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Nydahl P, Fick LS, Eggmann S. Break down barriers - Can point prevalence studies change mobilization practice in the intensive care unit? Intensive Crit Care Nurs 2024; 80:103537. [PMID: 37788523 DOI: 10.1016/j.iccn.2023.103537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Peter Nydahl
- Nursing Research, University Hospital of Schleswig-Holstein, Kiel, Germany.
| | - Lena-Sophia Fick
- Department of Physiotherapy, University Hospital of Schleswig-Holstein, Kiel, Germany.
| | - Sabrina Eggmann
- Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland.
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Redivo J, Kannan H, Souza AAF, Colleti Junior J, Kudchadkar SR. Physical rehabilitation in Brazilian pediatric intensive care units: a multicenter point prevalence study. CRITICAL CARE SCIENCE 2023; 35:290-301. [PMID: 38133159 PMCID: PMC10734802 DOI: 10.5935/2965-2774.20230388-en] [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: 11/20/2022] [Accepted: 07/22/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To determine the prevalence and factors associated with the physical rehabilitation of critically ill children in Brazilian pediatric intensive care units. METHODS A 2-day, cross-sectional, multicenter point prevalence study comprising 27 pediatric intensive care units (out of 738) was conducted in Brazil in April and June 2019. This Brazilian study was part of a large multinational study called Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU). The primary outcome was the prevalence of mobility provided by physical therapy or occupational therapy. Clinical data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥ 72 hours. RESULTS Children under the age of 3 years comprised 68% of the patient population. The prevalence of therapist-provided mobility was 74%, or 277 out of the 375 patient-days. Out-of-bed mobility was most positively associated with family presence (adjusted odds ratios 3.31;95%CI 1.70 - 6.43) and most negatively associated with arterial lines (adjusted odds ratios 0.16; 95%CI 0.05 - 0.57). Barriers to mobilization were reported on 27% of patient-days, the most common being lack of physician order (n = 18). Potential safety events occurred in 3% of all mobilization events. CONCLUSION Therapist-provided mobility in Brazilian pediatric intensive care units is frequent. Family presence was high and positively associated with out-of-bed mobility. The presence of physiotherapists 24 hours a day in Brazilian pediatric intensive care units may have a substantial impact on the mobilization of critically ill children.
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Affiliation(s)
- Juliana Redivo
- Department of Anesthesiology and Critical Care Medicine, Charlotte
R. Bloomberg Children’s Center, Johns Hopkins University School of Medicine -
Baltimore, United States
| | - Harini Kannan
- Department of Anesthesiology and Critical Care Medicine, Charlotte
R. Bloomberg Children’s Center, Johns Hopkins University School of Medicine -
Baltimore, United States
| | | | - José Colleti Junior
- Department of Pediatrics, Hospital Israelita Albert Einstein -
São Paulo (SP), Brazil
| | - Sapna Ravi Kudchadkar
- Department of Pediatrics, Johns Hopkins University School of
Medicine - Baltimore, United States
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3
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Liu H, Tian Y, Jiang B, Song Y, Du A, Ji S. Early mobilization practice in intensive care units: A large-scale cross-sectional survey in China. Nurs Crit Care 2023. [PMID: 36929678 DOI: 10.1111/nicc.12896] [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: 08/26/2022] [Revised: 01/11/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The field of early rehabilitation has developed slowly in mainland China and there are limited data on the implementation of early mobilization (EM) practice in intensive care unit (ICUs) in China. AIMS To investigate the implementation of EM in ICUs in mainland China and to analyse its influencing factors. DESIGN A cross-sectional electronic survey was conducted in 444 ICUs across 11 provinces in China. Head nurses provided data on institutional characteristics and EM practice in ICUs. Logistic regression models were used to identify factors associated with the implementation of EM. RESULTS In all, 56.98% (253/444) of ICUs implemented EM with comprehensive or complete implementation in 86 ICUs. Of the 191 ICUs that did not use EM, 136 planned to implement EM in the near future. Of the 253 ICUs that used EM, 21.34% of ICUs implemented EM for all eligible patients, while 24.90% would evaluate and carry out EM within 48 h after ICU admission, 39.13% had collaborative EM teams, 34.39% reported the use of EM protocols, 14.63% reported multidisciplinary rounds and 17.39% had medical orders and charging standards for all EM activities. Only 18.18% of ICUs conducted frequent professional training for EM, and abnormal events occurred in 15.41% of ICUs during EM practice. Multivariate logistic regression analysis revealed that an economically strong province, the presence of a dedicated therapist team, more ICU beds and a higher staff-to-bed ratio favoured the implementation of EM. Furthermore, multidisciplinary rounds, well-established medical orders and charging standards, and a high frequency of professional training can lead to the comprehensive promotion and development of EM practice in ICUs. CONCLUSIONS Both the implementation rate and quality of EM practice for critically ill patients require improvement. EM practice in Chinese ICUs is still nascent and requires development in a variety of domains. RELEVANCE FOR CLINICAL PRACTICE To facilitate the implementation of EM in ICUs, more human resources, especially the involvement of a professional therapist team, should be deployed. In addition, health providers should actively organize multidisciplinary rounds and professional training and formulate appropriate EM medical orders and charging standards.
