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Cussen J, Mukpradab S, Tobiano G, Haines KJ, O'Connor L, Marshall AP. Exploring critically ill patients' functional recovery through family partnerships: A descriptive qualitative study. Aust Crit Care 2024:S1036-7314(24)00120-6. [PMID: 39107155 DOI: 10.1016/j.aucc.2024.06.007] [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: 11/29/2023] [Revised: 05/02/2024] [Accepted: 06/11/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND Early mobilisation interventions play a role in preventing intensive care unit-acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions. OBJECTIVES The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients. METHODS A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted. CONCLUSIONS Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging.
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Affiliation(s)
- Julie Cussen
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
| | - Sasithorn Mukpradab
- Griffith University, Southport, Queensland, Australia; Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand.
| | - Georgia Tobiano
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
| | - Kimberley J Haines
- Physiotherapy Department, Western Health, Melbourne, Victoria, Australia; Department of Critical Care, Melbourne Medical School, The University of Melbourne, Victoria, Australia.
| | - Lauren O'Connor
- Gold Coast University Hospital, Southport, Queensland, Australia.
| | - Andrea P Marshall
- Gold Coast University Hospital, Southport, Queensland, Australia; Griffith University, Southport, Queensland, Australia.
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Wang L, Hua Y, Wang L, Zou X, Zhang Y, Ou X. The effects of early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1202754. [PMID: 37448799 PMCID: PMC10336545 DOI: 10.3389/fmed.2023.1202754] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023] Open
Abstract
Background The effects of early mobilization (EM) on intensive care unit (ICU) patients remain unclear. A meta-analysis of randomized controlled trials was performed to evaluate its effect in mechanically ventilated adult ICU patients. Methods We searched randomized controlled trials (RCTs) published in Medline, Embase, and CENTRAL databases (from inception to November 2022). According to the difference in timing and type, the intervention group was defined as a systematic EM group, and comparator groups were divided into the late mobilization group and the standard EM group. The primary outcome was mortality. The secondary outcomes were ICU length of stay, duration of mechanical ventilation (MV), and adverse events. EM had no impact on 180-day mortality and hospital mortality between intervention groups and comparator groups (RR 1.09, 95% CI 0.89-1.33, p = 0.39). Systemic EM reduced the ICU length of stay (LOS) (MD -2.18, 95% CI -4.22--0.13, p = 0.04) and the duration of MV (MD -2.27, 95% CI -3.99--0.56, p = 0.009), but it may increase the incidence of adverse events in patients compared with the standard EM group (RR 1.99, 95% CI 1.25-3.16, p = 0.004). Conclusion Systematic EM has no significant effect on short- or long-term mortality in mechanically ventilated adult ICU patients, but systematic EM could reduce the ICU LOS and duration of MV.
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Affiliation(s)
- Lijie Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yusi Hua
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Luping Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xia Zou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yan Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaofeng Ou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Davoudi A, Shickel B, Tighe PJ, Bihorac A, Rashidi P. Potentials and Challenges of Pervasive Sensing in the Intensive Care Unit. Front Digit Health 2022; 4:773387. [PMID: 35656333 PMCID: PMC9152012 DOI: 10.3389/fdgth.2022.773387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
Patients in critical care settings often require continuous and multifaceted monitoring. However, current clinical monitoring practices fail to capture important functional and behavioral indices such as mobility or agitation. Recent advances in non-invasive sensing technology, high throughput computing, and deep learning techniques are expected to transform the existing patient monitoring paradigm by enabling and streamlining granular and continuous monitoring of these crucial critical care measures. In this review, we highlight current approaches to pervasive sensing in critical care and identify limitations, future challenges, and opportunities in this emerging field.
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Affiliation(s)
- Anis Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States,*Correspondence: Anis Davoudi
| | - Benjamin Shickel
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Patrick James Tighe
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - Azra Bihorac
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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Abstract
The detrimental effects of immobility are well documented in the literature, yet immobility still plagues the hospitalized adult. As the influx of COVID-19 patients began, patient mobility was further compromised. The purpose of this quality improvement project was to assess the impact of COVID mobility teams, composed of deployed coworkers, on COVID-19–positive and person under investigation patient outcomes. Using mobility teams improved mobility in COVID-positive and person under investigation patients. Increasing patient mobility results in improved patient outcomes by preventing hospital-acquired functional decline, preventing intensive care unit transfers, and decreasing length of stay.
