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Yen HC, Chuang HJ, Hsiao WL, Tsai YC, Hsu PM, Chen WS, Han YY. Assessing the impact of early progressive mobilization on moderate-to-severe traumatic brain injury: a randomized controlled trial. Crit Care 2024; 28:172. [PMID: 38778416 PMCID: PMC11112875 DOI: 10.1186/s13054-024-04940-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major cause of neurodisability worldwide, with notably high disability rates among moderately severe TBI cases. Extensive previous research emphasizes the critical need for early initiation of rehabilitation interventions for these cases. However, the optimal timing and methodology of early mobilization in TBI remain to be conclusively determined. Therefore, we explored the impact of early progressive mobilization (EPM) protocols on the functional outcomes of ICU-admitted patients with moderate to severe TBI. METHODS This randomized controlled trial was conducted at a trauma ICU of a medical center; 65 patients were randomly assigned to either the EPM group or the early progressive upright positioning (EPUP) group. The EPM group received early out-of-bed mobilization therapy within seven days after injury, while the EPUP group underwent early in-bed upright position rehabilitation. The primary outcome was the Perme ICU Mobility Score and secondary outcomes included Functional Independence Measure motor domain (FIM-motor) score, phase angle (PhA), skeletal muscle index (SMI), the length of stay in the intensive care unit (ICU), and duration of ventilation. RESULTS Among 65 randomized patients, 33 were assigned to EPM and 32 to EPUP group. The EPM group significantly outperformed the EPUP group in the Perme ICU Mobility and FIM-motor scores, with a notably shorter ICU stay by 5.9 days (p < 0.001) and ventilation duration by 6.7 days (p = 0.001). However, no significant differences were observed in PhAs. CONCLUSION The early progressive out-of-bed mobilization protocol can enhance mobility and functional outcomes and shorten ICU stay and ventilation duration of patients with moderate-to-severe TBI. Our study's results support further investigation of EPM through larger, randomized clinical trials. Clinical trial registration ClinicalTrials.gov NCT04810273 . Registered 13 March 2021.
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Affiliation(s)
| | | | | | | | - Po-Min Hsu
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Yin-Yi Han
- National Taiwan University Hospital, Taipei, Taiwan.
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Cussen J, Mukpradab S, Tobiano G, Cooke C, Pearcy J, Marshall AP. Early mobility and family partnerships in the intensive care unit: A scoping review of reviews. Nurs Crit Care 2024; 29:597-613. [PMID: 37749618 DOI: 10.1111/nicc.12979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/09/2023] [Accepted: 09/07/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Critical illness significantly impacts the well-being of patients and families. Previous studies show that family members are willing to participate in patient care. Involving families in early mobility interventions may contribute to improved recovery and positive outcomes for patients and families. AIM In this scoping review, we investigated early mobility interventions for critically ill patients evaluated in randomized controlled trials and the extent to which family engagement in those interventions are reported in the literature. STUDY DESIGN In this scoping review of reviews, EMBASE, CINAHL, PubMed and Cochrane Central databases were searched in October 2019 and updated in February 2022. Systematic reviews were included and assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2. Data were synthesized using a narrative approach. PRISMA-ScR guidelines were adhered to for reporting. RESULTS Thirty-three reviews were included which described a range of early mobility interventions for critically ill patients; none explicitly mentioned family engagement. Almost half of the reviews were of low or critically low quality. Insufficient detail of early mobility interventions prompted information to be extracted from the primary studies. CONCLUSIONS There are a range of early mobility interventions for critically ill patients but few involve families. Given the positive outcomes of family participation, and family willingness to participate in care, there is a need to explore the feasibility and acceptability of family participation in early mobility interventions. RELEVANCE TO CLINICAL PRACTICE Family engagement in early mobility interventions for critically ill patients should be encouraged and supported. How to best support family members and clinicians in enacting family involvement in early mobility requires further investigation.
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Affiliation(s)
| | - Sasithorn Mukpradab
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Nursing, Prince of Songkla University, Thailand
| | - Georgia Tobiano
- Gold Coast Health, Queensland, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
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Garlet AB, Righi NC, Schardong J, Della Méa Plentz R. Effects of robotic rehabilitation using the Erigo ® device on patients with neurological injury: a systematic review and meta-analysis of randomized clinical trials. Disabil Rehabil Assist Technol 2024; 19:1135-1144. [PMID: 36469933 DOI: 10.1080/17483107.2022.2151656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/12/2022] [Accepted: 11/19/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To systematically review the effects of robotic rehabilitation with the Erigo® device on patients with neurological injury on safety, spasticity, muscle strength, functionality, gait/balance, and changes in the level of consciousness. METHODS MEDLINE, SciELO, EMBASE, The Cochrane Library - CENTRAL and PEDro databases were consulted without the restriction of date and language. Randomized controlled trials that evaluated the robotic rehabilitation and compared it to conventional or placebo therapy, isolated or in association with other therapy, were selected. Studies in which the treatment time was less than 10 sessions were excluded. The risk of bias was assessed with the use of the RoB 2.0 tool. RESULTS Nine studies were included, totaling 347 patients. The robotic rehabilitation performed by the Erigo® device proved to be safe for neurological patients. The meta-analysis showed an improvement for spasticity (MD = 0.29; 95% CI = -0.49 to -0.08; I2 = 0%), but there was no significant increase in muscle strength in patients with stroke (MD = 0.25; CI 95% = -0.22 to -0,71; I2 = 0%). Erigo® showed inconclusive effects on functionality, gait/balance and level of consciousness in patients with severe acquired brain injury and vegetative or minimally conscious state. All studies present some concerns for the risk of bias. CONCLUSION Erigo® as a robotic rehabilitation strategy is safe for patients with acquired brain injury and appears to reduce spasticity in patients with stroke. The effects on muscle strength, functionality, gait and balance and level of consciousness remain uncertain and the methodological quality of the clinical trials included in this review is limited.