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Affiliation(s)
- Huan Liu
- Department of Critical Care Medicine, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yongming Tian
- Department of Critical Care Medicine, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Biantong Jiang
- Department of Critical Care Medicine, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yuanyuan Song
- Department of Critical Care Medicine, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Aiping Du
- Department of Critical Care Medicine, West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Shuming Ji
- Office of Program Design and Statistics, West China Hospital, Sichuan University, Chengdu, China
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Zhao Q, Tao L, Li Q, Wu S, Wang D, Feng P, Luo N, Xie Y, Wang S, Jia C, Zeng G, Zhao H. National survey of the awareness and implementation status of early pulmonary rehabilitation for patients with critical illness in departments of pulmonary and critical care medicine in 2019. Chin Med J (Engl) 2023; 136:227-229. [PMID: 36848152 PMCID: PMC10106263 DOI: 10.1097/cm9.0000000000002345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Indexed: 03/01/2023] Open
Affiliation(s)
- Qing Zhao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China–Japan Friendship Hospital, Beijing 100029, China
- National Clinical Research Center for Respiratory Diseases, Beijing 100029, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing 100029, China
- National Center for Respiratory Medicine, Beijing 100029, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100091, China
| | - Quanguo Li
- Department of Pulmonary and Critical Care Medicine, Weifang Respiratory Disease Hospital, Weifang No.2 Renmin Hospital, Weifang, Shandong 261041, China
| | - Sinan Wu
- National Clinical Research Center for Respiratory Diseases, Beijing 100029, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing 100029, China
- National Center for Respiratory Medicine, Beijing 100029, China
- Department of Clinical Research and Data management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Dingyi Wang
- National Clinical Research Center for Respiratory Diseases, Beijing 100029, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing 100029, China
- National Center for Respiratory Medicine, Beijing 100029, China
- Department of Clinical Research and Data management, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Peng Feng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China–Japan Friendship Hospital, Beijing 100029, China
- National Clinical Research Center for Respiratory Diseases, Beijing 100029, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing 100029, China
- National Center for Respiratory Medicine, Beijing 100029, China
| | - Nan Luo
- Department of Hospital Development Office, China–Japan Friendship Hospital, Beijing 100029, China
| | - Yuxiao Xie
- Department of Medical Rehabilitation, China–Japan Friendship Hospital, Beijing 100029, China
| | - Siyuan Wang
- Department of Medical Rehabilitation, China–Japan Friendship Hospital, Beijing 100029, China
| | - Cunbo Jia
- National Center for Respiratory Medicine, Beijing 100029, China
| | - Gang Zeng
- Department of Respiratory Medicine, North District of Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, Jiangsu 215000, China
| | - Hongmei Zhao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China–Japan Friendship Hospital, Beijing 100029, China
- National Clinical Research Center for Respiratory Diseases, Beijing 100029, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing 100029, China
- National Center for Respiratory Medicine, Beijing 100029, China
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5