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Clarissa C, Salisbury L, Rodgers S, Kean S. A Constructivist Grounded Theory of Staff Experiences Relating to Early Mobilisation of Mechanically Ventilated Patients in Intensive Care. Glob Qual Nurs Res 2022; 9:23333936221074990. [PMID: 35224137 PMCID: PMC8874193 DOI: 10.1177/23333936221074990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Early mobilisation of mechanically ventilated patients has been suggested to be effective in mitigating muscle weakness, yet it is not a common practice. Understanding staff experiences is crucial to gain insights into what might facilitate or hinder its implementation. In this constructivist grounded theory study, data from two Scottish intensive care units were collected to understand healthcare staff experiences relating to early mobilisation in mechanical ventilation. Data included observations of mobilisation activities, individual staff interviews and two focus groups with multidisciplinary staff. Managing Risks emerged as the core category and was theorised using the concept of risk. The middle-range theory developed in this study suggests that the process of early mobilisation starts by staff defining patient status and includes a process of negotiating patient safety, which in turn enables performing accountable mobilisation within the dynamic context of an intensive care unit setting.
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Abstract
Objectives One goal of early mobilization programs is to facilitate discharge home after an ICU hospitalization, but little is known about which factors are associated with this outcome. Our objective was to evaluate factors associated with discharge home among medical ICU patients in an early mobilization program who were admitted to the hospital from home. Design Retrospective cohort study of medical ICU patients in an early mobilization program. Setting Tertiary care center medical ICU. Patients Medical ICU patients receiving early mobilization who were community-dwelling prior to admission. Interventions None. Measurements and Main Results A comprehensive set of baseline, ICU-related, and mobilization-related factors were tested for their association with discharge home using multivariable logistic regression. Among the analytic cohort (n = 183), the mean age was 61.9 years (sd 16.67 yr) and the mean Acute Physiology and Chronic Health Evaluation II score was 23.5 (sd 7.11). Overall, 65.0% of patients were discharged home after their critical illness. In multivariable analysis, each incremental increase in the maximum level of mobility achieved (range, 1-6) during the medical ICU stay was associated with nearly a 50% greater odds of discharge home (odds ratio, 1.46; 95% CI, 1.13-1.88), whereas increased age (odds ratio, 0.95; 95% CI, 0.93-0.98) and greater hospital length of stay (odds ratio, 0.94; 95% CI, 0.90-0.99) were associated with decreased odds of discharge home. Prehospital ambulatory status was not associated with discharge home. Conclusions Among medical ICU patients who resided at home prior to their ICU admission, the maximum level of mobility achieved in the medical ICU was the factor most strongly associated with discharge back home. Identification of this factor upon ICU-to-ward transfer may help target mobilization plans on the ward to facilitate a goal of discharge home.
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Factors Affecting Discharge to Home of Medical Patients Treated in an Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224324. [PMID: 31698814 PMCID: PMC6887772 DOI: 10.3390/ijerph16224324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/02/2019] [Accepted: 11/05/2019] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to examine the factors affecting the discharge to home of medical patients treated in an intensive care unit, including elements of in-hospital rehabilitation and prehospital movement ability. The participants of this retrospective cohort study were medical patients treated in an intensive care unit (ICU) and who began rehabilitation in ICU. We assessed the participants in the ICU and analyzed data on patient background, hospitalization, and rehabilitation status. There were 155 ICU patients available for analysis. A multivariable logistic regression model identified the four variables of age (OR 1.06, 95% CI 1.02–1.09), APACHE II score (OR 1.12, 95% CI 1.04–1.24), independence in home life before admission (OR 7.10, 95% CI 1.65–30.44), and standing within 5 days of admission (OR 6.58, 95% CI 2.60–16.61) as factors significantly related to discharge from hospital to home. Independence of home life before admission and early start of standing were identified as factors strongly related to discharge to home. The degree of independence in living before hospital admission and progress toward early mobilization are helpful when considering an ICU patient’s discharge destination.
