latronico N, Barbieri S, Blobner M, Schaller SJ, Eikermann M. Effects of mobility dose on discharge disposition in critically ill stroke patients. PM R 2023; 15:1547-1556. [PMID: 37448373 DOI: 10.1002/pmrj.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 01/14/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Mobilization in the intensive care unit (ICU) has the potential to improve patient outcomes following acute stroke. The optimal duration and intensity of mobilization for patients with hemorrhagic or ischemic stroke in the ICU remain unclear. OBJECTIVE To assess the effect of mobilization dose in the ICU on adverse discharge disposition in patients after stroke. DESIGN This is an international, prospective, observational cohort study of critically ill stroke patients (November 2017-September 2019). Duration and intensity of mobilization was quantified daily by the mobilization quantification score (MQS). SETTING Patients requiring ICU-level care were enrolled within 48 hours of admission at four separate academic medical centers (two in Europe, two in the United States). PARTICIPANTS Participants included individuals (>18 years old) admitted to an ICU within 48 hours of ischemic or hemorrhagic stroke onset who were functionally independent at baseline. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The primary outcome was adverse discharge disposition. RESULTS Of the patients screened, 163 were eligible for inclusion in the study. One patient was subsequently excluded due to insufficient data collection (n = 162). The dose of mobilization varied greatly between centers and patients, which could not be explained by patients' comorbidities or disease severity. High dose of mobilization (mean MQS > 7.3) was associated with a lower likelihood of adverse discharge (adjusted odds ratio, [aOR]: 0.14; 95% confidence interval [CI]: 0.06-0.31; p < .01). CONCLUSION The increased use of mobilization acutely in the ICU setting may improve patient outcomes.
Collapse
Affiliation(s)
- Nicole Mazwi
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - India Lissak
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karuna Wongtangman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Faculty of Medicine, Siriaj Hospital, Mahidol University, Bangkok, Thailand
| | - Katharina Platzbecker
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Lea Albrecht
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
| | - Bijan Teja
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Departments of Anesthesiology and Critical Care Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Xinling Xu
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole M Morteo
- Department of Physical Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tawnee Sparling
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicola Latronico
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy
| | - Silvia Barbieri
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, University of Brescia, Brescia, Italy
| | - Manfred Blobner
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
- University of Ulm, Faculty of Medicine, Department of Anesthesiology and Intensive Care, Ulm, Germany
| | - Stefan J Schaller
- Department of Anesthesiology and Intensive Care, Technical University of Munich, School of Medicine, Munich, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care, Berlin, Germany
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Montefiore Medical Center, Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
29
|
Mayer KP, Silva S, Beaty A, Davenport A, Minniti M, Dorn SU, White LS, Sabol VK, Pastva AM. Relationship of Age And Mobility Levels During Physical Rehabilitation With Clinical Outcomes in Critical Illness. Arch Rehabil Res Clin Transl 2023; 5:100305. [PMID: 38163032 PMCID: PMC10757188 DOI: 10.1016/j.arrct.2023.100305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Objective To determine whether age, mobility level, and change in mobility level across the first 3 physical rehabilitation sessions associate with clinical outcomes of patients who are critically ill. Design Retrospective, observational cohort study. Setting Medical Intensive Care Unit (MICU). Participants Hospitalized adults (n = 132) who received 3 or more, consecutive rehabilitation sessions in the MICU. Interventions Not applicable. Measurements and Main Results Sample included 132 patients with 60 (45%) classified as younger (18-59 years) and 72 (55%) as older (60+ years). The most common diagnosis was sepsis/septicemia (32.6%). Older relative to younger patients had a significantly slower rate of improvement in ICU Mobility Scale (IMS) scores across rehabilitation sessions (mean slope coefficient 0.3 vs 0.6 points, P<.001), were less likely to be discharged to home (30.6% vs 55.0%, P=.005), and were more likely to die within 12 months (41.7% vs 25.0%, P=.046). Covariate-adjusted models indicated greater early improvement in IMS scores were associated with discharge home (P=.005). Longer time to first rehabilitation session, lower initial IMS scores, and slower improvement in IMS scores were associated with increased ICU days (all P<.03). Conclusion Older age and not achieving the mobility milestone of sitting at edge of bed or limited progression of mobility across sessions is associated with poor patient outcomes. Our findings suggest that age and mobility level contribute to outcome prognostication, and can aide in clinical phenotyping and rehabilitative service allocation.
