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Jacobs JM, Rahamim A, Beil M, Guidet B, Vallet H, Flaatten H, Leaver SK, de Lange D, Szczeklik W, Jung C, Sviri S. Critical care beyond organ support: the importance of geriatric rehabilitation. Ann Intensive Care 2024; 14:71. [PMID: 38727919 PMCID: PMC11087448 DOI: 10.1186/s13613-024-01306-1] [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: 02/04/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Very old critically ill patients pose a growing challenge for intensive care. Critical illness and the burden of treatment in the intensive care unit (ICU) can lead to a long-lasting decline of functional and cognitive abilities, especially in very old patients. Multi-complexity and increased vulnerability to stress in these patients may lead to new and worsening disabilities, requiring careful assessment, prevention and rehabilitation. The potential for rehabilitation, which is crucial for optimal functional outcomes, requires a systematic, multi-disciplinary approach and careful long-term planning during and following ICU care. We describe this process and provide recommendations and checklists for comprehensive and timely assessments in the context of transitioning patients from ICU to post-ICU and acute hospital care, and review the barriers to the provision of good functional outcomes.
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Affiliation(s)
- Jeremy M Jacobs
- Department of Geriatric Rehabilitation and the Center for Palliative Care. Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ana Rahamim
- Geriatric Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Bertrand Guidet
- Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale, Paris, France
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Helene Vallet
- Department of Geriatrics, Centre d'immunologie et de Maladies Infectieuses (CIMI), Institut National de la Santé et de la Recherche Médicale (INSERM), UMRS 1135, Saint Antoine, Assistance Publique Hôpitaux de Paris,, Sorbonne Université, Paris, France
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Susannah K Leaver
- General Intensive Care, Department of Critical Care Medicine, St George's NHS Foundation Trust, London, UK
| | - Dylan de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of Medicine, Heinrich-Heine-University, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Martinache F, Foudhaïli A, Vigué B. Early rehabilitation after spinal cord injury: a scoping review protocol. JBI Evid Synth 2024:02174543-990000000-00294. [PMID: 38602049 DOI: 10.11124/jbies-22-00461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
OBJECTIVE The objective of this scoping review is to identify the timings and types of early rehabilitation after spinal cord injuries (SCI) that are documented in the literature, as well as identify possible research gaps in this field. INTRODUCTION Preclinical and clinical studies support the idea that early rehabilitation may be beneficial for patients with acute SCI. However, the timing and types of rehabilitation that should and could be used in the acute stage are still unclear. The first step towards such knowledge is to extensively review what is documented in the literature. INCLUSION CRITERIA This review will consider all papers focusing on early rehabilitation after SCI in adult humans or animals (<3 months post-SCI for humans and other primates and <3 weeks post-SCI for other animals). Interventions in the included papers must aim at sensorimotor or functional improvement and take place in a hospital or a rehabilitation center if they target human subjects. METHODS MEDLINE (PubMed), Scopus, Embase (Embase.com), PEDro, Web of Science Core Collection, CINAHL (EBSCOhost), Cochrane Database of Systematic Reviews, Cochrane CENTRAL, PROSPERO, ClinicalTrials.gov, and gray literature sources will be searched for eligible articles. This review will include published and unpublished experimental and observational studies, research protocols, conference abstracts, systematic reviews, and guidelines. No language or date limits will be applied. Two independent reviewers will perform study selection and data extraction, and the results will be presented according to the SCI type and severity. REVIEW REGISTRATION Open Science Framework https://osf.io/q45er.