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Affiliation(s)
- Andrieli Barbieri Garlet
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Natiele Camponogara Righi
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Jociane Schardong
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Rodrigo Della Méa Plentz
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
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Singam A. Mobilizing Progress: A Comprehensive Review of the Efficacy of Early Mobilization Therapy in the Intensive Care Unit. Cureus 2024; 16:e57595. [PMID: 38707138 PMCID: PMC11069628 DOI: 10.7759/cureus.57595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
Early mobilization therapy has emerged as a crucial aspect of intensive care unit (ICU) management, aiming to counteract the detrimental effects of prolonged immobility in critically ill patients. This comprehensive review examines the efficacy of early mobilization therapy in the ICU setting, synthesizing evidence from clinical trials, meta-analyses, and guidelines. Key findings indicate that early mobilization is associated with numerous benefits, including reduced muscle weakness, a shorter duration of mechanical ventilation, decreased ICU and hospital length of stay, and improved functional outcomes. However, safety concerns, staffing limitations, and patient-specific considerations pose significant barriers to widespread adoption. Despite these challenges, early mobilization is important for improving ICU patient outcomes. This review underscores the critical need for continued research and implementation efforts to optimize early mobilization protocols, address remaining challenges, and expand access to this beneficial therapy. By working collaboratively to overcome barriers and prioritize early mobilization, healthcare providers can enhance the quality of care and improve outcomes for critically ill patients in the ICU.
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Affiliation(s)
- Amol Singam
- Critical Care Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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5
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Martínez-Camacho MÁ, Jones-Baro RA, Gómez-González A, Morales-Hernández D, Lugo-García DS, Melo-Villalobos A, Navarrete-Rodríguez CA, Delgado-Camacho J. Physical and respiratory therapy in the critically ill patient with obesity: a narrative review. Front Med (Lausanne) 2024; 11:1321692. [PMID: 38455478 PMCID: PMC10918845 DOI: 10.3389/fmed.2024.1321692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/22/2024] [Indexed: 03/09/2024] Open
Abstract
Obesity has become increasingly prevalent in the intensive care unit, presenting a significant challenge for healthcare systems and professionals, including rehabilitation teams. Caring for critically ill patients with obesity involves addressing complex issues. Despite the well-established and safe practice of early mobilization during critical illness, in rehabilitation matters, the diverse clinical disturbances and scenarios within the obese patient population necessitate a comprehensive understanding. This includes recognizing the importance of metabolic support, both non-invasive and invasive ventilatory support, and their weaning processes as essential prerequisites. Physiotherapists, working collaboratively with a multidisciplinary team, play a crucial role in ensuring proper assessment and functional rehabilitation in the critical care setting. This review aims to provide critical insights into the key management and rehabilitation principles for obese patients in the intensive care unit.
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Affiliation(s)
- Miguel Ángel Martínez-Camacho
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
- Doctorate Programme in Health Sciences, Universidad Anahuac Norte, State of Mexico, Mexico
| | - Robert Alexander Jones-Baro
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
- Master’s Programme in Health Sciences, Instituto Politecnico Nacional, Mexico City, Mexico
| | - Alberto Gómez-González
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Diego Morales-Hernández
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Dalia Sahian Lugo-García
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Andrea Melo-Villalobos
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Carlos Alberto Navarrete-Rodríguez
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Josué Delgado-Camacho
- Critical Care Physical Therapy Department and Post-operative Recovery and Multi-Organ Support Unit, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
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Pérez Lucendo A, Piñeiro Otero P, Matía Almudévar P, Alcántara Carmona S, López López E, Ramasco Rueda F. Individualised analgesia, sedation, delirium and comfort management strategies in the ICU: a narrative review. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:509-535. [PMID: 37742996 DOI: 10.1016/j.redare.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023]
Abstract
This group is a product of the collaboration agreement signed by SOMIAMA (Sociedad de Medicina Intensiva de Madrid) and SAR MADRID (Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid) under which the organisations agreed to create joint working groups to improve critical patient care. Pain, discomfort, agitation, and delirium cause suffering, delay discharge, and can lead to serious complications in patients admitted to medical and surgical critical care units and post-anaesthesia care units. The main objectives in this type of unit include: Ensuring the comfort of patients suffering or recovering from a critical illness.Avoiding complications associated with the measures, particularly pharmacological, taken to ensure that comfort.