Collapse
Affiliation(s)
- Kirby P. Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, Lexington, KY
| | - Susan Silva
- Duke University School of Nursing, Duke University, Durham, NC
| | - Amanda Beaty
- Physical Therapy Division, Duke University School of Medicine, Durham, NC
- Department of Rehabilitation Services, Duke Health, Durham, NC
| | - Anne Davenport
- Physical Therapy Division, Duke University School of Medicine, Durham, NC
- Department of Rehabilitation Therapy, Sky Lakes Medical Center, Klamath Falls, OR
| | - Melissa Minniti
- Physical Therapy Division, Duke University School of Medicine, Durham, NC
- Department of Physical Medicine and Rehabilitation Services, James A Haley VA, Tampa, FL
| | - Sara Uribe Dorn
- Department of Rehabilitation Services, Duke Health, Durham, NC
| | - Lane S. White
- Department of Rehabilitation Services, Duke Health, Durham, NC
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | | | - Amy M. Pastva
- Physical Therapy Division, Duke University School of Medicine, Durham, NC
- Duke Claude D. Pepper Older Americans Independence Center, Duke University School of Medicine, Durham, NC
| |
Collapse
|
30
|
Han PH, Shih CY, Wang AY, Chen YC, Yang CC, Fan YC, Hsiang HF, Chiu HY. Effects of an interactive handgrip game on surgical patients requiring intensive care: An assessor-blinded randomized controlled trial. Intensive Crit Care Nurs 2023; 78:103474. [PMID: 37354696 DOI: 10.1016/j.iccn.2023.103474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To explore the effect of an interactive handgrip game on psychological distress and handgrip strength among critically ill surgical patients. DESIGN A randomised controlled trial. SETTING A surgical intensive care unit. INTERVENTION Participants were enrolled in the program within 48 hours of admission to the intensive care unit. Patients in the intervention group played a 20-minute interactive handgrip game twice daily for a maximum of three days in the intensive care unit in addition to routinely passive physical rehabilitation. Patients in the routine care group had a daily target of 20 min of passive physical rehabilitation as needed. MEASUREMENT The primary outcomes included depression, anxiety, and stress measured using the shortened version of the Depression Anxiety Stress Score scale. The secondary outcomes were perceived sleep evaluated using the Richards-Campbell Sleep Questionnaire, delirium assessed using the Intensive Care Delirium Screening Checklist, and handgrip strength measured using handgrip dynamometry within a handgrip device. RESULTS Two hundred and twenty-seven patients were eligible and 70 patients were recruited in the intervention (n = 35) and routine care groups (n = 35). The patients in the intervention group had lower scores (median = 6.0, 4.0, and 12.0) for depression, anxiety, and stress compared with those in the routine care group (12.0, 12.0, and 20.0; all p < 0.05). The interactive handgrip game did not significantly improve sleep quality and prevent the occurrence of delirium (both p > 0.05). The patients who received the interactive handgrip game intervention exhibited significantly enhanced handgrip strength in both hands over time (both p < 0.001). CONCLUSION An interactive handgrip game may benefit the psychological well-being and handgrip strength of critically ill patients. IMPLICATIONS FOR CLINICAL PRACTICE Interactive handgrip games is effective active exercise which should be integrated into routine nursing practice.
Collapse
Affiliation(s)
- Ping-Hsuan Han
- Department of Interaction Design, National Taipei University of Technology, Taipei, Taiwan
| | - Chun-Ying Shih
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - An-Yi Wang
- Department of Critical Care Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Chen Chen
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chi-Chen Yang
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yen-Chun Fan
- College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Hui-Fen Hsiang
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
31
|
Lehmkuhl L, Dreyer P, Laerkner E, Tanghus Olsen H, Jespersen E, Juel Rothmann M. Getting the body back on track - Understanding the phenomenon of mobilisation when conscious and mechanically ventilated patients are mobilised in the intensive care unit. Intensive Crit Care Nurs 2023; 78:103450. [PMID: 37172466 DOI: 10.1016/j.iccn.2023.103450] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To gain an in-depth understanding of the phenomenon of mobilisation when conscious and mechanically ventilated patients are mobilised in the intensive care unit. DESIGN A qualitative study with a phenomenological-hermeneutic approach. Data were generated in three intensive care units from September 2019 to March 2020. Participant observations of twelve conscious mechanically ventilated patients, thirty-five nurses and four physiotherapists were performed. Furthermore, seven semi-structured patient interviews were conducted, both on the ward and after discharge. FINDINGS Mobilisation during mechanical ventilation in the intensive care unit followed a trajectory from a failing body to a growing sense of independence in getting the body back on track. Three themes were revealed: 'Challenging to move a failing body', 'Ambiguity of both resistance and willingness in the process of strengthen the body', and 'An ongoing effort in getting the body back on track'. CONCLUSIONS Mobilisation when conscious and mechanically ventilated included support of the living body by physical prompts and ongoing bodily guidance. Resistance and willingness regarding mobilisation were found to be a way of coping with bodily reactions of comfort or discomfort, embedded in a need to feel bodily control. The trajectory of mobilisation promoted a sense of agency, as mobilisation activities at different stages during the intensive care unit stay supported the patients in becoming more active collaborators in getting the body back on track. IMPLICATIONS FOR CLINICAL PRACTICE Ongoing bodily guidance provided by healthcare professionals can promote bodily control and support conscious and mechanically ventilated patients in active participation in mobilisation. Furthermore, understanding the ambiguity of patients' reactions caused by loss of bodily control provides a potential to prepare mechanically ventilated patients for and assist them with mobilisation. In particular, the first mobilisation in the intensive care unit seems to influence the success of future mobilisation, as the body remembers negative experiences.
Collapse
Affiliation(s)
- Lene Lehmkuhl
- Department of Anaesthesiology and Intensive Care, OUH Svendborg Hospital, Baagøes Alle 15, 5700 Svendborg, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark.
| | - Pia Dreyer
- Department of Public Health, Aarhus University, Bartholin's Alle 2, 8000 Aarhus C, Denmark; Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Eva Laerkner
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Anaesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Hanne Tanghus Olsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Eva Jespersen
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Oncology, Odense University Hospital, Kløvervænget 8D, 5000 Odense C, Denmark.
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Steno Diabetes Center Odense, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Centre for Innovative Medical Technology, Odense University Hospital, Kløvervænget 8C, 5000 Odense, Denmark; Department of Endocrinology, Odense University Hospital, J. B. Winsløws Vej 9a, 5000 Odense, Denmark.