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Affiliation(s)
- Florence Martinache
- Université Paris-Saclay, CIAMS, 91405, Orsay, France
- Techno Concept, Manosque, France
- Département d'Anesthésie Réanimation, Service de Rééducation Post-Réanimation (SRPR), AP-HP, CHU de Bicêtre, 94275, Le-Kremlin-Bicêtre, France
| | - Adéla Foudhaïli
- Département de Médecine Physique et Réadaptation, AP-HP, CHU Lariboisiére, F-75010, Paris, France
- Université Paris Cité, Inserm, MASCOT, F-75010 Paris, France
- Université Paris Cité, Institut des Sciences du Sport-Santé de Paris, F-75015 Paris, France
| | - Bernard Vigué
- Département d'Anesthésie Réanimation, Service de Rééducation Post-Réanimation (SRPR), AP-HP, CHU de Bicêtre, 94275, Le-Kremlin-Bicêtre, France
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Barr J, Downs B, Ferrell K, Talebian M, Robinson S, Kolodisner L, Kendall H, Holdych J. Improving Outcomes in Mechanically Ventilated Adult ICU Patients Following Implementation of the ICU Liberation (ABCDEF) Bundle Across a Large Healthcare System. Crit Care Explor 2024; 6:e1001. [PMID: 38250248 PMCID: PMC10798758 DOI: 10.1097/cce.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
OBJECTIVES To measure how the ICU Liberation Bundle (aka ABCDEF Bundle or the Bundle) affected clinical outcomes in mechanically ventilated (MV) adult ICU patients, as well as bundle sustainability and spread across a healthcare system. DESIGN We conducted a multicenter, prospective, cohort observational study to measure bundle performance versus patient outcomes and sustainability in 11 adult ICUs at six community hospitals. We then prospectively measured bundle spread and performance across the other 28 hospitals of the healthcare system. SETTING A large community-based healthcare system. PATIENTS In 11 study ICUs, we enrolled 1,914 MV patients (baseline n = 925, bundle performance/outcomes n = 989), 3,019 non-MV patients (baseline n = 1,323, bundle performance/outcomes n = 1,696), and 2,332 MV patients (bundle sustainability). We enrolled 9,717 MV ICU patients in the other 28 hospitals to assess bundle spread. INTERVENTIONS We used evidence-based strategies to implement the bundle in all 34 hospitals. MEASUREMENTS AND MAIN RESULTS We compared outcomes for the 12-month baseline and bundle performance periods. Bundle implementation reduced ICU length of stay (LOS) by 0.5 days (p = 0.02), MV duration by 0.6 days (p = 0.01), and ICU LOS greater than or equal to 7 days by 18.1% (p < 0.01). Performance period bundle compliance was compared with the preceding 3-month baseline compliance period. Compliance with pain management and spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) remained high, and reintubation rates remained low. Sedation assessments increased (p < 0.01) and benzodiazepine sedation use decreased (p < 0.01). Delirium assessments increased (p = 0.02) and delirium prevalence decreased (p = 0.02). Patient mobilization and ICU family engagement did not significantly improve. Bundle element sustainability varied. SAT/SBT compliance dropped by nearly half, benzodiazepine use remained low, sedation and delirium monitoring and management remained high, and patient mobility and family engagement remained low. Bundle compliance in ICUs across the healthcare system exceeded that of study ICUs. CONCLUSIONS The ICU Liberation Bundle improves outcomes in MV adult ICU patients. Evidence-based implementation strategies improve bundle performance, spread, and sustainability across large healthcare systems.
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Affiliation(s)
- Juliana Barr
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, CA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Brenda Downs
- Critical Care, Emergency Services and Sepsis, CommonSpirit Health, Phoenix, AZ
| | - Ken Ferrell
- Data Science, CommonSpirit Health, Phoenix, AZ
| | - Mojdeh Talebian
- Data Science Department, CommonSpirit Health, Phoenix, AZ
- ICU and Pulmonary Services, Dignity Health, Sequoia Hospital, Redwood City, CA
| | - Seth Robinson
- ICU, Dignity Health, Woodland Memorial Hospital, Woodland, CA
| | - Liesl Kolodisner
- Quality Reporting and Information, CommonSpirit Health, Phoenix, AZ
| | - Heather Kendall
- Gordon and Betty Moore Foundation Grants, Care Management, Roseville, CA
| | - Janet Holdych
- Acute Care Quality, CommonSpirit Health, Glendale, CA
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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.