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Tadyanemhandu C, van Aswegen H, Ntsiea V. Barriers and facilitators to implementation of early mobilisation of critically ill patients in Zimbabwean and South African public sector hospitals: a qualitative study. Disabil Rehabil 2022; 44:6699-6709. [PMID: 34461792 PMCID: PMC9183945 DOI: 10.1080/09638288.2021.1970827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 06/21/2021] [Accepted: 08/15/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Implementing early mobilisation in intensive care is challenging, and a detailed knowledge of factors that may hinder or facilitate implementation is essential for success. The study was done to explore the perceived barriers and facilitators to early mobilisation by physiotherapists in Zimbabwean and South African public sector hospital ICUs. METHODS A qualitative study was done in eight public sector hospitals from South Africa and four hospitals from Zimbabwe. Physiotherapists from the participating hospitals who had at least two years working experience in ICU were invited to participate in semi-structured, in-depth, face-to-face interviews. Purposive sampling was done. Data collected included interpretation of early mobilisation, perceived barriers, and facilitators to early mobilisation. Data analysis was done using the content analysis method. FINDINGS A total of 22 physiotherapists were interviewed. In defining the activities regarded as early mobilisation, there was diversity in relation to the specific activities and the nature of the patients in which the defined activities were suitable for. Perceived barriers which emerged included lack of professional autonomy or boundaries, motivation, and clinical skills. Perceived facilitators to early mobilisation included the availability of guidelines, good communication, adequate staff, and mobilisation equipment. CONCLUSIONS Barriers and facilitators to early mobilisation are multifactorial. There is need for multidisciplinary team collaboration and planning before implementing early mobilisation activities.Implications to rehabilitationProfessional roles/identity and or boundaries emerged to be a barrier that hinder implementation of early mobilisation if not clearly defined.Non-rotational physiotherapy coverage was highlighted to be important in facilitating good communication and teamwork and sustainability of services in ICU.Good communication channels and referrals between different disciplines should be employed in ICU to prevent delay in rendering services to ICU patients.
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Affiliation(s)
- Cathrine Tadyanemhandu
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
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Bennion J, Garrett R, Mansell SK, Barron D, Martin D, Mein G. Barriers and facilitators of early mobilisation for intensive care unit delirium: perspectives from patients, family members and carers. A qualitative study protocol. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background/Aims One-third of patients develop delirium following admission to an intensive care unit. Intensive care unit delirium is associated with poor patient outcomes, including long-term disability and high mortality. Early mobilisation contributes towards the prevention and reduction of intensive care unit delirium. However, the implementation of early mobilisation is infrequent. The aim of this protocol is to explore participants' experiences of the barriers to, and facilitators of, early mobilisation in the adult intensive care unit specific to people experiencing delirium. Methods Three moderators will carry out up to six focus groups including up to five participants in each group. Focus group discussions will be used to explore the experiences of patients, carers and family members using Microsoft Teams. Participants will be recruited from the charity ICUsteps using a purposive sampling technique. Results Discussions will be audio-recorded and simultaneously transcribed verbatim using the otter.ai programme. Member check approval will be sought to ensure accuracy of data. Framework analysis using a thematic methodology will identify themes in the data. Conclusions It is anticipated that the findings of this study will contribute towards further understanding the implementation of early mobilisation in order to improve measures for prevention and management of delirium in the adult intensive care unit.