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Affiliation(s)
- A Pérez Lucendo
- Servicio de Medicina Intensiva, Hospital Universitario de La Princesa, Madrid, Spain.
| | - P Piñeiro Otero
- Servicio de Anestesiología y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - P Matía Almudévar
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - S Alcántara Carmona
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - E López López
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Ramasco Rueda
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain
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O'Neil A, Hines D, Wirdzek E, Thornburg C, Murray D, Porter J. Early Mobilization, Early Ambulation, and Burn Therapy in the Acute Hospital Setting. Phys Med Rehabil Clin N Am 2023; 34:733-754. [PMID: 37806694 DOI: 10.1016/j.pmr.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Rehabilitation therapies in the burn acute care environment continue to evolve. Immediate access to therapy is considered standard, and therapy is a key component of the transprofessional care team. Early positioning, edema management, and therapy care in the intensive care unit (ICU) environment can limit later complications; mobility in the ICU can be engaged safely using a systems-based approach in the absence of nondirectable agitation. Later in the course of acute care, early ambulation is an appropriate intervention that can improve outcomes.
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Affiliation(s)
- Audrey O'Neil
- Burn Rehabilitation Services; Eskenazi Health, Richard M Fairbanks Burn Center, 720 Eskenazi Avenue, 4th Floor, Indianapolis, IN 46202, USA
| | - Danika Hines
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Emily Wirdzek
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Cody Thornburg
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA
| | - Derek Murray
- Burn Therapy, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA.
| | - John Porter
- Physiatry, Valleywise, Valleywise Health, 2601 East Roosevelt Street, Phoenix, AZ 85008, USA; Trauma and Burn Services, Department of Surgery, University of Arizona, Creighton University, Phoenix, AZ, USA
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8
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Yang X, Zhang T, Cao L, Ye L, Song W. Early Mobilization for Critically Ill Patients. Respir Care 2023; 68:781-795. [PMID: 37041029 PMCID: PMC10209006 DOI: 10.4187/respcare.10481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Advances in the field of critical care medicine have helped improve the survival rate of these ill patients. Several studies have demonstrated the potential benefits of early mobilization as an important component of critical care rehabilitation. However, there have been some inconsistent results. Moreover, the lack of standardized mobilization protocols and the associated safety concerns are a barrier to the implementation of early mobilization in critically ill patients. Therefore, determining the appropriate modalities of implementation of early mobilization is a key imperative to leverage its potential in these patients. In this paper, we review the contemporary literature to summarize the strategies for early mobilization of critically ill patients, assess the implementation and validity based on the International Classification of Functioning, Disability and Health, as well as discuss the safety aspects of early mobilization.
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Affiliation(s)
- Xiaolong Yang
- Department of Rehabilitation Medicine, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Tiantian Zhang
- Department of Rehabilitation Medicine, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Lei Cao
- Department of Rehabilitation Medicine, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Linlin Ye
- Department of Rehabilitation Medicine, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation Medicine, Capital Medical University Xuanwu Hospital, Beijing, China.
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9
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Hanada M, Hidaka M, Soyama A, Tanaka T, Hara T, Matsushima H, Haraguchi M, Kitamura M, Sekino M, Oikawa M, Nagura H, Takeuchi R, Sato S, Takahata H, Eguchi S, Kozu R. Association between hospital acquired disability and post-discharge mortality in patients after living donor liver transplantation. BMC Surg 2022; 22:445. [PMID: 36581830 PMCID: PMC9798581 DOI: 10.1186/s12893-022-01896-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Hospital-acquired disability (HAD) in patients who undergo living donor liver transplantation (LDLT) is expected to worsen physical functions due to inactivity during hospitalization. The aim of this study was to explore whether a decline in activities of daily living from hospital admission to discharge is associated with prognosis in LDLT patients, who once discharged from a hospital. METHODS We retrospectively examined the relationship between HAD and prognosis in 135 patients who underwent LDLT from June 2008 to June 2018, and discharged from hospital once. HAD was defined as a decline of over 5 points in the Barthel Index as an activity of daily living assessment. Additionally, LDLT patients were classified into four groups: low or high skeletal muscle index (SMI) and HAD or non-HAD. Univariate and multivariate Cox proportional hazard models were used to evaluate the association between HAD and survival. RESULTS HAD was identified in 47 LDLT patients (34.8%). The HAD group had a significantly higher all-cause mortality than the non-HAD group (log-rank: p < 0.001), and in the HAD/low SMI group, all-cause mortality was highest between the groups (log-rank: p < 0.001). In multivariable analysis, HAD was an independent risk factor for all-cause mortality (hazard ratio [HR]: 16.54; P < 0.001) and HAD/low SMI group (HR: 16.82; P = 0.002). CONCLUSION HAD was identified as an independent risk factor for all-cause mortality suggesting that it could be a key component in determining prognosis after LDLT. Future larger-scale studies are needed to consider the overall new strategy of perioperative rehabilitation, including enhancement of preoperative physiotherapy programs to improve physical function.