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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
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Jensen ER, Peper KK, Egger M, Muller F, Shahriari E, Haddadin S. Monitoring Active Patient Participation During Robotic Rehabilitation: Comparison Between a Robot-Based Metric and an EMG-Based Metric. IEEE Trans Neural Syst Rehabil Eng 2023; 31:4156-4166. [PMID: 37844007 DOI: 10.1109/tnsre.2023.3323390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
While rehabilitation robots present a much-needed solution to improving early mobilization therapy in demanding clinical settings, they also present new challenges and opportunities in patient monitoring. Aside from the fundamental challenge of quantifying a patient's voluntary contribution during robot-led therapy motion, many sensors cannot be used in clinical settings due to time and space limitations. In this paper, we present and compare two metrics for monitoring a patient's active participation in the motion. The two metrics, each derived from first principles, have the same biomechanical interpretability, i.e., active work by the patient during the robotic mobilization therapy, but are calculated in two different spaces (Cartesian vs. muscle space). Furthermore, the sensors used to quantify these two metrics are fully independent from each other and the associated measurements are unrelated. Specifically, the robot-based work metric utilizes robot-integrated force sensors, while the EMG-based work metric requires electrophysiological sensors. We then apply the two metrics to therapy performed using a clinically certified, commercially available robotic system and compare them against the specific instructions given to the healthy subjects as well as against each other. Both metric outputs qualitatively match the expected behavior of the healthy subjects. Additionally, strong correlations (median [Formula: see text]) are shown between the two metrics, not only for healthy subjects (n = 12) but also for patients (n = 2), providing solid evidence for their validity and translatability. Importantly, the robot-based work metric does not rely on any sensors outside of those integrated into the robot, thus making it ideal for application in clinical settings.
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Yu M, Mi J, Zhang C, Chen H, Luo X. Knowledge, attitude and practice regarding hypoactive delirium among ICU nurses: A nationwide cross-sectional study. Nurse Educ Pract 2023; 72:103749. [PMID: 37660518 DOI: 10.1016/j.nepr.2023.103749] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to assess the knowledge, attitude and practice (KAP) of intensive care unit (ICU) nurses in patients with hypoactive delirium in China. BACKGROUND The presentation of hypoactive delirium is not obvious and tends to be ignored. However, it has a high incidence and can cause critical impairment. Although nurses are the primary caregivers of patients, the evidence of the current status of KAP of hypoactive delirium among ICU nurses is insufficient in China. DESIGN The study participants were 2835 ICU nurses from 201 hospitals in 69 cities from 31 provinces in China. METHODS The current status of KAP of hypoactive delirium among ICU nurses was determined using a self-reported structured questionnaire, including 52 questions covering general personal information; three dimensions of KAP; and relevant issues. Descriptive analyses of the sample distribution were reported as percentages and medians. The factors were detected using univariate and multivariate analyses. To guide the reporting of the research, a STROBE checklist of cross-sectional studies was used. RESULTS Of the 3101 returned questionnaires, 2835 were analyzed. Approximately 64. 94 % and 53. 30 % of them were identified with a positive attitude and appropriate practice, respectively, whereas only 1. 