| |
Collapse
|
32
|
Matsuoka A, Yoshihiro S, Shida H, Aikawa G, Fujinami Y, Kawamura Y, Nakanishi N, Shimizu M, Watanabe S, Sugimoto K, Taito S, Inoue S. Effects of Mobilization within 72 h of ICU Admission in Critically Ill Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2023; 12:5888. [PMID: 37762829 PMCID: PMC10531519 DOI: 10.3390/jcm12185888] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Previous systematic review and meta-analysis indicates that rehabilitation within a week of intensive care unit (ICU) admission benefits physical function in critically ill patients. This updated systematic review and meta-analysis aim to clarify effects of initiating rehabilitation within 72 h of ICU admission on long-term physical, cognitive, and mental health. We systematically searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for randomized controlled trials (RCTs) between April 2019 and November 2022 to add to the previous review. Two investigators independently selected and extracted data. Pooled effect estimates for muscle strength, cognitive function, mental health after discharge, and adverse events were calculated. Evidence certainty was assessed via Grading of Recommendations, Assessment, Development, and Evaluations. Eleven RCTs were included in the meta-analysis. Early rehabilitation may improve muscle strength (three trials; standard mean difference [SMD], 0.16; 95% confidence interval [CI], -0.04-0.36) and cognitive function (two trials; SMD, 0.54; 95% CI, -0.13-1.20). Contrastingly, early mobilization showed limited impact on mental health or adverse events. In summary, initiating rehabilitation for critically ill patients within 72 h may improve physical and cognitive function to prevent post-intensive care syndrome without increasing adverse events. The effect on mental function remains uncertain.
Collapse
Affiliation(s)
- Ayaka Matsuoka
- Department of Emergency and Critical Care Medicine, Saga University, 5-1-1 Nabeshima, Saga City 849-8501, Japan;
| | - Shodai Yoshihiro
- Department of Pharmacy, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi 722-8508, Japan;
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan;
| | - Haruka Shida
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2 Kasumigaseki, Chiyodaku, Tokyo 100-0013, Japan;
| | - Gen Aikawa
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi 319-1295, Japan;
| | - Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Central City Hospital, 439 Kakogawacho Honmachi, Kakogawa 675-8611, Japan;
| | - Yusuke Kawamura
- Department of Rehabilitation, Showa General Hospital, 8-1-1 Hanakoganei, Tokyo 187-8510, Japan;
| | - Nobuto Nakanishi
- Department of Disaster and Emergency Medicine, Kobe University, 7-5-2 Kusunoki, Chuo-ward, Kobe 650-0017, Japan;
| | - Motohiro Shimizu
- Department of Intensive Care Medicine, Ryokusen-kai Yonemori Hospital, 1-7-1, Yojiro, Kagoshima 890-0062, Japan;
| | - Shinichi Watanabe
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, 2-92, Gifu 500-8281, Japan;
| | - Kensuke Sugimoto
- Intensive Care Unit, Gunma University Hospital; 39-15 Showa, Maebashi 371-8511, Japan;
| | - Shunsuke Taito
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan;
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3, Kasumi, Hiroshima 734-8551, Japan
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Kobe University, 7-5-2 Kusunoki, Chuo-ward, Kobe 650-0017, Japan;
| |
Collapse
|
33
|
Eggers D, Hermes C, Esteve H, Nickoleit M, Filipovic S, König V, Riessen R, Krüger L, Nydahl P. [Interprofessional curriculum for early mobilization : Developed by the nursing section of the DGIIN in close cooperation with the German early mobilization network]. Med Klin Intensivmed Notfmed 2023; 118:487-491. [PMID: 37401953 DOI: 10.1007/s00063-023-01035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Detlef Eggers
- Fachweiterbildungsstätte für Intensiv- und Anästhesiepflege und Pädiatrische Intensiv- und Anästhesiepflege, Universitätsklinikum Gießen und Marburg, Standort Marburg, Marburg, Deutschland
| | - Carsten Hermes
- Hochschule für Angewandte Wissenschaften Hamburg (HAW Hamburg), Alexanderstr. 1, 20099, Hamburg, Deutschland.
- Akkon-Hochschule für Humanwissenschaften, Berlin, Deutschland.
| | - Hermann Esteve
- Medizinische Intensivstation, Klinikum Traunstein, Traunstein, Deutschland
| | | | | | | | - Reimer Riessen
- Department für Innere Medizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Lars Krüger
- Stabsstelle Projekt- und Wissensmanagement/Pflegeentwicklung Intensivpflege, Pflegedirektion, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bochum, Deutschland
| | - Peter Nydahl
- Pflegeforschung und -entwicklung, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| |
Collapse
|
34
|
King E, Nydahl P, Manning JC. Rehabilitation across the life course and critical care pathway: Much more than learning to walk again. Nurs Crit Care 2023; 28:475-477. [PMID: 37379003 DOI: 10.1111/nicc.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Elizabeth King
- Oxford Allied Health Professions Research & Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Peter Nydahl
- Nursing Research, University Hospital of Schleswig-Holstein, Kiel, Germany
- Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria
| | - Joseph C Manning
- Children and Young People Health Research (CYPHR), School of Health Sciences, The University of Nottingham, Nottingham, United Kingdom
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| |
Collapse
|
35
|
Rittel CM, Borg BA, Hanessian AV, Kuhar A, Fain MJ, Bime C. Longitudinal Assessment of Mobility and Self-care Among Critically Ill Older Adults. An Age-Friendly Health Systems Initiative Quality Improvement Study. Dimens Crit Care Nurs 2023; 42:234-239. [PMID: 37219478 PMCID: PMC10208591 DOI: 10.1097/dcc.0000000000000588] [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] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Early mobility in the intensive care unit (ICU) is vital to maintaining an older adult patient's performance of activities of daily living, functional mobility, and overall quality of life. Prior studies have shown reduced length of inpatient stay and onset of delirium in patients with early mobilization. Despite these benefits, many ICU patients are often labeled as too sick to participate in therapy and frequently do not receive physical (PT) or occupational therapy (OT) consults until they are considered floor status. This delay in therapy can negatively affect a patient's capacity to participate in his/her self-care, add to the burden on caregivers, and limit disposition options. OBJECTIVES Our goals were to perform a longitudinal assessment of mobility and self-care among older patients through their medical ICU (MICU) stays and to quantify visits by therapy services to identify areas for improvement in achieving early intervention in this at-risk population. METHOD This was a retrospective quality improvement analysis of a cohort of admissions to the MICU at a large tertiary academic medical center between November 2018 and May 2019. Admission information, PT and OT consult information, Perme Intensive Care Unit Mobility Score, and Modified Barthel Index scores were entered into a quality improvement registry. Inclusion criteria consisted of age older than 65 years and at least 2 distinct visits by PT and/or OT for evaluation. Patients without consults and patients with weekend-only MICU stays were not assessed. RESULTS There were 302 MICU patients 65 years or older admitted during the study period. Forty-four percent (132) of these patients received PT/OT consults, and among these, 32% (42) had at least 2 visits to allow comparison of objective scores. Seventy-five percent of patients had improved Perme scores (median, 9.4%; interquartile range, 2.3%-15.6%), and 58% of patients had improved Modified Barthel Index scores (median, 3%; interquartile range, -2% to 13.5%). However, 17% of potential therapy days were missed because of inadequate staffing/time, and 14% were missed because of being sedated or unable to participate. CONCLUSIONS In our cohort of patients older than 65 years, receipt of therapy in the MICU led to modest improvements in score-assessed mobility and self-care before transfer to floor. Staffing, time constraints, and patient sedation or encephalopathy appeared to interfere most with further potential benefits. In the next phase, we plan to implement strategies to increase PT/OT availability in the MICU and implement a protocol to increase identification and referral of candidates for whom early therapy can prevent loss of mobility and ability to perform self-care.