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Affiliation(s)
| | | | | | - Duncan Barron
- Centre for Public Engagement Kingston and St. George's Faculty of Health, Social Care and Education, London, UK
| | - Daniel Martin
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Gillian Mein
- Centre for Allied Health, Faculty of Health, Social Care and Education, St. George's University of London, London, UK
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7
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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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Raurell-Torredà M, Arias-Rivera S, Martí JD, Frade-Mera MJ, Zaragoza-García I, Gallart E, Velasco-Sanz TR, San José-Arribas A, Blazquez-Martínez E. Care and treatments related to intensive care unit-acquired muscle weakness: A cohort study. Aust Crit Care 2021; 34:435-445. [PMID: 33663950 DOI: 10.1016/j.aucc.2020.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/28/2020] [Accepted: 12/13/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Intensive care unit-acquired muscle weakness (ICUAW) has an incidence of 40-46%. Early mobilisation is known to be a protective factor. OBJECTIVE The aim of the study was to identify the incidence of ICUAW in Spain and to evaluate variables likely to contribute to the development of ICUAW. METHODS A 4-month, prospective observational multicentre cohort study was conducted on patients receiving invasive mechanical ventilation for at least 48 h. Data were collected from ICU day 3 until ICU discharge. The primary outcome was presence of ICUAW (diagnosed using the Medical Research Council [MRC] scale). The secondary outcome was nurse-patient ratio, physiotherapist availability, analgesia, sedation and delirium management, glycaemic control, and daily level of mobility during the ICU stay as per the ICU Mobility Scale. A logistic regression model was constructed based exclusively on days 3-5 of the ICU stay. RESULTS The data of 642 patients were analysed from 80 ICUs, accounting for 35% of all ICUs in Spain. The incidence of ICUAW was 58% (275 of 474 patients; 95% confidence interval [CI] [53-62]). The predictors for ICUAW were older age (odds ratio [OR] = 1.01; 95% CI [1.00-1.03]) and more days with renal replacement therapy (OR = 1.01; 95% CI [1.00-1.02]). The protective factors for ICUAW were male gender (OR = 0.58; 95% CI [0.38-0.89]), higher Barthel Index (showing prehospital functional independence) (OR = 0.97; 95% CI [0.95-0.99]), more days of being awake and cooperative (defined by a feasible MRC assessment) (OR = 0.98; 95% CI [0.97-0.99]), presence of delirium (OR = 0.98; 95% CI [0.97-0.99]), and more days with active mobilisation (ICU Mobility Scale ≥ 4) (OR = 0.98; 95% CI [0.97-0.99]). CONCLUSIONS The risk factors for ICUAW were functional dependence before admission, female gender, older age, and more days on renal replacement therapy. The protective factors for ICUAW were feasibility of MRC assessment, the presence of delirium, and being actively mobilised during the first 5 days in the ICU.
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Affiliation(s)
- M Raurell-Torredà
- Department of Fundamental and Medical Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Spain
| | - S Arias-Rivera
- University Hospital of Getafe, CIBER Respiratory Diseases, Carlos III Institute of Health, Madrid, Spain
| | - J D Martí
- Clinic University Hospital, Barcelona, Spain
| | - M J Frade-Mera
- 12 Octubre University Hospital, Madrid, Spain; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Complutense University of Madrid, Spain
| | - I Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Complutense University of Madrid, Spain; Care Research Group (Invecuid), 12 de Octubre Hospital Institute of Health Research (imas12), Madrid, Spain.
| | - E Gallart
- Vall Hebron University Hospital, Barcelona, Spain
| | - T R Velasco-Sanz
- San Carlos University Hospital, Madrid, Spain; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, Complutense University of Madrid, Spain
| | - A San José-Arribas
- Sant Pau University School of Nursing (Santa Creu i Sant Pau Hospital), Barcelona, Spain
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Raurell-Torredà M, Regaira-Martínez E, Planas-Pascual B, Ferrer-Roca R, Martí JD, Blazquez-Martínez E, Ballesteros-Reviriego G, Vinuesa-Suárez I, Zariquiey-Esteva G. Early mobilisation algorithm for the critical patient. Expert recommendations. ENFERMERIA INTENSIVA 2021; 32:153-163. [PMID: 34366295 DOI: 10.1016/j.enfie.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. OBJECTIVE To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). METHODOLOGY Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. RESULTS 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. CONCLUSIONS The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.
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Affiliation(s)
- M Raurell-Torredà
- Universidad de Barcelona, Investigadora principal proyecto MoviPre, Barcelona, Spain
| | - E Regaira-Martínez
- Clínica Universidad de Navarra, Pamplona, Spain; GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC).