48 % showed a good level of knowledge. The regression analysis showed that age, years of working in the ICU, educational background, professional title, caring for patients with delirium, attending training on hypoactive delirium and hospital grading were significantly associated with their KAP status(P<005). CONCLUSIONS Hypoactive delirium is an ignored entity by nursing professionals, with no definite nursing procedure. This study shows that receiving relevant training is a factor affecting KAP status, indicating that training should be strengthened. Additionally, appropriate screening and nursing procedures should be developed to standardize the behavior of ICU nurses and improve the quality of care. RELEVANCE TO CLINICAL PRACTICE ICU nurses have poor knowledge of hypoactive delirium and related training should be strengthened, especially for middle-aged nurses. Screening and nursing procedures should be set up, which is critical to promote nursing practice. NO PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Mengting Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Mi
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Chuanlin Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuan Luo
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Hori Y, Mihashi M. Relationship Between Delirium Development and Its Causative Factors in the Intensive Care Unit After Cardiac Surgery. Yonago Acta Med 2023; 66:214-222. [PMID: 37229376 PMCID: PMC10203640 DOI: 10.33160/yam.2023.05.003] [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: 11/08/2022] [Accepted: 03/10/2023] [Indexed: 05/27/2023]
Abstract
Background Delirium is a clinical symptom that can have serious side effects in patients, and it develops acutely and shows reversibility. Postoperative delirium is an important neuropsychological complication after surgery that directly or indirectly affects patients. Cardiac surgery increases the risk of delirium due to the complexity of surgical procedures, use of intraoperative and postoperative anesthetics and other pharmacologic agents, and possible postoperative complications. This study aims to determine the relationship between the development of delirium and its causative factors after cardiac surgery and its associated postoperative complications, and identify the high-relevance risk factors of postoperative delirium. Methods The participants comprised 730 patients who were admitted to the intensive care unit and underwent cardiac surgery. The collected data included 19 risk factors based on the patients' medical information records. As a delirium diagnostic tool, we used the Intensive Care Delirium Screening Checklist, with four or more points indicating delirium. For statistical analysis, the dependent variables were determined based on the presence or absence of delirium, while the independent variables were determined based on the risk factors of delirium. A t-test, χ2 test, and logistic regression analysis were performed on risk factors between the two groups-the delirium group and no delirium group. Results Postoperative delirium was observed in 126 (17.3%) of 730 patients after cardiac surgery. Postoperative complications were more common in the delirium group. Independent risk factors associated with postoperative delirium were identified in 7 of the 12 factors. Conclusion As cardiac surgery is invasive and affects the development and severity of delirium, efforts and intervention methods are necessary to predict the risk factors for the development of delirium before surgery, and to prevent its occurrence after surgery. In the future, it is necessary to further investigate factors associated with delirium that can be directly intervened.
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Affiliation(s)
- Yukio Hori
- Kurume University Graduate School of Medicine, Kurume 830-0003, Japan and
| | - Mutsuko Mihashi
- Kurume University School of Medicine, Nursing, Kurume 830-0003, Japan
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Gabele D, Mendez S, Giuliano KK. Early and progressive mobility in a community hospital: A new interdisciplinary safe patient handling and mobility model. Nurs Manag (Harrow) 2023; 54:22-27. [PMID: 36795081 PMCID: PMC9977411 DOI: 10.1097/01.numa.0000919068.76409.b2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
An early mobility program in a small community hospital resulted in high levels of staff engagement and decreased rates for falls and heel and sacral pressure injuries.