Collapse
|
36
|
Schweickert WD, Jablonski J, Bayes B, Chowdhury M, Whitman C, Tian J, Blette B, Tran T, Halpern SD. Structured Mobilization for Critically Ill Patients: A Pragmatic Cluster-randomized Trial. Am J Respir Crit Care Med 2023; 208:49-58. [PMID: 36996413 DOI: 10.1164/rccm.202209-1763oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 03/30/2023] [Indexed: 04/01/2023] Open
Abstract
Rationale: Small trials and professional recommendations support mobilization interventions to improve recovery among critically ill patients, but their real-world effectiveness is unknown. Objective: To evaluate a low-cost, multifaceted mobilization intervention. Methods: We conducted a stepped-wedge cluster-randomized trial across 12 ICUs with diverse case mixes. The primary and secondary samples included patients mechanically ventilated for ⩾48 hours who were ambulatory before admission, and all patients with ICU stays ⩾48 hours, respectively. The mobilization intervention included 1) designation and posting of daily mobilization goals; 2) interprofessional closed-loop communication coordinated by each ICU's facilitator; and 3) performance feedback. Measurements and Main Results: From March 4, 2019 through March 15, 2020, 848 and 1,069 patients were enrolled in the usual care and intervention phases in the primary sample, respectively. The intervention did not increase the primary outcome, patient's maximal Intensive Care Mobility Scale (range, 0-10) score within 48 hours before ICU discharge (estimated mean difference, 0.16; 95% confidence interval, -0.31 to 0.63; P = 0.51). More patients in the intervention (37.2%) than usual care (30.7%) groups achieved the prespecified secondary outcome of ability to stand before ICU discharge (odds ratio, 1.48; 95% confidence interval, 1.02 to 2.15; P = 0.04). Similar results were observed among the 7,115 patients in the secondary sample. The percentage of days on which patients received physical therapy mediated 90.1% of the intervention effect on standing. ICU mortality (31.5% vs. 29.0%), falls (0.7% vs. 0.4%), and unplanned extubations (2.0% vs. 1.8%) were similar between groups (all P > 0.3). Conclusions: A low-cost, multifaceted mobilization intervention did not improve overall mobility but improved patients' odds of standing and was safe. Clinical trial registered with www.clinicaltrials.gov (NCT03863470).
Collapse
Affiliation(s)
- William D Schweickert
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Brian Bayes
- Palliative and Advanced Illness Research Center
| | | | | | - Jenny Tian
- Palliative and Advanced Illness Research Center
| | - Bryan Blette
- Palliative and Advanced Illness Research Center
- Department of Biostatistics, Epidemiology, and Informatics, and
| | - Teresa Tran
- Palliative and Advanced Illness Research Center
| | - Scott D Halpern
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine
- Palliative and Advanced Illness Research Center
- Department of Biostatistics, Epidemiology, and Informatics, and
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| |
Collapse
|
37
|
Sakuramoto H, Nakamura K, Ouchi A, Okamoto S, Watanabe S, Liu K, Morita Y, Katsukawa H, Kotani T. Current Practice and Barriers to the Implementation of Mobilization in ICUs in Japan: A Multicenter Prospective Cohort Study. J Clin Med 2023; 12:3955. [PMID: 37373649 DOI: 10.3390/jcm12123955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/13/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Background: Limited information is currently available on the barriers to implementing mobilization at the bedside for critically ill patients. Therefore, we investigated the current practice of and barriers to the implementation of mobilization in intensive care units (ICU). Methods: A multicenter prospective observational study was conducted at nine hospitals between June 2019 and December 2019. Consecutive patients admitted to the ICU for more than 48 h were enrolled. Quantitative data were analyzed descriptively, and qualitative data were analyzed thematically. Results: The 203 patients enrolled in the present study were divided into 69 elective surgical patients and 134 unplanned admission patients. The mean periods of time until the initiation of rehabilitation programs after ICU admission were 2.9 ± 7.7 and 1.7 ± 2.0 days, respectively. Median ICU mobility scales were five (Interquartile range: three and eight) and six (Interquartile range: three and nine), respectively. The most common barriers to mobilization in the ICU were circulatory instability (29.9%) and a physician's order for postoperative bed rest (23.4%) in the unplanned admission and elective surgery groups, respectively. Conclusions: Rehabilitation programs were initiated later for unplanned admission patients and were less intense than those for elective surgical patients, irrespective of the time after ICU admission.