| | - B Planas-Pascual
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - R Ferrer-Roca
- Hospital Universitario Vall d'Hebron, Barcelona, Spain; Presidente de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)
| | - J D Martí
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Clínic de Barcelona, Barcelona, Spain
| | - E Blazquez-Martínez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario de Bellvitge, L'Hospitalet de Llobgregat, Barcelona, Spain
| | - G Ballesteros-Reviriego
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - I Vinuesa-Suárez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - G Zariquiey-Esteva
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Bertozzi MN, Cagide S, Navarro E, Accoce M. Description of physical rehabilitation in intensive care units in Argentina: usual practice and during the COVID-19 pandemic. Online survey. Rev Bras Ter Intensiva 2021; 33:188-195. [PMID: 34231799 PMCID: PMC8275077 DOI: 10.5935/0103-507x.20210026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 03/09/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To describe the usual practice of mobility therapy in the adult intensive care unit for patients with and without COVID-19. Methods Online survey in which physical therapists working in an adult intensive care unit in Argentina participated. Sixteen multiple-choice or single-response questions grouped into three sections were asked. The first section addressed personal, professional and work environment data. The second section presented questions regarding usual care, and the third focused on practices under COVID-19 pandemic conditions. Results Of 351 physical therapists, 76.1% answer that they were exclusively responsible for patient mobility. The highest motor-based goal varied according to four patient scenarios: Mechanically ventilated patients, patients weaned from mechanical ventilation, patients who had never required mechanical ventilation, and patients with COVID-19 under mechanical ventilation. In the first and last scenarios, the highest goal was to optimize muscle strength, while for the other two, it was to perform activities of daily living. Finally, the greatest limitation in working with patients with COVID-19 was respiratory and/or contact isolation. Conclusion Physical therapists in Argentina reported being responsible for the mobility of patients in the intensive care unit. The highest motor-based therapeutic goals for four classic scenarios in the closed area were limited by the need for mechanical ventilation. The greatest limitation when mobilizing patients with COVID-19 was respiratory and contact isolation.
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Affiliation(s)
- Matias Nicolás Bertozzi
- Sanatorio Anchorena San Martín - Buenos Aires, Argentina.,Hospital Donación "Francisco Santojanni" - Buenos Aires, Argentina
| | - Sabrina Cagide
- Sanatorio Anchorena San Martín - Buenos Aires, Argentina.,Hospital Municipal "Dr. Bernardo Houssay" - Vicente Lopez, Argentina
| | - Emiliano Navarro
- Sanatorio Anchorena San Martín - Buenos Aires, Argentina.,Centro del Parque Cuidados Respiratorios - Buenos Aires, Argentina.,Hospital General de Agudos "Carlos G. Durand" - Buenos Aires, Argentina
| | - Matias Accoce
- Sanatorio Anchorena San Martín - Buenos Aires, Argentina.,Hospital de Quemados "Dr. Arturo Umberto Illia" - Buenos Aires, Argentina.,Universidad Abierta Interamericana - Buenos Aires, Argentina
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11
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Raurell-Torredà M, Arias-Rivera S, Martí JD, Frade-Mera MJ, Zaragoza-García I, Gallart E, Velasco-Sanz TR, San José-Arribas A, Blazquez-Martínez E. Variables associated with mobility levels in critically ill patients: A cohort study. Nurs Crit Care 2021; 27:546-557. [PMID: 34008238 DOI: 10.1111/nicc.12639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early mobilization in the intensive care unit (ICU) helps improve patients' functional status at discharge. However, many barriers hinder this practice. AIM AND OBJECTIVES To identify mobility levels acquired by critically ill patients and their variables. DESIGN A multi-centre cohort study was conducted in adult patients receiving invasive mechanical ventilation for at least 48 hours. METHODS The primary outcome was level of mobility according to the ICU mobility scale. The secondary outcome was human resource availability and existence of ABCDEF bundle guidelines. A logistic regression was performed, based on days 3 to 5 of the ICU stay and significant association with active mobility. RESULTS Six hundred and forty-two patients were included from 80 ICUs. Active moving in and out of bed was found on 9.9% of patient-days from day 8 of the ICU stay. Bed exercises, or passive transfers, and immobility were observed on 45.6% and 42.2% of patient-days, respectively. Patients achieving active mobility (189/642, 29.4%) were in ICUs with more physiotherapist hours. Active mobility was more likely with a 1:4 nurse-patient ratio (odds ratio [OR] 3.7 95% confidence interval [CI] [1.2-11.2]), high MRC sum-score (OR 1.05 95% CI [1.04-1.06]) and presence of delirium (OR 1.01 95% CI [1.00-1.02]). By contrast, active mobility was hindered by higher BMI (OR 0.92 95% CI [0.88-0.97]), a 1:3 nurse-patient ratio (OR 0.54 95% CI [0.32-0.93]), or a shift-dependent nurse-patient ratio (OR 0.27 95% CI [0.12-0.62]). CONCLUSIONS Immobility and passive mobilization were prevalent. A high MRC sum-score and presence of delirium are protective factors of mobilization. A 1:4 nurse-patient ratio shows a stronger association with active mobility than a 1:3 ratio. RELEVANCE TO CLINICAL PRACTICE Severity-criteria-based nurse-patient ratios hinder mobilization. Active mobilization may be enhanced by using nursing-intervention-based ratios, increasing physiotherapist hours, and achieving wider application of the ABCDEF bundle, resulting in more awake, cooperative patients.