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Affiliation(s)
- Danielle Gabele
- Danielle Gabele is the chief nurse executive at Ventura County Medical Center and Santa Paula Hospital in Ventura, Calif., and a former CNO at Cedars Sinai Marina del Rey Hospital in Marina del Rey, Calif. Sheriee Mendez is the program manager, Safe Patient Handling and Falls at Cedars Sinai Marina del Rey Hospital in Marina del Rey, Calif. Karen K. Giuliano is a professor and the co-director of the Elaine Marieb Center for Nursing and Engineering Innovation at the University of Massachusetts Amherst in Amherst, Mass
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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
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Cai S, Cui H, Pan W, Li J, Lin X, Zhang Y. Two-stage prediction model for postoperative delirium in patients in the intensive care unit after cardiac surgery. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6965024. [PMID: 36579859 DOI: 10.1093/ejcts/ezac573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/08/2022] [Accepted: 12/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Postoperative delirium is a common severe complication in patients in the intensive care unit after cardiac surgery. We developed a two-stage prediction model and quantified the risk of developing postoperative delirium to assist in early prevention before and after surgery. METHODS We conducted a prospective cohort study and consecutively recruited adult patients after cardiac surgery. The Confusion Assessment Method for patients in the intensive care unit was used to diagnose delirium 5 days postoperatively. The stage I model was constructed using patient demographics, health conditions and laboratory results obtained preoperatively, whereas the stage II model was built on both pre- and postoperative predictors. The model was validated internally using the bootstrap method and externally using data from an external cohort. RESULTS The two-stage model was developed with 654 patients and was externally validated with 214 patients undergoing cardiac surgery. The stage I model contained 6 predictors, whereas the stage II model included 10 predictors. The stage I model had an area under the receiver operating characteristic curve of 0.76 (95% confidence interval: 0.68-0.81), and the stage II model's area under the receiver operating characteristic curve increased to 0.85 [95% confidence interval (CI): 0.81-0.89]. The external validation resulted in an area under the curve of 0.76 (95% CI: 0.67-0.86) for the stage I model and 0.78 (95% CI: 0.69-0.86) for the stage II model. CONCLUSIONS The two-stage model assisted medical staff in identifying patients at high risk for postoperative delirium before and 24 h after cardiac surgery. This model showed good discriminative power and predictive accuracy and can be easily accessed in clinical settings. TRIAL REGISTRATION The study was registered with the US National Institutes of Health ClinicalTrials.gov (NCT03704324; registered 11 October 2018).
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Affiliation(s)
- Shining Cai
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Department of Critical Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,The Centre for Critical Care Zhongshan Hospital: A Joanna Briggs Institute Center of Excellence, Shanghai, 200032, China
| | - Hang Cui
- School of Data Science, Fudan University, Shanghai, 200433, China
| | - Wenyan Pan
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,The Centre for Critical Care Zhongshan Hospital: A Joanna Briggs Institute Center of Excellence, Shanghai, 200032, China
| | - Jingjing Li
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Department of Critical Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,The Centre for Critical Care Zhongshan Hospital: A Joanna Briggs Institute Center of Excellence, Shanghai, 200032, China
| | - Xiaolei Lin
- School of Data Science, Fudan University, Shanghai, 200433, China
| | - Yuxia Zhang
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,The Centre for Critical Care Zhongshan Hospital: A Joanna Briggs Institute Center of Excellence, Shanghai, 200032, China
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Rosenberg MJ, Reschke MF, Tomilovskaya ES, Wood SJ. Multiple field tests on landing day: Early mobility may improve postural recovery following spaceflight. Front Physiol 2022; 13:921368. [PMID: 36187781 PMCID: PMC9515505 DOI: 10.3389/fphys.2022.921368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Adaptation to microgravity causes astronauts to experience sensorimotor disturbances during return to Earth leading to functional difficulties. Recently, the Field Test (FT) study involving an incrementally demanding sensorimotor functional test battery has allowed for an unprecedented view into early decrements and recovery from multiple tests conducted on the landing day following 6-months International Space Station missions. Although the protocol was challenging and temporarily increased motion sickness symptoms, there were anecdotal reports that performing these tasks within the first few hours of landing accelerated their recovery. Therefore, results from computerized dynamic posturography (CDP) following return to Houston were used to compare recovery between crewmembers that participated in FT (n = 18) with those that did not (controls, n = 11). While there were significant decrements in postural performance for both groups, some FT participants tended to perform closer to their preflight baseline in the most challenging condition of the CDP sensitive to vestibular function—eyes closed, unstable support and head movements. However, the distribution of difference scores appeared bimodal with other FT participants in the lower range of performance. We attribute these observations to the manner in which the field tests were implemented—some benefitted by encouraging early movement to drive adaptation when performed in a constrained incremental fashion; however, movements above aversive thresholds may have impaired adaptation in others. Challenging the sensorimotor system with increasingly provocative movements performed as close to landing as possible, as long as within individual thresholds, could be a useful intervention to accelerate astronaut’s sensorimotor readaptation that deserves further study.