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Fleming LM, Zhao X, DeVore AD, Heidenreich PA, Yancy CW, Fonarow GC, Hernandez AF, Kociol RD. Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions. Circ Heart Fail 2019; 11:e004634. [PMID: 29643066 DOI: 10.1161/circheartfailure.117.004634] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/02/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and stroke patients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality. METHODS AND RESULTS The study population included 369 hospitals and 285 653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry. We used multivariate logistic regression with generalized estimating equations at the hospital level to identify predictors of EA and determine the association between EA and outcomes. Sixty-five percent of patients ambulated by day 2 of the hospital admission. Patient-level predictors of EA included younger age, male sex, and hospitalization outside of the Northeast (P<0.01 for all). Hospital size and academic status were not predictive. Hospital-level analysis revealed that those hospitals with EA rates in the top 25% were less likely to have a long length of stay (defined as >4 days) compared with those in the bottom 25% (odds ratio, 0.83; confidence interval, 0.73-0.94; P=0.004). Among a subgroup of fee-for-service Medicare beneficiaries, we found that hospitals in the highest quartile of rates of EA demonstrated a statistically significant 24% lower 30-day readmission rates (P<0.0001). Both end points demonstrated a dose-response association and statistically significant P for trend test. CONCLUSIONS Multivariable-adjusted hospital-level analysis suggests an association between EA and both shorter length of stay and lower 30-day readmissions. Further prospective studies are needed to validate these findings.
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Affiliation(s)
- Lisa M Fleming
- Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.)
| | - Xin Zhao
- Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.)
| | - Adam D DeVore
- Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.)
| | - Paul A Heidenreich
- Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.)
| | - Clyde W Yancy
- Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.)
| | - Gregg C Fonarow
- Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.)
| | - Adrian F Hernandez
- Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.)
| | - Robb D Kociol
- Smith Cardiovascular Outcomes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (L.M.F.). Duke Clinical Research Institute, Durham, NC (X.Z., A.D.D., A.F.H.). Department of Medicine, Stanford Medical Center, Palo Alto, CA (P.A.H.). Northwestern University, Chicago, IL (C.W.Y.). Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.). Advanced Heart Failure and Mechanical Circulatory Support, University of Massachusetts Memorial Medical Center, University of Massachusetts Medical School, Worcester (R.D.K.).
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Kato M, Saitoh M, Kawamura T, Iwata K, Sakurada K, Okamura D, Tahara M, Yuguchi S, Kamisaka K, Oura K, Mori Y, Morisawa T, Takahashi T. Postoperative atrial fibrillation is associated with delayed early rehabilitation after heart valve surgery: a multicenter study. Phys Ther Res 2019; 22:1-8. [PMID: 31289706 DOI: 10.1298/ptr.e9957] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/29/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. The aim of this multicenter study was to determine the relationship between POAF and patients' progress in early rehabilitation after heart valve surgery. METHODS We enrolled 302 patients (mean age, 69±10 years) who had undergone heart valve surgery. POAF was monitored using continuous electrocardiogram telemetry, and the Short Physical Performance Battery (SPPB) was used to assess lower-extremity function before surgery and at the time of discharge. Progress in early rehabilitation was evaluated by the duration from the surgery to independent walking. We determined factors associated delayed early rehabilitation and evaluated the interplay of POAF and delayed early rehabilitation in increasing the risk of decline in lower-extremity function from preoperatively to hospital discharge. RESULTS Multivariate analysis determined POAF to be independent predictors of delayed early rehabilitation after heart valve surgery (OR: 3.906, P = .01). The association between delayed early rehabilitation and decline in lower extremity function was stronger in patients with POAF (OR: 2.73, P = .041) than in those without (OR: 2.22, P = .052). CONCLUSIONS POAF was clinical predictors of delayed early rehabilitation in patients undergoing heart valve surgery. The combination of POAF with delayed early rehabilitation conferred a high risk of decline in lower-extremity function during hospitalization.