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Affiliation(s)
- Masatoshi Hanada
- grid.411873.80000 0004 0616 1585Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan ,grid.174567.60000 0000 8902 2273Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masaaki Hidaka
- grid.174567.60000 0000 8902 2273Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiko Soyama
- grid.174567.60000 0000 8902 2273Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takayuki Tanaka
- grid.174567.60000 0000 8902 2273Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takanobu Hara
- grid.174567.60000 0000 8902 2273Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hajime Matsushima
- grid.174567.60000 0000 8902 2273Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masafumi Haraguchi
- grid.174567.60000 0000 8902 2273Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mineaki Kitamura
- grid.174567.60000 0000 8902 2273Department of Nephrology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Motohiro Sekino
- grid.411873.80000 0004 0616 1585Division of Intensive Care, Nagasaki University Hospital, Nagasaki, Japan
| | - Masato Oikawa
- grid.411873.80000 0004 0616 1585Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan ,grid.174567.60000 0000 8902 2273Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroki Nagura
- grid.411873.80000 0004 0616 1585Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan ,grid.174567.60000 0000 8902 2273Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Rina Takeuchi
- grid.411873.80000 0004 0616 1585Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Shuntaro Sato
- grid.411873.80000 0004 0616 1585Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Hideaki Takahata
- grid.411873.80000 0004 0616 1585Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
| | - Susumu Eguchi
- grid.174567.60000 0000 8902 2273Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryo Kozu
- grid.411873.80000 0004 0616 1585Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan ,grid.174567.60000 0000 8902 2273Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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10
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Lindholz M, Schellenberg CM, Grunow JJ, Kagerbauer S, Milnik A, Zickler D, Angermair S, Reißhauer A, Witzenrath M, Menk M, Boie S, Balzer F, Schaller SJ. Mobilisation of critically ill patients receiving norepinephrine: a retrospective cohort study. Crit Care 2022; 26:362. [PMID: 36434724 PMCID: PMC9700948 DOI: 10.1186/s13054-022-04245-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/15/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mobilisation and exercise intervention in general are safe and feasible in critically ill patients. For patients requiring catecholamines, however, doses of norepinephrine safe for mobilisation in the intensive care unit (ICU) are not defined. This study aimed to describe mobilisation practice in our hospital and identify doses of norepinephrine that allowed a safe mobilisation. METHODS We conducted a retrospective single-centre cohort study of 16 ICUs at a university hospital in Germany with patients admitted between March 2018 and November 2021. Data were collected from our patient data management system. We analysed the effect of norepinephrine on level (ICU Mobility Scale) and frequency (units per day) of mobilisation, early mobilisation (within 72 h of ICU admission), mortality, and rate of adverse events. Data were extracted from free-text mobilisation entries using supervised machine learning (support vector machine). Statistical analyses were done using (generalised) linear (mixed-effect) models, as well as chi-square tests and ANOVAs. RESULTS A total of 12,462 patients were analysed in this study. They received a total of 59,415 mobilisation units. Of these patients, 842 (6.8%) received mobilisation under continuous norepinephrine administration. Norepinephrine administration was negatively associated with the frequency of mobilisation (adjusted difference -0.07 mobilisations per day; 95% CI - 0.09, - 0.05; p ≤ 0.001) and early mobilisation (adjusted OR 0.83; 95% CI 0.76, 0.90; p ≤ 0.001), while a higher norepinephrine dose corresponded to a lower chance to be mobilised out-of-bed (adjusted OR 0.01; 95% CI 0.00, 0.04; p ≤ 0.001). Mobilisation with norepinephrine did not significantly affect mortality (p > 0.1). Higher compared to lower doses of norepinephrine did not lead to a significant increase in adverse events in our practice (p > 0.1). We identified that mobilisation was safe with up to 0.20 µg/kg/min norepinephrine for out-of-bed (IMS ≥ 2) and 0.33 µg/kg/min for in-bed (IMS 0-1) mobilisation. CONCLUSIONS Mobilisation with norepinephrine can be done safely when considering the status of the patient and safety guidelines. We demonstrated that safe mobilisation was possible with norepinephrine doses up to 0.20 µg/kg/min for out-of-bed (IMS ≥ 2) and 0.33 µg/kg/min for in-bed (IMS 0-1) mobilisation.
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Affiliation(s)
- Maximilian Lindholz
- grid.6363.00000 0001 2218 4662Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Clara M. Schellenberg
- grid.6363.00000 0001 2218 4662Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Julius J. Grunow
- grid.6363.00000 0001 2218 4662Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Simone Kagerbauer
- grid.6936.a0000000123222966Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Munich, Germany ,grid.6582.90000 0004 1936 9748Department of Anesthesiology and Intensive Care Medicine, Ulm University, Ulm, Germany
| | - Annette Milnik
- grid.6612.30000 0004 1937 0642Division of Molecular Neuroscience, University of Basel, Basel, Switzerland
| | - Daniel Zickler
- grid.6363.00000 0001 2218 4662Department of Nephrology and Medical Intensive Care, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Stefan Angermair
- grid.6363.00000 0001 2218 4662Department of Anesthesiology and Operative Intensive Care Medicine (CBF), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Anett Reißhauer
- grid.6363.00000 0001 2218 4662Department of Physical Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Martin Witzenrath
- grid.6363.00000 0001 2218 4662Department of Infectious Diseases and Pulmonary Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Mario Menk
- grid.6363.00000 0001 2218 4662Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany ,grid.6363.00000 0001 2218 4662Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Sebastian Boie
- grid.6363.00000 0001 2218 4662Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Felix Balzer
- grid.6363.00000 0001 2218 4662Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Stefan J. Schaller
- grid.6363.00000 0001 2218 4662Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany ,grid.6936.a0000000123222966Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, Munich, Germany
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Rodrigues-Gomes RM, Martí JD, Rolán RM, Gelabert-González M. Rapid chest compression effects on intracranial pressure in patients with acute cerebral injury. Trials 2022; 23:312. [PMID: 35428364 PMCID: PMC9012060 DOI: 10.1186/s13063-022-06189-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with acute brain injury often require invasive mechanical ventilation, increasing the risk of developing complications such as respiratory secretions retention. Rapid chest compression is a manual chest physiotherapy technique that aims to improve clearance of secretions in these patients. However, the rapid chest compression technique has been suggested to be associated with increased intracranial pressure in patients with acute brain injury. The aim of this work is to elucidate the effects of the technique on intracranial pressure in mechanically ventilated patients with acute brain injury. Furthermore, the effects of the technique in different volumes and flows recorded by the ventilator and the relationship between the pressure applied in the intervention group and the different variables will also be studied. METHODS Randomized clinical trial, double-blinded. Patients with acute brain injury on invasive mechanical ventilation > 48 h will be included and randomized in two groups. In the control group, a technique of passive hallux mobilization will be applied, and in the intervention group, it will be performed using the rapid chest compression technique. Intracranial pressure (main variable) will be collected with an intracranial pressure monitoring system placed at the lateral ventricles (Integra Camino). DISCUSSION The safety of chest physiotherapy techniques in patients at risk of intracranial hyperpressure is still uncertain. The aim of this study is to identify if the rapid manual chest compression technique is safe in ventilated patients with acute brain injury. TRIAL REGISTRATION NCT03609866 . Registered on 08/01/2018.