Collapse
Affiliation(s)
- Hideaki Sakuramoto
- Department of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata 811-4157, Fukuoka, Japan
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Kanagawa, Japan
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1 Jonancho, Hitachi 317-0077, Ibaraki, Japan
| | - Akira Ouchi
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, Hitachi 319-1295, Ibaraki, Japan
| | - Saiko Okamoto
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1 Jonancho, Hitachi 317-0077, Ibaraki, Japan
| | - Shinichi Watanabe
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, 2-92 Higashiuzura, Gifu 500-8281, Gifu, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Rd, Chermside, QLD 4032, Australia
- Faculty of Medicine, The University of Queensland, 20 Weightman St, Herston, QLD 4006, Australia
- Non-Profit Organization ICU Collaboration Network (ICON), 2-15-13 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yasunari Morita
- Department of Emergency and Intensive Care Medicine, National Hospital Organization Nagoya Medical Center, Nagoya 460-0001, Aichi, Japan
| | - Hajime Katsukawa
- Japanese Society for Early Mobilization, 1-2-12 Kudankita, Chiyoda-ku, Tokyo 102-0073, Japan
| | - Toru Kotani
- Department of Intensive Care Medicine, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan
| |
Collapse
|
38
|
Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Heart Lung Transplant 2023; 42:e1-e64. [PMID: 36805198 DOI: 10.1016/j.healun.2022.10.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
39
|
Zhang X, Kang Y, Luo Z, Chen Q, Yang M, Zeng J, Yu P, Zhang Q. Feasibility and safety of 1-min sit-to-stand test in acute decompensated heart failure confirmed by lung ultrasound. Front Cardiovasc Med 2023; 10:1103247. [PMID: 36970350 PMCID: PMC10030608 DOI: 10.3389/fcvm.2023.1103247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023] Open
Abstract
AimThis study innovatively proposed the 1-min sit-to-stand test (1-min STST) as an assessment tool for functional capacity in acute decompensated heart failure (ADHF), in which its feasibility and safety were investigated.MethodsThis was a prospective, single-center cohort study. The 1-min STST was performed after the first 48 h of admission when vital signs and Borg score were collected. Lung ultrasound was used to measure pulmonary edema by B-lines before and after the test.ResultsSeventy-five patients were enrolled in the study, of whom 40% were in functional class IV on admission. The mean age was 58.3 ± 15.7 years and 40% of the patients were male. 95% patients accomplished the test and the average number of repetitions was 18 ± 7. No adverse event was recorded during or after the 1-min STST. Blood pressure, heart rate, and degree of dyspnea were increased after the test (all p < 0.001), while oxygen saturation was slightly decreased (97.0 ± 1.6 vs. 96.3 ± 2.0%, p = 0.003). The degree of pulmonary edema (χ2 = 8.300, p = 0.081) was not significantly changed, while there was a reduction in the absolute number of B-lines [9 (3, 16) vs. 7 (3, 13), p = 0.008].ConclusionThe application of the 1-min STST in early stage of ADHF appeared to be safe and feasible, which induce neither adverse event nor pulmonary edema. It may serve as a new tool of functional capacity assessment, as well as a reference of exercise rehabilitation.
Collapse
Affiliation(s)
- Xiu Zhang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Kang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zeruxin Luo
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiaowei Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mengxuan Yang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jijuan Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Pengming Yu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Pengming Yu,
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
- Qing Zhang,
| |
Collapse
|
40
|
Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Card Fail 2023; 29:304-374. [PMID: 36754750 DOI: 10.1016/j.cardfail.2022.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
41
|
Hauff T, Petosic A, Småstuen MC, Wøien H, Sunde K, Stafseth SK. Patient mobilisation in the intensive care unit and evaluation of a multifaceted intervention including Facebook groups: A quasi-experimental study. Intensive Crit Care Nurs 2023; 74:103315. [PMID: 36192314 DOI: 10.1016/j.iccn.2022.103315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 12/14/2022]
Abstract
AIMS To describe prevalence and time to mobilisation in intensive care unit patients defined as a minimum sitting in an upright position in bed, and evaluate the impact of a multifaceted quality improvement campaign on likelihood of patients being mobilised. RESEARCH METHODOLOGY/DESIGN Quality improvement project using a quasi-experimental study design, comparing patient cohorts before (Before) and after (Intervention) a campaign including educational sessions, audit and feedback of intensive care unit quality indicators via closed Facebook-groups and e-mail and local opinion leaders. Secondary analysis of mobilisation data from adult intensive care patient stays extracted from electronical medical charts. Likelihood of being mobilised was analysed with Multivariate Cox-regression model and reported as Sub-hazard Ratio (SHR). SETTING Four intensive care units in a university hospital. MAIN OUTCOME MEASURES Prevalence and time to first documented mobilisation, defined as at least "sitting in bed" during the intensive care unit stay. RESULTS Overall, 929 patients were analysed, of whom 710 (76 %) were mobilised; 73 % (356/ 489) in Before vs 81 % (354/ 440) in Intervention (p = 0.007). Median time to mobilisation was 69.9 (IQR: 30.0, 149.8) hours; 71.7 (33.9, 157.9) in Before and 66.0 (27.1, 140.3) in Intervention (p = 0.104). Higher SAPS II-scores were associated with lower likelihood (SHR 0.98, 95 % CI 0.97-0.99), whereas admissions due to gastroenterological failure (SHR 2.1, 95 % CI 1.4-3.0), neurological failure (SHR 1.5, 95 % CI 1.0-2.2) and other causes (intoxication, postoperative care, haematological-, and kidney failure) (SHR 1.7, 95 % CI 1.13-2.6) were associated with higher likelihood of mobilisation vs respiratory failure. CONCLUSION A quality improvement campaign including use of Facebook groups is feasible and may improve mobilisation in intensive care unit patients. Most patients were mobilised within 72 hours following intensive care unit admission, and SAPS II scores and causes for intensive care unit admission were both associated with likelihood of being mobilised.