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Affiliation(s)
| | - Millard F. Reschke
- Neurosciences Laboratory, NASA Johnson Space Center, Houston, TX, United States
| | | | - Scott J. Wood
- Neurosciences Laboratory, NASA Johnson Space Center, Houston, TX, United States
- *Correspondence: Scott J. Wood,
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Anderson R. Effects of an Electronic Health Record Tool on Team Communication and Patient Mobility: A 2-Year Follow-up Study. Crit Care Nurse 2022; 42:23-31. [PMID: 35362081 DOI: 10.4037/ccn2022385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Intensive care unit early mobility programs improve patients' functional status and outcomes. An electronic health record-based communication tool improved interprofessional communication within an early mobility program. Long-term sustainability of this communication tool has not been evaluated. LOCAL PROBLEM Ineffective interprofessional communication was perceived as a barrier to success of an intensive care unit early mobility program at the project institution. An electronic health record-based communication tool was successfully implemented to improve communication. Sustaining the intervention is of continued importance. METHODS Longitudinal data were collected 2 years after initial implementation of the communication tool to evaluate its continued impact on patient outcomes and staff engagement with an intensive care unit early mobility program. RESULTS Initial implementation of the electronic health record-based communication tool resulted in statistically and clinically significant improvements in patient and staff metrics. Compared with postimplementation data, 2-year longitudinal follow-up data revealed nonsignificant changes in patient outcomes (time from admission to mobility goal, mechanical ventilation duration, length of intensive care unit stay, and discharge disposition recommendations to higher independence levels). Staff reported continued use of the communication tool and positive perceptions of its impact on the intensive care unit early mobility program. CONCLUSIONS Nonsignificant changes in patient outcomes may indicate sustainment of the effect of the communication tool's original implementation. Employing appropriate sustainment techniques is essential to maintain practice change. The electronic health record-based communication tool can improve interprofessional communication within an intensive care unit early mobility program, improving patient outcomes and staff teamwork.
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Affiliation(s)
- Robert Anderson
- Robert Anderson is a pulmonary and critical care nurse practitioner, Mayo Clinic, Rochester, Minnesota
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Kawar LN, Crawford CL, Mendoza RG, Harrison SJ, Thibodeaux MW, Spicer JE. Validity and Usefulness of an Electronic Health Care Record-Generated Mobility Ambulation Tool: The Human Body Was Designed to Move. J Nurs Care Qual 2022; 37:68-74. [PMID: 34261088 DOI: 10.1097/ncq.0000000000000580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mobility is a vital function of human life. Nurses have an essential role in preventing hospitalized patient complications through movement and ambulation. PURPOSE This study examined the integration, accuracy, and precision of a paper-based mobility/ambulation tool into an electronic health record (EHR) to assess inpatient mobility/ambulation status. METHODS This multisite mixed-methods study was a time-series correlational evaluation of a mobility/ambulation tool into the EHR. RESULTS Sustainability data revealed strong correlations between nurse responses and EHR levels (r = 0.602; scores r = 0.624). Cronbach's α values were 0.737 and 0.761. Nurses' anecdotes supported the findings. CONCLUSION Findings revealed that the EHR-Mobility Ambulation Tool is a valid, reliable, and stable tool. EHR-generated scores can assist in reducing charting burden, care planning, and inform the interdisciplinary health team at all patient care stages. Tool adoption could potentially assist nurses plan interventions suitable to maintain or increase hospitalized patients' mobility status and contribute to discharge planning.