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Clarissa C, Salisbury L, Rodgers S, Kean S. Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities. J Intensive Care 2019; 7:3. [PMID: 30680218 PMCID: PMC6337811 DOI: 10.1186/s40560-018-0355-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/11/2018] [Indexed: 12/18/2022] Open
Abstract
Background Mechanically ventilated patients often develop muscle weakness post-intensive care admission. Current evidence suggests that early mobilisation of these patients can be an effective intervention in improving their outcomes. However, what constitutes early mobilisation in mechanically ventilated patients (EM-MV) remains unclear. We aimed to systematically explore the definitions and activity types of EM-MV in the literature. Methods Whittemore and Knafl’s framework guided this review. CINAHL, MEDLINE, EMBASE, PsycINFO, ASSIA, and Cochrane Library were searched to capture studies from 2000 to 2018, combined with hand search of grey literature and reference lists of included studies. The Critical Appraisal Skills Programme tools were used to assess the methodological quality of included studies. Data extraction and quality assessment of studies were performed independently by each reviewer before coming together in sub-groups for discussion and agreement. An inductive and data-driven thematic analysis was undertaken on verbatim extracts of EM-MV definitions and activities in included studies. Results Seventy-six studies were included from which four major themes were inferred: (1) non-standardised definition, (2) contextual factors, (3) negotiated process and (4) collaboration between patients and staff. The first theme indicates that EM-MV is either not fully defined in studies or when a definition is provided this is not standardised across studies. The remaining themes reflect the diversity of EM-MV activities which depends on patients’ characteristics and ICU settings; the negotiated decision-making process between patients and staff; and their interdependent relationship during the implementation. Conclusions This review highlights the absence of an agreed definition and on what constitutes early mobilisation in mechanically ventilated patients. To advance research and practice an agreed and shared definition is a pre-requisite.
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Affiliation(s)
- Catherine Clarissa
- 1Department of Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Lisa Salisbury
- 2Division of Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography, Queen Margaret University, Queen Margaret University Drive, Musselburgh, EH21 6UU UK
| | - Sheila Rodgers
- 1Department of Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
| | - Susanne Kean
- 1Department of Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG UK
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Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. Rehabilitation and early mobilization in the critical patient: systematic review. J Phys Ther Sci 2018; 30:1193-1201. [PMID: 30214124 PMCID: PMC6127491 DOI: 10.1589/jpts.30.1193] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/29/2018] [Indexed: 12/23/2022] Open
Abstract
[Purpose] To review the literature that examines rehabilitation and early mobilization
and that involves different practices (effects of interventions) for the critically ill
patient. [Materials and Methods] A PRISMA-Systematic review has been conducted based on
different data sources: Biblioteca Virtual en Salud, CINHAL, Pubmed, Scopus, and Web of
Science were used to identify randomized controlled trials, crossover trials, and
case-control studies. [Results] Eleven studies were included. Early rehabilitation had no
significant effect on the length of stay and number of cases of Intensive Care Unit
Acquired Weaknesses. However, early rehabilitation had a significant effect on the
functional status, muscle strength, mechanical ventilation duration, walking ability at
discharge, and health quality of life. [Conclusion] Rehabilitation and early mobilization
are associated with an increased probability of walking more distance at discharge. Early
rehabilitation is associated with an increase in functional capacity and muscle strength,
an improvement in walking distance and better perception of the health-related quality of
life. Cycloergometer and electrical stimulation can be used to maintain muscle strength.
Further research is needed to establish stronger evidences.