Collapse
Affiliation(s)
- Tonje Hauff
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway. https://twitter.com/@HauffTonje
| | - Antonija Petosic
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway; The Norwegian Intensive Care Registry, Haukeland University Hospital, Helse Bergen, Bergen, Norway. https://twitter.com/@AntonijaPetosic
| | - Milada Cvancarova Småstuen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Department of Public Health, Oslo Metropolitan University, Oslo, Norway.
| | - Hilde Wøien
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway. https://twitter.com/@ien_hilde
| | - Kjetil Sunde
- Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Siv K Stafseth
- Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway.
| |
Collapse
|
42
|
Facilitators & barriers and practices of early mobilization in critically ill burn patients: A survey. Burns 2023; 49:42-54. [PMID: 36202684 DOI: 10.1016/j.burns.2022.08.023] [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: 02/22/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Early mobilization (EM) of intensive care (IC) patients is important but complex with facilitators and barriers. Compared to general IC patients, burn IC patients are more hyper-metabolic. They have extensive wounds, lengthy wound dressing changes, and repeated surgeries that may affect possibilities of EM. This study aimed to identify facilitators and barriers of EM in burn IC patients among all disciplines involved. Additionally, we assessed EM practices, i.e. when are which patients considered suitable for EM. METHODS A survey was sent to 139 professionals involved in EM of burn IC patients (discipline groups: Intensivists, medical doctors, registered nurses, therapists). RESULTS Response rate was 57 %. The majority found EM very important, yet different definitions were chosen. Perceived barriers mainly concerned patient-level factors, most frequently hemodynamic instability and excessive sedation followed by skin graft surgery, fatigue, and pain management. Most frequent barriers at the provider-level were limited staffing, safety concerns, and conflicting perceptions about the suitability of EM. At the institutional-level, we found no high barriers. Interdisciplinary variation on perceived barriers, when to initiate it, and permitted maximal activity were ascertained. CONCLUSION Skin grafts and pain management were barriers of EM specific for burn care. Opinions on frequency, dosage and duration of EM varied widely. Improving interdisciplinary communication is key.
Collapse
|
43
|
Tirona K. Just Keep MOVEN: An Evidence-Based Approach to Improving Outcomes in Patients Receiving Mechanical Ventilation. Crit Care Nurse 2023; 43:75-79. [PMID: 36720273 DOI: 10.4037/ccn2023754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Kelsey Tirona
- Kelsey Tirona is a clinician III registered nurse in the heart and vascular intensive care unit at Penn Presbyterian Medical Center in Philadelphia, Pennsylvania
| |
Collapse
|
44
|
Kho ME, Connolly B. From Strict Bedrest to Early Mobilization. Crit Care Clin 2023; 39:479-502. [DOI: 10.1016/j.ccc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
|
45
|
Fuest KE, Ulm B, Daum N, Lindholz M, Lorenz M, Blobner K, Langer N, Hodgson C, Herridge M, Blobner M, Schaller SJ. Clustering of critically ill patients using an individualized learning approach enables dose optimization of mobilization in the ICU. Crit Care 2023; 27:1. [PMID: 36597110 PMCID: PMC9808956 DOI: 10.1186/s13054-022-04291-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND While early mobilization is commonly implemented in intensive care unit treatment guidelines to improve functional outcome, the characterization of the optimal individual dosage (frequency, level or duration) remains unclear. The aim of this study was to demonstrate that artificial intelligence-based clustering of a large ICU cohort can provide individualized mobilization recommendations that have a positive impact on the likelihood of being discharged home. METHODS This study is an analysis of a prospective observational database of two interdisciplinary intensive care units in Munich, Germany. Dosage of mobilization is determined by sessions per day, mean duration, early mobilization as well as average and maximum level achieved. A k-means cluster analysis was conducted including collected parameters at ICU admission to generate clinically definable clusters. RESULTS Between April 2017 and May 2019, 948 patients were included. Four different clusters were identified, comprising "Young Trauma," "Severely ill & Frail," "Old non-frail" and "Middle-aged" patients. Early mobilization (< 72 h) was the most important factor to be discharged home in "Young Trauma" patients (ORadj 10.0 [2.8 to 44.0], p < 0.001). In the cluster of "Middle-aged" patients, the likelihood to be discharged home increased with each mobilization level, to a maximum 24-fold increased likelihood for ambulating (ORadj 24.0 [7.4 to 86.1], p < 0.001). The likelihood increased significantly when standing or ambulating was achieved in the older, non-frail cluster (ORadj 4.7 [1.2 to 23.2], p = 0.035 and ORadj 8.1 [1.8 to 45.8], p = 0.010). CONCLUSIONS An artificial intelligence-based learning approach was able to divide a heterogeneous critical care cohort into four clusters, which differed significantly in their clinical characteristics and in their mobilization parameters. Depending on the cluster, different mobilization strategies supported the likelihood of being discharged home enabling an individualized and resource-optimized mobilization approach. TRIAL REGISTRATION Clinical Trials NCT03666286, retrospectively registered 04 September 2018.