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Mukpradab S, Mitchell M, Marshall AP. An Interprofessional Team Approach to Early Mobilisation of Critically Ill Adults: An Integrative Review. Int J Nurs Stud 2022; 129:104210. [DOI: 10.1016/j.ijnurstu.2022.104210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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13
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dos Santos Moraes TL, de Farias JMF, Rezende BS, de Carvalho FO, Santiago MS, Porto ES, Doria FM, Santana KCS, Gomes MV, Leite VS, Madruga RETTA, dos Santos Maciel LY, Andrade JD, de Farias Neto JP, Aidar FJ, da Silva Junior WM. Limited Mobility to the Bed Reduces the Chances of Discharge and Increases the Chances of Death in the ICU. Clin Pract 2021; 12:8-16. [PMID: 35076492 PMCID: PMC8788280 DOI: 10.3390/clinpract12010002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/06/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Progressive mobility in the ICU has been recommended; however, the definitions of low, moderate, and high mobility in the ICU still diverge between studies. Therefore, our objective was to classify the mobility of the sample from verticalization and active withdrawal from the bed, and from that, to analyze the chances of discharge, death, and readmission to the ICU. MATERIALS AND METHODS This is an observational and retrospective study that consults the medical records of individuals admitted to the ICU of the University Hospital of Sergipe (HU/SE) between August 2017 and August 2018. Mobility level was classified based on the Intensive Care Unit Mobility Scale (IMS). RESULTS A total of 121 individuals were included. The mean age was 61.45 ± 16.45, being 53.7% female. Of these, 28 (23.1%) had low mobility, 33 (27.3%) had moderate mobility, and 60 (49.6%) had high mobility. Individuals with low mobility were 45 times more likely to die (OR = 45.3; 95% CI = 3.23-636.3) and 88 times less likely to be discharged from the ICU (OR = 0.22; 95% CI = 0.002-0.30). CONCLUSION Those who evolved with low mobility had a higher chance of death and a lower chance of discharge from the ICU. Moderate and high mobility were not associated with the investigated outcomes.
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Affiliation(s)
- Talita Leite dos Santos Moraes
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Joana Monteiro Fraga de Farias
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Brunielly Santana Rezende
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | | | - Michael Silveira Santiago
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Erick Sobral Porto
- Department of Medicine, Tiradentes University (UNIT), Aracaju 49032-490, SE, Brazil;
| | - Felipe Meireles Doria
- Group of Studies and Research of Performance, Sport, Health and Paralympic Sports (GEPEPS), Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil;
| | | | - Marcel Vieira Gomes
- Program of Traumatology and Orthopaedics, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.V.G.); (V.S.L.)
| | - Victor Siqueira Leite
- Program of Traumatology and Orthopaedics, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil; (M.V.G.); (V.S.L.)
| | | | | | - Juliana Dantas Andrade
- University Hospital, Federal University of Sergipe (HU/UFS), Aracaju 49060-108, SE, Brazil; (F.O.d.C.); (J.D.A.)
| | | | - Felipe J. Aidar
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
| | - Walderi Monteiro da Silva Junior
- Graduate Program in Physical Education, Federal University of Sergipe (PPGEF-UFS), São Cristovão 49100-000, SE, Brazil; (J.M.F.d.F.); (B.S.R.); (M.S.S.); (F.J.A.); (W.M.d.S.J.)
- University Hospital, Federal University of Sergipe (HU/UFS), Aracaju 49060-108, SE, Brazil; (F.O.d.C.); (J.D.A.)