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Affiliation(s)
- Patricia Arias-Fernández
- Health Sciences School, Department of Nursing and Physiotherapy, Intensive Care Unit, University Hospital of León, Spain
| | | | - Juan Gómez-Salgado
- Nursing School, University of Huelva: 21071 Huelva, Spain.,University Espiritu Santo, Ecuador
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Decoyna JAA, McLiesh P, Salamon YM. Nurses and physiotherapists' experience in mobilising postoperative orthopaedic patients with altered mental status: A phenomenological study. Int J Orthop Trauma Nurs 2018. [PMID: 29519684 DOI: 10.1016/j.ijotn.2018.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A major goal of care for orthopaedic surgical patients is the achievement of their pre-morbid functional level or at least an improvement of their functional ability. However, patients with altered mental status can significantly impact this and other outcomes and influence the delivery of care. Patient mobilisation is a role shared by both nurses and physiotherapists. AIMS To enhance the understanding of nurses and physiotherapists' experience in mobilising postoperative orthopaedic patients with altered mental status. METHOD Three nurses and three physiotherapists were recruited using purposive sampling. Data was collected through interviews and analysed using Burnard's 14 stages of thematic content analysis. RESULTS Four main categories emerged from the study: altruism, interprofessional specialist practice, patient dynamics and challenges. Nurses and physiotherapists' experience have more similarities than differences under the four categories. CONCLUSION Nurses and physiotherapists experience numerous challenges from both patient and resources related factors such as environment, staffing and time limitations; safety risks to patient and staff; and communication barriers due to patient's altered mental state. While tensions and variations in priorities of care delivery exist between the two groups, interdisciplinary collaboration of both professional groups was clearly evident and enabled optimisation of mobilisation goals for this patient population and revealed more similarities than differences in their experience. Patient and staff safety takes precedence over mobilisation and safety risks in this patient group can be mitigated by adequate resources, competence, and teamwork.
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Affiliation(s)
| | - Paul McLiesh
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
| | - Yvette Michelle Salamon
- Adelaide Nursing School, Faculty of Health and Medical Sciences, University of Adelaide, South Australia, Australia
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Benyan AS. [Blunt chest trauma: possibilities to stabilize multiple and floating ribs fractures]. Khirurgiia (Mosk) 2017:69-74. [PMID: 28805782 DOI: 10.17116/hirurgia2017869-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To improve surgical treatment of patients with multiple and flotating ribs fractures. MATERIAL AND METHODS A comparative analysis of two groups of victims with rib fractures was carried out. 148 patients of the control group underwent conservative treatment, mechanical ventilation, skeletal traction. In 167 patients of the main group we used advanced surgical tactics based on differentiated, stepwise and combined chest stabilization including osteosynthesis of ribs and thoracoscopy. RESULTS Immediate results for each type of stabilization were evaluated. The most durable respiratory support was observed in case of ventilation alone - internal pneumatic stabilization without surgical stabilization. Osteosynthesis of the ribs had the best outcomes compared with other methods. An efficacy of developed tactics was confirmed by significantly reduced morbidity, mortality, mechanical ventilation time and ICU-stay in main group. CONCLUSION Surgical tactics in patients with multiple and flotating fractures of the ribs is determined by type of ribs and internal organs damage, combined trauma severity and conditions of medical care. Differentiated, stepwise and combined chest stabilization by using of high-tech methods of medical care (osteosynthesis, thoracoscopy) improves the outcomes in these patients.
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Affiliation(s)
- A S Benyan
- Seredavin Samara Regional Clinical Hospital, Samara, Russia
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Abstract
OBJECTIVES To develop and validate a noninvasive mobility sensor to automatically and continuously detect and measure patient mobility in the ICU. DESIGN Prospective, observational study. SETTING Surgical ICU at an academic hospital. PATIENTS Three hundred sixty-two hours of sensor color and depth image data were recorded and curated into 109 segments, each containing 1,000 images, from eight patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three Microsoft Kinect sensors (Microsoft, Beijing, China) were deployed in one ICU room to collect continuous patient mobility data. We developed software that automatically analyzes the sensor data to measure mobility and assign the highest level within a time period. To characterize the highest mobility level, a validated 11-point mobility scale was collapsed into four categories: nothing in bed, in-bed activity, out-of-bed activity, and walking. Of the 109 sensor segments, the noninvasive mobility sensor was developed using 26 of these from three ICU patients and validated on 83 remaining segments from five different patients. Three physicians annotated each segment for the highest mobility level. The weighted Kappa (κ) statistic for agreement between automated noninvasive mobility sensor output versus manual physician annotation was 0.86 (95% CI, 0.72-1.00). Disagreement primarily occurred in the "nothing in bed" versus "in-bed activity" categories because "the sensor assessed movement continuously," which was significantly more sensitive to motion than physician annotations using a discrete manual scale. CONCLUSIONS Noninvasive mobility sensor is a novel and feasible method for automating evaluation of ICU patient mobility.