Collapse
Affiliation(s)
- Kristina E. Fuest
- grid.15474.330000 0004 0477 2438Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany
| | - Bernhard Ulm
- grid.15474.330000 0004 0477 2438Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany
| | - Nils Daum
- grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| | - Maximilian Lindholz
- grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| | - Marco Lorenz
- grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| | - Kilian Blobner
- grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany ,grid.15474.330000 0004 0477 2438Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Orthopedics, Munich, Germany
| | - Nadine Langer
- grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| | - Carol Hodgson
- grid.1002.30000 0004 1936 7857Acute and Critical Care, Monash University, Melbourne, VIC Australia
| | - Margaret Herridge
- grid.231844.80000 0004 0474 0428Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, ON Canada
| | - Manfred Blobner
- grid.15474.330000 0004 0477 2438Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany ,grid.410712.10000 0004 0473 882XFaculty of Medicine, Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm, Germany
| | - Stefan J. Schaller
- grid.15474.330000 0004 0477 2438Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany ,grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| |
Collapse
|
46
|
Kho ME. Critically appraised paper: In adults receiving intensive care, increased early active mobilisation did not improve clinical outcomes but increased adverse events [commentary]. J Physiother 2023; 69:56. [PMID: 36528505 DOI: 10.1016/j.jphys.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| |
Collapse
|
47
|
Javaherian M, Shadmehr A, Keshtkar A, Beigmohammadi MT, Dabbaghipour N, Syed A, Attarbashi Moghadam B. Safety and efficacy of pulmonary physiotherapy in hospitalized patients with severe COVID-19 pneumonia (PPTCOVID study): A prospective, randomised, single-blind, controlled trial. PLoS One 2023; 18:e0268428. [PMID: 36719885 PMCID: PMC9888698 DOI: 10.1371/journal.pone.0268428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 03/31/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pulmonary physiotherapy (PPT) is an important treatment in the management of patients with different types of pulmonary disorders. We aimed to evaluate safety and efficacy of PPT in hospitalized patients with severe COVID-19 pneumonia. METHODS In this randomised, single-blind, controlled trial, we enrolled hospitalized, non-intubated patients (18 to 75 years with oxygen saturation (Spo2) in free-air breathing ≤90%) with COVID-19 pneumonia at a referral hospital. Participants were randomly assigned (1:1) to receive PPT (six sessions PPT with breathing exercises and airway clearance techniques) or basic care. The primary outcomes were venous blood O2 (pO2) and CO2 (pCO2) pressures, Spo2, and three-minute walking test (3MWT) that were assessed before and end of sixth session. Secondary outcomes included level of dyspnea, venous blood PH, one-month mortality, three-month mortality and short form-36 (SF-36) after one and three months. The assessor was blinded to the assignment. This trial is registered with ClinicalTrials.gov (NCT04357340). FINDINGS In April-May 2020, 40 participants were randomly assigned to PPT or basic care groups. While at the end of intervention, pO2 (adjusted mean difference to baseline measure (AMD) 6.43 mmHg [95%CI 2.8, 10.07], P<0.01), Spo2 (AMD 4.43% [95%CI 2.04, 6.83], P = 0.0011), and 3MTW (AMD 91.44 m [95%CI 68.88, 113.99], P<0.01) were higher in PPT group and basic care group, pCO2 was not improved (AMD -2.1 mmHg [95%CI-6.36, 2.21], P = 0.33). Based on the logistic model adjusted to baseline Spo2, the risks of mortality were reduced 81% ([95%CI: 97% reduction to 30% increase], P = .09) and 84% ([95%CI 74% reduction to 5% increase], P = .06) at one-month and three-month, respectively. There were no significant differences in most SF-36 domains scores after one and three months. No serious adverse event was observed during PPT sessions. CONCLUSION Early PPT can be considered a safe and relatively effective therapeutic choice for patients with severe COVID-19.
Collapse
Affiliation(s)
- Mohammad Javaherian
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Shadmehr
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbasali Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences and Health Services, Tehran, Iran
| | - Mohammad Taghi Beigmohammadi
- Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Dabbaghipour
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Aabis Syed
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Behrouz Attarbashi Moghadam
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
- * E-mail:
| |
Collapse
|
48
|
Chicano-Corrales A, Bañeras-Rius J, de Frutos F, Sánchez-Salado JC, Ariza-Solé A, Blasco-Lucas A, Sbraga F, Díez-López C, Calvo-Barriuso E, Castillo García J, Molina-Mazón CS, López-López A, Tinoco-Amorós I, Abellán-García A, González-Costello J. Impact of mobilization in patients with short-term mechanical circulatory support such as Levitronix® CentriMag as a bridge to heart transplantation. ENFERMERIA INTENSIVA 2023; 34:12-18. [PMID: 36774246 DOI: 10.1016/j.enfie.2022.03.002] [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: 06/22/2021] [Accepted: 03/10/2022] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Despite the benefits of mobilisation in the critical patient, the evidence in patients with Levitronix® CentriMag as a bridge to heart transplantation (HT) is scarce. The objective of this study is to analyze the impact of mobility on these patients. METHODS Retrospective observational study of patients who received a HT with Levitronix® CentriMag admitted between 2010 and 2019 to a tertiary hospital. Degree of mobility and nutritional status were assessed at the time of HT. Outcomes including infections, length of hospital admission and mortality were evaluated. RESULTS 27 patients were included and divided in two groups according to degree of mobility (22 with low mobility and 5 with high mobility). 90-day survival after HT was 63.6% in patients with low mobility and 80% in high mobility group; no statistically significant differences were observed. No differences were observed regarding ICU discharge after HT at 30 days. Nevertheless, lower albumin levels were observed in low mobility group (24,5 g/L (IQR: 23-30) vs 33 g/L (IQR: 26-36); p = .029). Invasive mechanical ventilation (IMV) post HT was longer in patients with low mobility (p = .014). There were no significant differences in appearance of pressure ulcers, or post HT infections among mobility groups. CONCLUSIONS Patients with high mobility had a shorter time of IMV and a better nutritional status. No complications were observed associated to mobility. No differences were observed between the degree of mobility and 90-day mortality, ICU stay or post HT adverse events.