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Affiliation(s)
- Lina Najib Kawar
- Patient Care Services, Kaiser Permanente Southern California, Pasadena, California (Drs Kawar, Crawford, and Harrison and Ms Thibodeaux); Kaiser Permanente, Baldwin Park, California (Ms Mendoza); and Kaiser Permanente Southern California & Hawai'i Market, Pasadena, California (Dr Spicer)
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Effectiveness of Different Physiotherapy Protocols in Children in the Intensive Care Unit: A Randomized Clinical Trial. Pediatr Phys Ther 2022; 34:10-15. [PMID: 34873117 DOI: 10.1097/pep.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to investigate the effectiveness of different physical therapy protocols on the autonomic modulation of heart rate, time of invasive mechanical ventilation (IMV), and length of hospital stay. METHODS This was a randomized clinical study with 20 children on IMV in an intensive care unit (ICU), between July 2018 and September 2019. The control group (n = 10) performed the hospital's physical therapy protocol and the experimental group (n = 10) performed the physical therapy protocol based on physical exercise. RESULTS Higher values of heart rate variability were found in the experimental group, both in individual and intergroup analyses. There was a significant reduction in the time of IMV and ICU stay. CONCLUSION There was an improvement in heart rate variability, reduced time on mechanical ventilation and length of stay in the ICU in individuals who performed the study protocol.
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Luna ECW, Perme C, Gastaldi AC. Relationship between potential barriers to early mobilization in adult patients during intensive care stay using the Perme ICU Mobility score. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2021; 57:148-153. [PMID: 34820503 PMCID: PMC8607990 DOI: 10.29390/cjrt-2021-018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Identifying barriers to early mobilization is essential for the management of patients in the intensive care unit (ICU). Our objective was to identify the potential barriers to early mobilization in adult patients using the Perme ICU Mobility Score (Perme Score) and its relationship with days of mechanical ventilation (MV) and length of stay in ICU. Methods This was a pilot, observational, and prospective study. We included 142 adult patients admitted to a 14-bed ICU, in a fourth-level complexity hospital in Cali, Colombia. The Perme Score was used to evaluate potential barriers to mobility. We used the Spearman’s correlation coefficient to find potential correlations between the number of barriers to mobility per patient and the duration of MV and ICU stay. Results We identified significant inverse correlations between total days in MV and the total score of barriers to mobility at ICU admission (r = –0.773; p < 0.05) and at ICU discharge (r = –0.559; p < 0.05). Also, between ICU length of stay and total score of barriers to mobility at ICU admission (r = –0.420; p < 0.05) and at ICU discharge (r = –0.283; p < 0.05). Moreover, we found a significant correlation between total score of the barriers item and total Perme score (r = 0.91; p < 0.01). Conclusions Using the Perme Score we identified potential barriers to mobility upon admission to the ICU that were maintained until discharge. Our findings indicate a strong positive correlation at ICU admission between the total Perme Score and the total score of “Category #2 – Potential Mobility Barriers” in the Perme Score.
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Affiliation(s)
- Esther C Wilches Luna
- Exercise and Cardiopulmonary Health Research Group (GIESC by its Spanish acronym) Universidad del Valle, Cali, Colombia.,Faculty of Health, School of Human Rehabilitation, Universidad del Valle, Cali, Colombia.,Society of Respiratory Physiotherapists (SOFIRE SAS by its Spanish acronym), Cali, Colombia.,Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo / Brazil
| | - Christiane Perme
- Department Rehabilitation Services, Houston Methodist Hospital. Houston, TX, United States of America
| | - Ada Clarice Gastaldi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo / Brazil
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Jennings ML, Granger DA, Bryce CI, Twitchell D, Yeakel K, Teaford PA. Effect of animal assisted interactions on activity and stress response in children in acute care settings. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2021; 8:100076. [PMID: 35757663 PMCID: PMC9216416 DOI: 10.1016/j.cpnec.2021.100076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Determine the effects of animal assisted interactions (AAI) on activity and stress response in pediatric acute care settings. Design Randomized treatment control design. Setting Inpatient pediatric acute care units (PICU, CVICU and Hematology/Oncology). Patients Eighty pediatric inpatients (49% male) age 2–19 years. Intervention The AAI experimental group patients interacted with therapy dog teams for 5–10 min and the comparison group patients continued their current activity without an AAI visit. Measurement and results Salivary cortisol, activity level, and mood were assessed before and after AAI. AAI was associated with a decrease in cortisol levels and increases in mood and activity. Conclusion AAI benefits children in pediatric acute care units. AAI effects activity and stress response in pediatric acute care settings AAI is associated with decreased cortisol levels and increased mood and activity Benefits may influence mobility, recovery and post-discharge psycho-social outcomes