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Effect of daily use of electronic checklist on physical rehabilitation consultations in critically ill patients. J Crit Care 2016; 38:357-361. [PMID: 28043721 DOI: 10.1016/j.jcrc.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 11/28/2016] [Accepted: 12/17/2016] [Indexed: 11/21/2022]
Abstract
RATIONALE In intensive care unit (ICU) practice, great emphasis is placed on the functional stabilization of the major organ systems, sometimes at the expense of physical rehabilitation. Checklists have shown to be an effective tool for standardizing care models. Our aim was to the study the effect of the use of an electronic checklist on occupational therapy/physical therapy (OT-PT) consults in critically ill patients. METHODS A retrospective observational study of all adults admitted for the first time in an academic medical ICU in year 2014 was conducted. The patient demographics, outcomes, checklist use, and physical therapy consults were collected from Electronic Medical Records (EMR). RESULTS A total of 2399 unique patients were admitted to the medical ICU, 55% were male and median (IQR) age was 65 (52-77) years. A total of 17% of patients received OT-PT consults among patients with checklist use (N=1897), and among non-checklist user (N=502), it was 7.6%. The total time of OT-PT administered in the ICU was 48 vs 31min, p=0.08.The patients who received the daily electronic checklist had high medical acuity but had lower ICU mortality. Hospital mortality was found to be no different. CONCLUSIONS The use of the electronic checklist in the ICU was associated with increased number of the OT-PT consults.
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Rojek-Jarmuła A, Hombach R, Krzych ŁJ. Does the APACHE II score predict performance of activities of daily living in patients discharged from a weaning center? KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2016; 13:353-358. [PMID: 28096834 PMCID: PMC5233767 DOI: 10.5114/kitp.2016.64880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 09/09/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Data regarding the functional status of patients after prolonged mechanical ventilation are scarce, and little is known about its clinical predictors. AIM To investigate whether the Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission may predict performance in activities of daily living on discharge from a weaning center. MATERIAL AND METHODS All consecutive patients admitted between January 1, 2012 and December 31, 2013 were enrolled (n = 130). During this period, 15 subjects died, and 115 were successfully discharged (34 women; 81 men). APACHE II was calculated based on the worst values taken during the first 24 hours after admission. On discharge, the Barthel Index (BI) and its extended version, the Early Rehabilitation Barthel Index (ERBI), were assessed. RESULTS Median BI was 20 points (IQR 5; 40), and ERBI was 20 points (-50; 40). There was no correlation between APACHE II and either BI (R = -0.07; p = 0.47) or ERBI (R = -0.07; p = 0.44). APACHE II predicted the need for assistance with bathing (AUROC = 0.833; p < 0.001), grooming (AUROC = 0.823; p < 0.001), toilet use (AUROC = 0.887; p < 0.001), and urination (AUROC = 0.658; p = 0.04). APACHE II had no impact on any ERBI items associated with ventilator weaning, including the need of further mechanical ventilation (AUROC = 0.534; p = 0.65) or tracheostomy (AUROC = 0.544; p = 0.42). CONCLUSIONS Although APACHE II cannot predict the overall functional status in patients discharged from a weaning center, it helps identify subjects who will need support with bathing, grooming, and toilet use. The APACHE II score is inadequate to predict performance in activities associated with further respiratory support.