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Affiliation(s)
- Marta Raurell-Torredà
- Department of Fundamental and Medical Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Susana Arias-Rivera
- Department of Nursing Management, University Hospital of Getafe, Madrid, Spain.,Research Department, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Daniel Martí
- Cardiovascular Surgery Intensive Care Department, Instituto Clínico Cardiovascular, Clinic University Hospital, Barcelona, Spain
| | - María Jesús Frade-Mera
- Critical Care Department, 12 Octubre University Hospital, Madrid, Spain.,Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
| | - Ignacio Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.,Research department (Invecuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Centro de Actividades Ambulatorias, Madrid, Spain
| | - Elisabet Gallart
- Critical Care Department, Vall Hebron University Hospital, Barcelona, Spain
| | - Tamara Raquel Velasco-Sanz
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.,Critical Care Department, San Carlos University Hospital, Madrid, Spain
| | - Alicia San José-Arribas
- Department of Nursing, Escola Universitaria d'Infermeria Sant Pau (Hospital de la Santa Creu i Sant Pau), Barcelona, Spain
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Mobilization During Critical Illness: A Higher Level of Mobilization Improves Health Status at 6 Months, a Secondary Analysis of a Prospective Cohort Study. Crit Care Med 2021; 49:e860-e869. [PMID: 33967203 DOI: 10.1097/ccm.0000000000005058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine the influence of active mobilization during critical illness on health status in survivors 6 months post ICU admission. DESIGN Post hoc secondary analysis of a prospective cohort study conducted between November 2013 and March 2015. SETTING Two tertiary hospital ICU's in Victoria, Australia. PATIENTS Of 194 eligible patients admitted, mobility data for 186 patients were obtained. Inclusion and exclusion criteria were as per the original trial. INTERVENTIONS The dosage of mobilization in ICU was measured by 1) the Intensive Care Mobility Scale where a higher Intensive Care Mobility Scale level was considered a higher intensity of mobilization or 2) the number of active mobilization sessions performed during the ICU stay. The data were extracted from medical records and analyzed against Euro-quality of life-5D-5 Level version answers obtained from phone interviews with survivors 6 months following ICU admission. The primary outcome was change in health status measured by the Euro-quality of life-5D-5 Level utility score, with change in Euro-quality of life-5D-5 Level mobility domain a secondary outcome. MEASUREMENTS AND MAIN RESULTS Achieving higher levels of mobilization (as per the Intensive Care Mobility Scale) was independently associated with improved outcomes at 6 months (Euro-quality of life-5D-5 Level utility score unstandardized regression coefficient [β] 0.022 [95% CI, 0.002-0.042]; p = 0.033; Euro-quality of life-5D-5 Level mobility domain β = 0.127 [CI, 0.049-0.205]; p = 0.001). Increasing the number of active mobilization sessions was not found to independently influence health status. Illness severity, total comorbidities, and admission diagnosis also independently influenced health status. CONCLUSIONS In critically ill survivors, achieving higher levels of mobilization, but not increasing the number of active mobilization sessions, improved health status 6 months after ICU admission.