- Department of Physiotherapy, Federal University of Sergipe (UFS), São Cristovão 49100-000, SE, Brazil;
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14
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Liang Z, Yip H, Sena Moore K, Ferreira T, Ji M, Signorile JF, Munro C. Self-Managed Music-Guided Exercise Intervention Improved Upper and Lower Extremity Muscle Strength for ICU Survivors-A Pilot Randomized Controlled Study. Biol Res Nurs 2021; 24:145-151. [PMID: 34738474 DOI: 10.1177/10998004211050297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
ObjectiveThe objective of this study was to evaluate effects of a self-managed music-guided exercise intervention on muscle strength among intensive care unit (ICU) survivors. Methods We used a two-arm randomized-controlled trial. Following ICU discharge, eligible participants were assigned to one of two groups: music group (n = 13) or active control group (n = 13). The music group was taught to self-manage upper and lower extremity exercise movements by listening to an individualized music-guided playlist twice daily for 5 days. The active control group was provided an exercise brochure and advised to perform the same exercises at the same intervals. Dynamometers were used to measure muscle strength. T-tests and Weighted GEE models were used for testing the intervention effect between groups. Results Twenty-six subjects were enrolled. The mean age was 62.8 (SD = 13.8), 53.8% were male, 65.4% were Caucasian, and the mean APACHE severity of illness score was 59 (SD = 23.4). Reasons for ICU admission were mainly cardiac and medical. The music group showed significant improvements in handgrip, plantar flexion, leg extension, elbow flexion, and shoulder adduction strengths on left and right sides. Additionally, left and right leg extensor and left plantar flexor strengths showed significant post-differences, and small to moderately large effect sizes, between the music group and control group. Conclusion These findings suggest that a music-guided exercise intervention has the potential to improve muscle strength in ICU survivors and prevent further post-ICU deterioration in ICU survivors. Future trials should build upon these preliminary findings.
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Affiliation(s)
- Zhan Liang
- School of Nursing and Health Studies, 5452University of Miami, Coral Gables, FL, USA
| | - Hilary Yip
- Frost School of Music, 5452University of Miami, Coral Gables, FL, USA
| | - Kimberly Sena Moore
- Bower School of Music & the Arts, 3391Florida Gulf Coast University, Fort Myers, FL, USA
| | - Tanira Ferreira
- Division of Pulmonary Disease and Critical Care, Department of Medicine, University of Miami Hospital & Clinics, Miami, FL, USA
| | - Ming Ji
- College of Nursing, University of South Florida, Tampa, FL, USA
| | - Joseph F Signorile
- Department of Kinesiology and Sport Sciences, 25802University of Miami, Coral Gables, FL, USA
| | - Cindy Munro
- School of Nursing and Health Studies, 5452University of Miami, Coral Gables, FL, USA
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15
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Fukushima T, Adachi T, Hanada M, Tanaka T, Oikawa M, Nagura H, Eguchi S, Kozu R. Role of Early Mobilization on the Clinical Course of Patients who Underwent Pancreaticoduodenectomy: A Retrospective Cohort Study. TOHOKU J EXP MED 2021; 254:287-294. [PMID: 34456202 DOI: 10.1620/tjem.254.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The length of hospital stay is an important outcome measure in patients who have undergone pancreaticoduodenectomy. Although postoperative complications are known to adversely affect the length of hospital stay (LOS), the influence of early mobilization on LOS has not been clarified yet. This study aimed to examine the impact of the initial ambulation day, which is one of the components of early mobilization, on LOS after pancreaticoduodenectomy. We retrospectively enrolled patients who underwent pancreaticoduodenectomy between January 2013 and December 2017. Postoperative complications were evaluated using the Clavien-Dindo classification (CDC) system. Patients were divided into two groups based on the median LOS (early and late-discharge groups) and compared to determine their characteristics. Multivariate logistic regression analysis was performed with LOS as the dependent variable. Patients in the late-discharge group were significantly older, had an initial ambulation delay, and had higher rates of advanced disease stages and a CDC grade ≥ IIIa than those in the early discharge group. In the multivariate logistic regression analysis, CDC grade ≥ IIIa, initial ambulation day, and age were found to be significant independent factors associated with LOS. Our results demonstrated that not only postoperative complications, but also the initial ambulation day, could affect LOS after pancreaticoduodenectomy, emphasizing the importance of early ambulation for patients who undergo this surgery.
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Affiliation(s)
- Takuya Fukushima
- Department of Rehabilitation Medicine, Nagasaki University Hospital.,Department of Musculoskeletal Oncology and Rehabilitation, National Cancer Center
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Masatoshi Hanada
- Department of Rehabilitation Medicine, Nagasaki University Hospital.,Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Takayuki Tanaka
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Masato Oikawa
- Department of Rehabilitation Medicine, Nagasaki University Hospital.,Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Hiroki Nagura
- Department of Rehabilitation Medicine, Nagasaki University Hospital.,Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Ryo Kozu
- Department of Rehabilitation Medicine, Nagasaki University Hospital.,Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences
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Respiratory Support Adjustments and Monitoring of Mechanically Ventilated Patients Performing Early Mobilization: A Scoping Review. Crit Care Explor 2021; 3:e0407. [PMID: 33912837 PMCID: PMC8078339 DOI: 10.1097/cce.0000000000000407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: This scoping review is aimed to summarize current knowledge on respiratory support adjustments and monitoring of metabolic and respiratory variables in mechanically ventilated adult patients performing early mobilization. Data Sources: Eight electronic databases were searched from inception to February 2021, using a predefined search strategy. Study Selection: Two blinded reviewers performed document selection by title, abstract, and full text according to the following criteria: mechanically ventilated adult patients performing any mobilization intervention, respiratory support adjustments, and/or monitoring of metabolic/respiratory real-time variables. Data Extraction: Four physiotherapists extracted relevant information using a prespecified template. Data Synthesis: From 1,208 references screened, 35 documents were selected for analysis, where 20 (57%) were published between 2016 and 2020. Respiratory support settings (ventilatory modes or respiratory variables) were reported in 21 documents (60%). Reported modes were assisted (n = 11) and assist-control (n = 9). Adjustment of variables and modes were identified in only seven documents (20%). The most frequent respiratory variable was the Fio2, and only four studies modified the level of ventilatory support. Mechanical ventilator brand/model used was not specified in 26 documents (74%). Monitoring of respiratory, metabolic, and both variables were reported in 22 documents (63%), four documents (11%) and 10 documents (29%), respectively. These variables were reported to assess the physiologic response (n = 21) or safety (n = 13). Monitored variables were mostly respiratory rate (n = 26), pulse oximetry (n = 22), and oxygen consumption (n = 9). Remarkably, no study assessed the work of breathing or effort during mobilization. Conclusions: Little information on respiratory support adjustments during mobilization of mechanically ventilated patients was identified. Monitoring of metabolic and respiratory variables is also scant. More studies on the effects of adjustments of the level/mode of ventilatory support on exercise performance and respiratory muscle activity monitoring for safe and efficient implementation of early mobilization in mechanically ventilated patients are needed.