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Affiliation(s)
- Anna Rojek-Jarmuła
- Weaning Station, Marienhaus Klinikum Eifel, Neuerburg, Germany
- Department of Anesthesiology and Intensive Care, Marienhaus Klinikum Eifel St. Elizabeth, Gerolstein, Germany
| | - Rainer Hombach
- Weaning Station, Marienhaus Klinikum Eifel, Neuerburg, Germany
| | - Łukasz J. Krzych
- Department of Anesthesiology and Intensive Care, School of Medicine, Medical University of Silesia, Katowice, Poland
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Mase K, Noguchi T, Tagami M, Imura S, Tomita K, Monma M, Nozoe M, Takashima S, Kawakatsu K. Compression of the lungs by the heart in supine, side-lying, semi-prone positions. J Phys Ther Sci 2016; 28:2470-2473. [PMID: 27799672 PMCID: PMC5080154 DOI: 10.1589/jpts.28.2470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/23/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Clarification of the differences in the compression volume of the lungs by the
heart (CVLH) between postures may facilitate the selection of optimal postures in
respiratory care. Determining CVLH in the supine, semi-prone (Sim’s position), and
side-lying positions was the aim of this study. [Subjects and Methods] Eight healthy
volunteers (six males, two females; mean age, 29.0 ± 9.2 years) were enrolled in the
study. Measurements were performed in the supine, right and left semi-prone, and right and
left side-lying positions. semi-prone position was inclined 45° ventrally from the
side-lying position. A 1.5-T system with a fast advanced spin-echo sequence in the coronal
plane was used for magnetic resonance imaging. [Results] CVLH and heart compression ratio
were significantly lower in the semi-prone position on both sides than the other
positions. The heart was displaced ventrally when semi-prone and a larger area of the
heart leaned on the ventral chest wall, localizing compression to part of the ventral
region of the dependent lung. [Conclusion] The region of lungs compressed by the heart is
reduced in the semi-prone position due to ventral displacement of the heart. These results
suggest that maintaining expansion of the dependent lung is easier in the semi-prone
position.
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Affiliation(s)
- Kyoushi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
| | - Tisa Noguchi
- Department of Rehabilitation, Konan Hospital, Japan
| | - Miki Tagami
- Department of Physical Therapy, Uekusa Gakuen University, Japan
| | - Shigeyuki Imura
- Department of Physical Therapy, Uekusa Gakuen University, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Masahiko Monma
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Japan
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
| | - Sachie Takashima
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
| | - Kunihiro Kawakatsu
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
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Mase K, Tagami M, Imura S, Tomita K, Monma M, Nozoe M, Takashima Y. Regional lung volume differences between the side-lying and semi-prone positions. J Phys Ther Sci 2016; 28:1020-5. [PMID: 27134405 PMCID: PMC4842417 DOI: 10.1589/jpts.28.1020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 12/15/2015] [Indexed: 01/04/2023] Open
Abstract
[Purpose] This study aimed to clarify the differences in regional lung volume between the semi-prone (Sim's position) and side-lying position, and the optimal position for increasing lung volume. [Methods] Measurements were performed in both positions on both sides. Sim's position was inclined 45° forward from the side-lying position. A 1.5-T system with a fast advanced spin-echo sequence in the coronal plane was used for magnetic resonance imaging. [Results] The two positions did not significantly differ in total lung capacity and its subdivisions on both sides, except the left lung in the right side-lying position and right Sim's position. In the nondependent lung, the percentage lung volume of the dorsal segment was significantly higher in the right Sim's position than in the right side-lying position. However, no significant difference was observed between the left side-lying and left Sim's position. [Conclusion] The heart was displaced ventrally by gravity in Sim's position and leaned on the ventral parapet. The spaces for the expansion of the ventral and dorsal segments of the lung were decreased and increased in Sim's position, respectively. With a nondependent left lung, the increase in the percentage lung volume of the dorsal segment was greater in Sim's position than in the side-lying position.
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Affiliation(s)
- Kyoushi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
| | - Miki Tagami
- Department of Physical Therapy, Uekusa Gakuen University, Japan
| | - Shigeyuki Imura
- Department of Physical Therapy, Uekusa Gakuen University, Japan
| | - Kazuhide Tomita
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Masahiko Monma
- Department of Radiological Sciences, Ibaraki Prefectural University of Health Sciences, Japan
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
| | - Yukie Takashima
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Japan
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