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Fontela PC, Glaeser SS, Martins LF, Condessa RL, Prediger DT, Forgiarini SG, Forgiarini LA, Lisboa TC, Friedman G. Medical Research Council Scale Predicts Spontaneous Breathing Trial Failure and Difficult or Prolonged Weaning of Critically Ill Individuals. Respir Care 2021; 66:733-741. [PMID: 33653914 PMCID: PMC9994125 DOI: 10.4187/respcare.07739] [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 Handgrip strength is an alternative measure to assess peripheral muscle strength and is correlated with the Medical Research Council (MRC) scale, with promising values for diagnosing ICU-acquired weakness (ICUAW). Because ICUAW has been associated with delayed weaning from mechanical ventilation, we hypothesized that ICUAW evaluated with both the MRC scale score and handgrip strength are associated with failure of a spontaneous breathing trial (SBT) and duration of mechanical ventilation weaning. METHODS We conducted a prospective observational study in 3 general ICUs with a total of 54 beds at 2 academic hospitals. Adult subjects with > 48 h of mechanical ventilation who were eligible for weaning were included in the study. RESULTS In the evaluation before the first SBT, the MRC score (P < .001) and handgrip strength (P < .001) were significantly different between subjects extubated after a successful first SBT (simple weaning) and those extubated any time after a failed first SBT (difficult weaning). Only the MRC score discriminated between first SBT success or failure (P < .001); in multivariate analysis, the MRC score was significantly associated with first SBT failure (odds ratio 0.91, 95% CI 0.88-0.97, P < .001) and difficult weaning (odds ratio 0.91, 95% CI 0.87-0.96, P < .001). Handgrip strength exhibited good accuracy in identifying ICUAW. CONCLUSIONS MRC score was independently associated with SBT failure and difficult or prolonged weaning.
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Affiliation(s)
- Paula C Fontela
- Pneumological Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Sheila S Glaeser
- Physiotherapy Service, Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luciane Fg Martins
- Physiotherapy Service, Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Robledo L Condessa
- Physiotherapy Service, Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Douglas T Prediger
- Physiotherapy Service, Intensive Care Unit, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Soraia Gi Forgiarini
- Physiotherapy, Centro Universitário Metodista, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luiz A Forgiarini
- Health and Human Development and Physiotherapy, Universidade LaSalle, Canoas, Rio Grande do Sul, Brazil
| | - Thiago C Lisboa
- Pneumological Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Intensive Care Medicine Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gilberto Friedman
- Pneumological Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
- Intensive Care Medicine Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Raurell-Torredà M, Regaira-Martínez E, Planas-Pascual B, Ferrer-Roca R, Martí JD, Blazquez-Martínez E, Ballesteros-Reviriego G, Vinuesa-Suárez I, Zariquiey-Esteva G. Early mobilisation algorithm for the critical patient. Expert recommendations. ENFERMERIA INTENSIVA 2021. [PMID: 33745807 DOI: 10.1016/j.enfi.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Intensive care unit (ICU)-acquired weakness is developed by 40%-46% of patients admitted to ICU. Different studies have shown that Early Mobilisation (EM) is safe, feasible, cost-effective and improves patient outcomes in the short and long term. OBJECTIVE To design an EM algorithm for the critical patient in general and to list recommendations for EM in specific subpopulations of the critical patient most at risk for mobilisation: neurocritical, traumatic, undergoing continuous renal replacement therapy (CRRT) and with ventricular assist devices (VAD) or extracorporeal membrane oxygenation (ECMO). METHODOLOGY Review undertaken in the Medline, CINAHL, Cochrane and PEDro databases of studies published in the last 10 years, providing EM protocols/interventions. RESULTS 30 articles were included. Of these, 21 were on guiding EM in critical patients in general, 7 in neurocritical and/or traumatic patients, 1 on patients undergoing CRRT and 1 on patients with ECMO and/or VAD. Two figures were designed: one for decision-making, taking the ABCDEF bundle into account and the other with the safety criteria and mobility objective for each. CONCLUSIONS The EM algorithms provided can promote early mobilisation (between the 1st and 5th day from admission to ICU), along with aspects to consider before mobilisation and safety criteria for discontinuing it.
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Affiliation(s)
- M Raurell-Torredà
- Universidad de Barcelona, Investigadora principal proyecto MoviPre, Barcelona, España
| | - E Regaira-Martínez
- Clínica Universidad de Navarra, Pamplona, España; GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC).