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17
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Yang R, Zheng Q, Zuo D, Zhang C, Gan X. Safety Assessment Criteria for Early Active Mobilization in Mechanically Ventilated ICU Subjects. Respir Care 2021; 66:307-315. [PMID: 32900917 PMCID: PMC9994225 DOI: 10.4187/respcare.07888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although studies have confirmed the safety and feasibility of early active mobilization, its implementation status is still unsatisfactory. The most important obstacle is ensuring patient safety. Comprehensively assessing the physical condition of patients considered for mobilization is the basis of safety. However, appropriate guidance is lacking. We performed a systematic review to extract and summarize current safety assessment criteria for the early active mobilization of mechanically ventilated patients in the ICU. METHODS A systematic literature search was conducted using English and Chinese databases according to the PRISMA checklist and guidelines to identify relevant original studies that evaluated safety assessment variables and specific parameters. RESULTS A total of 24 medium- and high-quality articles involving a total of 4,842 subjects were included in the analysis. Among these studies, there were 15 randomized controlled trials involving 1,777 subjects (888 in the control groups, 889 in the interventional groups) and 9 cohort studies involving 3,065 subjects (1,240 in the control groups, 1,825 in the exposure groups). There were 5 safety assessment criteria, including cardiovascular, respiratory, neurological, musculoskeletal, and other. Within these were 17 different variables and 48 specific parameters. CONCLUSIONS The safety assessment criteria should focus on cardiac reserve, respiratory reserve, consciousness, and muscle strength. It is especially important to note whether the parameters are stable because parameter stability can be more representative of a patient's condition than absolute values. We provide a flow diagram for clinical safety assessments; however, some limitations exist, and this assessment requires further validation and optimization.
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Affiliation(s)
- Ruiqi Yang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiulan Zheng
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Zuo
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuanlai Zhang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiuni Gan
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Mohan S, Patodia S, Kumaravel S, Venkataraman R, Vijayaraghavan BKT. Improving Mobility in Critically Ill Patients in a Tertiary Care ICU: Opportunities and Challenges. Indian J Crit Care Med 2021; 25:34-42. [PMID: 33603299 PMCID: PMC7874286 DOI: 10.5005/jp-journals-10071-23438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Patients in the intensive care unit (ICU) are subjected to prolonged bed rest secondary to critical illness and related therapies. Data suggest that such bed rest can have adverse consequences on the post-discharge quality of life. There is limited data from India on mobilization practices. We undertook a quality improvement (QI) initiative to understand our mobilization practices, identify challenges, and test interventions. Materials and methods We carried out a three-phase QI project, and the study was conducted in our 24-bedded ICU. Pre-intervention and post-intervention mobilization performance and scores were analyzed. We also recorded data on adverse events and barriers to mobilization. Descriptive statistics were used to report all the results. Results A total of 140 patients (1,033 patient days) and 207 patients (932 patient days) were included in our initial audit and post-implementation audit, respectively. In pre-implementation, 31.3% of patients were mobilized with an average mobility score of 2 and this improved to 57.9% with average mobility score of 3.4. Additionally, we demonstrated improvements in the mobility scores of our intubated patients (49.8% achieving a mobility score of 3-5 as compared to 16.7%). Conclusion A multidisciplinary approach is feasible and resulted in significant improvements in early mobilization among critically ill adults. How to cite this article Mohan S, Patodia S, Kumaravel S, Venkataraman R, Vijayaraghavan BKT. Improving Mobility in Critically Ill Patients in a Tertiary Care ICU: Opportunities and Challenges. Indian J Crit Care Med 2021;25(1):34-42.
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Affiliation(s)
- Sneha Mohan
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Sristi Patodia
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Sudha Kumaravel
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Ramesh Venkataraman
- Department of Critical Care Medicine, Apollo Hospitals, Chennai, Tamil Nadu, India
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Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit. Crit Care Res Pract 2020; 2020:7840743. [PMID: 33294221 PMCID: PMC7714600 DOI: 10.1155/2020/7840743] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Patients admitted to the intensive care unit (ICU) are generally confined to bed leading to limited mobility that may have detrimental effects on different body systems. Early mobilization prevents or reduces these effects and improves outcomes in patients following critical illness. The purpose of this review is to summarize different aspects of early mobilization in intensive care. Methods Electronic databases of PubMed, Google Scholar, ScienceDirect, and Scopus were searched using a combination of keywords. Full-text articles meeting the inclusion criteria were selected. Results Fifty-six studies on various aspects such as the effectiveness of early mobilization in various intensive care units, newer techniques in early mobilization, outcome measures for physical function in the intensive care unit, safety, and practice and barriers to early mobilization were included. Conclusion: Early mobilization is found to have positive effects on various outcomes in patients with or without mechanical ventilation. The newer techniques can be used to facilitate early mobilization. Scoring systems—specific to the ICU—are available and should be used to quantify patients' status at different intervals of time. Early mobilization is not commonly practiced in many countries. Various barriers to early mobilization have been identified, and different strategies can be used to overcome them.