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Lessons Learned From Implementing Rehabilitation at a COVID-19 Field Hospital. Am J Phys Med Rehabil 2021; 100:1027-1030. [PMID: 34508061 DOI: 10.1097/phm.0000000000001878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Rehabilitation experts play an important role in preventing hospital-acquired debility, increasing patients' abilities to safely perform activities of daily living, and facilitating discharge to the home setting for patients with COVID-19. Surges in COVID-19 hospitalization rates combined with increases in length of hospital stay and decreases in postacute care placements have necessitated the opening of COVID-19 field hospitals around the country. Most field hospitals lack the resources to offer a full suite of rehabilitation services, but there are opportunities for small teams of rehabilitation experts to increase their reach by using innovative strategies. This article describes the implementation of a small team of rehabilitation experts in a COVID-19 field hospital and strategies used by this team to maximize patient activity and mobility, facilitate timely discharge, and maximize the number of patients discharged to the home setting. Strategies include training nonclinical staff to assist with activity and mobility promotion and using a rehabilitation triage system to determine needs of individual patients and facilitate efficient resource utilization. The authors reflect on successful aspects of these strategies, as well as barriers to rehabilitation implementation, and make recommendations for other field hospitals seeking to implement rehabilitation during the COVID-19 pandemic or future health crises.
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Cooper D, Gasperini M, Parkosewich JA. Nurses' Perceptions of Barriers to Out-of-Bed Activities Among Patients Receiving Mechanical Ventilation. Am J Crit Care 2021; 30:266-274. [PMID: 34195779 DOI: 10.4037/ajcc2021801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delays in early patient mobility are common in critical care areas. Oral intubation with mechanical ventilation is negatively associated with out-of-bed activities. OBJECTIVES To explore nurses' mobility practices for patients with oral intubation and mechanical ventilation and identify barriers related to patient, nurse, and environment-of-care factors specific to this population. METHODS In this cross-sectional, descriptive study in a medical intensive care unit, mobility was defined as standing, sitting in a chair, or walking. A total of 105 patients who met predefined mobility criteria and their 48 nurses were enrolled. Nurses were interviewed about mobility practices at the ends of shifts. Descriptive statistics summarized nurse and patient characteristics and mobility barriers. RESULTS Patients were deemed ready to begin mobility within a mean (SD) of 41.5 (34.8) hours after oral endotracheal intubation. Two-thirds of nurses reported that they never or rarely got these patients out of bed. Only 12.4% of patients had a clinician's activity order. Common patient-related barriers were uncooperative behavior (21.9%) and active medical issues (15%), even in patients who met mobility criteria. Nurse-related barriers were concerns for patient safety, specifically falls (14.3% of patients) and harm (9.5%). The environment of care posed very few barriers; nurses rarely mentioned that lack of help (13.3% of patients) or lack of clinician's activity order (5.7%) impeded mobility. CONCLUSIONS Mobility practices were nonexistent in these patients despite patients' being deemed ready to begin out-of-bed activities. Nurses must be attentive to their unit's mobility culture to overcome these barriers.
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Affiliation(s)
- Dawn Cooper
- Dawn Cooper is a clinical nurse specialist in the medical intensive care unit, York Street Campus, New Haven, Connecticut
| | - Monica Gasperini
- Monica Gasperini is a clinical nurse III in the medical intensive care unit and a clinical instructor at the Center for Professional Practice, New Haven, Connecticut
| | - Janet A. Parkosewich
- Janet A. Parkosewich is the nurse researcher for the Division of Nursing, Yale New Haven Hospital, New Haven, Connecticut
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