Collapse
Affiliation(s)
- A Chicano-Corrales
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - J Bañeras-Rius
- Institut de Recerca del Hospital Vall d'Hebron, Servicio de Cardiología del Hospital Universitari Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - F de Frutos
- Departamento de Cardiología del Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J C Sánchez-Salado
- Departamento de Cardiología del Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - A Ariza-Solé
- Institut de Recerca del Hospital Vall d'Hebron, Servicio de Cardiología del Hospital Universitari Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - A Blasco-Lucas
- Departamento de Cirugía Cardíaca del Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F Sbraga
- Departamento de Cirugía Cardíaca del Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - C Díez-López
- Departamento de Cardiología del Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - E Calvo-Barriuso
- Hemodinámica, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J Castillo García
- Perfusionista, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain
| | - C S Molina-Mazón
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Unidad de Electrofisiología y Arritmias, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; GRIN, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Sistema de Emergencias Médicas de Cataluña, Spain
| | - A López-López
- Unidad Cuidados Intensivos, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - I Tinoco-Amorós
- Unidad de Cuidados Intensivos Cardiológicos y Hemodinámica, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Abellán-García
- Unidad de Cuidados Intensivos Cardiológicos, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - J González-Costello
- Institut de Recerca del Hospital Vall d'Hebron, Servicio de Cardiología del Hospital Universitari Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| |
Collapse
|
49
|
Gutierrez-Arias R, Nydahl P, Pieper D, González-Seguel F, Jalil Y, Oliveros MJ, Torres-Castro R, Seron P. Effectiveness of physical rehabilitation interventions in critically ill patients-A protocol for an overview of systematic reviews. PLoS One 2023; 18:e0284417. [PMID: 37053257 PMCID: PMC10101388 DOI: 10.1371/journal.pone.0284417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION Adult and pediatric patients admitted to intensive care units (ICUs) requiring invasive ventilatory support, sedation, and muscle blockade may present neuromusculoskeletal deterioration. Different physical rehabilitation interventions have been studied to evaluate their effectiveness in improving critically ill patients' outcomes. Given that many published systematic reviews (SRs) aims to determine the effectiveness of different types of physical rehabilitation interventions, it is necessary to group them systematically and assess the methodological quality of SRs to help clinicians make better evidence-based decisions. This overview of SRs (OoSRs) aims to map the existing evidence and to determine the effectiveness of physical rehabilitation interventions to improve neuromusculoskeletal function and other clinical outcomes in adult and pediatric critically ill patients. METHODS An OoSRs of randomized and non-randomized clinical trials involving critically ill adult and pediatric patients receiving physical rehabilitation intervention will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will conduct study selection, data extraction, and methodological quality assessment. Discrepancies will be resolved by consensus or a third reviewer. The degree of overlap of studies will be calculated using the corrected covered area. The methodological quality of the SRs will be measured using the AMSTAR-2 tool. The GRADE framework will report the certainty of evidence by selecting the "best" SR for each physical rehabilitation intervention and outcome. DISCUSSION The findings of this overview are expected to determine the effectiveness and safety of physical rehabilitation interventions to improve neuromusculoskeletal function in adult and pediatric critically ill patients based on a wide selection of the best available evidence and to determine the knowledge gaps in this topic by mapping and assessing the methodological quality of published SRs. REGISTRATION NUMBER CRD42023389672.
Collapse
Affiliation(s)
- Ruvistay Gutierrez-Arias
- Servicio de Medicina Física y Rehabilitación, Unidad de Kinesiología, Instituto Nacional del Tórax, Santiago, Chile
- Exercise and Rehabilitation Sciences Laboratory, Faculty of Rehabilitation Sciences, School of Physical Therapy, Universidad Andres Bello, Santiago, Chile
| | - Peter Nydahl
- Department of Nursing Research, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Dawid Pieper
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health Systems Research, Rüdersdorf, Germany
- Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany
| | - Felipe González-Seguel
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Yorschua Jalil
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Ciencias de la Salud, Carrera de Kinesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria-Jose Oliveros
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
| | | | - Pamela Seron
- Departamento de Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
- Centro de Excelencia CIGES, Universidad de La Frontera, Temuco, Chile
| |
Collapse
|
50
|
Borges LF, Fraga Righetti R, de Souza Francisco D, Pereira Yamaguti W, Barros CFD. Hemodynamic impact of early mobilization in critical patients receiving vasoactive drugs: A prospective cohort study. PLoS One 2022; 17:e0279269. [PMID: 36538515 PMCID: PMC9767358 DOI: 10.1371/journal.pone.0279269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Vasoactive drugs are one of the most common patient-related barriers to early mobilization. Little is known about the hemodynamic effects of early mobilization on patients receiving vasoactive drugs. This study aims to observe and describe the impact of mobilization on the vital signs of critical patients receiving vasoactive drugs as well as the occurrence of adverse events. METHODS This is a cohort study performed in an Intensive Care Unit with patients receiving vasoactive drugs. All patients, either mobilized or non-mobilized, had their clinical data such as vital signs [heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation], type and dosage of the vasoactive drug, and respiratory support collected at rest. For mobilized patients, the vital signs were also collected after mobilization, and so was the highest level of mobility achieved and the occurrence of adverse events. The criteria involved in the decision of mobilizing the patients were registered. RESULTS 53 patients were included in this study and 222 physiotherapy sessions were monitored. In most of the sessions (n = 150, 67.6%), patients were mobilized despite the use of vasoactive drugs. There was a statistically significant increase in heart rate and respiratory rate after mobilization when compared to rest (p<0.05). Only two (1.3%) out of 150 mobilizations presented an adverse event. Most of the time, non-mobilizations were justified by the existence of a clinical contraindication (n = 61, 84.7%). CONCLUSIONS The alterations observed in the vital signs of mobilized patients may have reflected physiological adjustments of patients' cardiovascular and respiratory systems to the increase in physical demand imposed by the early mobilization. The adverse events were rare, not serious, and reversed through actions such as a minimal increase of the vasoactive drug dosage.
Collapse
|