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20
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Aquim EE, Bernardo WM, Buzzini RF, Azeredo NSGD, Cunha LSD, Damasceno MCP, Deucher RADO, Duarte ACM, Librelato JT, Melo-Silva CA, Nemer SN, Silva SDFD, Verona C. Brazilian Guidelines for Early Mobilization in Intensive Care Unit. Rev Bras Ter Intensiva 2020; 31:434-443. [PMID: 31967216 PMCID: PMC7008992 DOI: 10.5935/0103-507x.20190084] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 09/17/2019] [Indexed: 12/27/2022] Open
Abstract
Immobility can cause several complications, including skeletal muscle atrophy and weakness, that influence the recovery of critically ill patients. This effect can be mitigated by early mobilization. Six key questions guided this research: Is early mobilization safe? Which patients are candidates for early mobilization? What are the contraindications? What is the appropriate dose, and how should it be defined? What results are obtained? What are the prognostic indicators for the use of early mobilization? The objective of this guideline was to produce a document that would provide evidence-based recommendations and suggestions regarding the early mobilization of critically ill adult patients, with the aim of improving understanding of the topic and making a positive impact on patient care. This guideline was based on a systematic review of articles conducted using the PICO search strategy, as recommended by the Guidelines Project of the Associação Médica Brasileira. Randomized clinical trials, prognostic cohort studies, and systematic reviews with or without meta-analysis were selected, and the evidence was classified according to the Oxford Center for Evidence-based Medicine Levels of Evidence. For all the questions addressed, enough evidence was found to support safe and well-defined early mobilization, with prognostic indicators that support and recommend the technique. Early mobilization is associated with better functional outcomes and should be performed whenever indicated. Early mobilization is safe and should be the goal of the entire multidisciplinary team.
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Affiliation(s)
| | - Wanderley Marques Bernardo
- Associação Médica Brasileira - São Paulo (SP), Brasil.,Universidade de São Paulo - São Paulo (SP), Brasil
| | | | | | | | | | | | | | | | | | | | | | - Cleber Verona
- Associação de Medicina Intensiva Brasileira - São Paulo (SP), Brasil
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Camus-Molina A, González-Seguel F, Castro-Ávila AC, Leppe J. Construct Validity of the Chilean-Spanish Version of the Functional Status Score for the Intensive Care Unit: A Prospective Observational Study Using Actigraphy in Mechanically Ventilated Patients. Arch Phys Med Rehabil 2020; 101:1914-1921. [PMID: 32446906 DOI: 10.1016/j.apmr.2020.04.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/17/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the construct validity (hypotheses testing) of the Chilean-Spanish version of the Functional Status Score for the Intensive Care Unit (FSS-ICU) using continuous actigraphy from intensive care unit (ICU) admission to ICU discharge. DESIGN The Chilean-Spanish version of the FSS-ICU was used in a prospective observational study to mainly evaluate its correlation with actigraphy variables. The FSS-ICU was assessed on awakening and at ICU discharge, while actigraphy variables were recorded from ICU admission to ICU discharge. SETTING A 12-bed academic medical-surgical ICU. PARTICIPANTS Mechanically ventilated patients (N=30), of 92 patients screened. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Construct validity of the FSS-ICU Chilean-Spanish version was assessed by testing 12 hypotheses, including the correlation with activity counts, activity time (>99 counts/min), inactivity time (0-99 counts/min), muscle strength, ICU length of stay, and duration of mechanical ventilation. RESULTS The median FSS-ICU was 19 points (interquartile range [IQR], 10-26 points) on awakening and 28.5 points (IQR, 22-32 points) at ICU discharge. There was no floor/ceiling effect of the FSS-ICU at awakening (0%/0%) and only a ceiling effect at ICU discharge that was acceptable (0%/10%). Less activity time was associated with better mobility on the FSS-ICU at both awakening (ρ=-0.62, P<.001) and ICU discharge (ρ=-0.79, P<.001). Activity counts and activity time were not correlated as expected with the FSS-ICU. CONCLUSIONS The Chilean-Spanish FSS-ICU had a strong correlation with inactivity time during the ICU stay. These findings enhance the available clinimetric properties of the FSS-ICU.
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Affiliation(s)
- Agustín Camus-Molina
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Felipe González-Seguel
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Departamento de Paciente Crítico, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
| | - Ana Cristina Castro-Ávila
- School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Department of Health Sciences, University of York, York, United Kingdom
| | - Jaime Leppe
- School of Physical Therapy, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
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22
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Early Mobilization of Patients Receiving Vasoactive Drugs in Critical Care Units: A Systematic Review. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2020. [DOI: 10.1097/jat.0000000000000140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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