| | - B Planas-Pascual
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, España
| | - R Ferrer-Roca
- Hospital Universitario Vall d'Hebron, Barcelona, España; Presidente de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC)
| | - J D Martí
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Clínic de Barcelona, Barcelona, España
| | - E Blazquez-Martínez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario de Bellvitge, L'Hospitalet de Llobgregat, Barcelona, España
| | - G Ballesteros-Reviriego
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, España
| | - I Vinuesa-Suárez
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, España
| | - G Zariquiey-Esteva
- GT Rehabilitación de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC); Hospital Universitario Vall d'Hebron, Barcelona, España
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Nakanishi N, Doi S, Kawahara Y, Shiraishi M, Oto J. Effect of vibration therapy on physical function in critically ill adults (VTICIA trial): protocol for a single-blinded randomised controlled trial. BMJ Open 2021; 11:e043348. [PMID: 33653754 PMCID: PMC7929803 DOI: 10.1136/bmjopen-2020-043348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Vibration therapy has been used as an additional approach in passive rehabilitation. Recently, it has been demonstrated to be feasible and safe for critically ill patients, whose muscle weakness and intensive care unit (ICU)-acquired weakness are serious problems. However, the effectiveness of vibration therapy in this population is unclear. METHODS AND ANALYSIS This study will enrol 188 adult critically ill patients who require further ICU stay after they can achieve sitting at the edge of the bed or wheelchair. The sample size calculation is based on a 15% improvement of Functional Status Score for the ICU. They will be randomised to vibration therapy coupled with protocolised mobilisation or to protocolised mobilisation alone; outcomes will be compared between the two groups. Therapy will be administered using a low-frequency vibration device (5.6-13 Hz) for 15 min/day from when the patient first achieves a sitting position and onward until discharge from the ICU. Outcome assessments will be blinded to the intervention. Primary outcome will be measured using the Functional Status Score for the ICU during discharge. Secondary outcomes will be identified as follows: delirium, Medical Research Council Score, ICU-acquired weakness, the change of biceps brachii and rectus femoris muscle mass measured by ultrasound, ICU mobility scale and ventilator-free and ICU-free days (number of free days during 28 days after admission). For safety assessment, vital signs will be monitored during the intervention. ETHICS AND DISSEMINATION This study has been approved by the Clinical Research Ethics Committee of Tokushima University Hospital. Results will be disseminated through publication in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER UMIN000039616.
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Affiliation(s)
- Nobuto Nakanishi
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Satoshi Doi
- Department of Nursing, Tokushima University Hospital, Tokushima, Japan
| | - Yoshimi Kawahara
- Department of Nursing, Tokushima University Hospital, Tokushima, Japan
| | - Mie Shiraishi
- Department of Nursing, Tokushima University Hospital, Tokushima, Japan
| | - Jun Oto
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
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Tadyanemhandu C, van Aswegen H, Ntsiea V. Organizational structures and early mobilization practices in South African public sector intensive care units-A cross-sectional study. J Eval Clin Pract 2021; 27:42-52. [PMID: 32141685 PMCID: PMC7483254 DOI: 10.1111/jep.13378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/15/2020] [Accepted: 02/03/2020] [Indexed: 12/12/2022]
Abstract
RATIONALE Understanding current early mobilization practice of patients in intensive care unit (ICU) is critical to the design and implementation of strategies to facilitate its application in a diverse population of critically ill patients encountered in public sector hospitals. AIM To evaluate the organizational structures of South African public sector hospital ICUs and to describe early mobilization practices in these units. METHODS A cross-sectional survey was done in participating public hospitals from eight provinces in South Africa. Convenience sampling was done. Data collected included hospital and ICU structure, adult patient demographic and clinical data, and mobilization activities done in ICU over the previous 24 hours prior to the day of the survey. RESULTS A total of 29 ICUs from 13 participating hospitals were surveyed resulting in 205 patient records. Majority of the surveyed ICUs were "open" type (n = 16; 55.2%). A standardized sedation scoring system was used in 18 units (62.1%) and only two units (6.9%) had an early mobilization protocol in place. Mean age of the patients surveyed was 43.5 (±17.7) years and 148 (72.2%) patients were on mechanical ventilation. Primary reasons for admission to ICU included traumatic injury (n = 86; 42%) and postoperative care (n = 33; 16.1%). Mobilization activities performed in the previous 24 hours included turning the patient in bed (n = 88; 42.9%), marching on the spot (n = 9; 4.4%) and walking (n = 10; 4.9%). Out-of-bed mobilization was done in only 40 (19.5%) patients. The most common barriers to early mobilization included patient unresponsiveness (n = 50; 24.4%) and hemodynamic instability (n = 42; 20.5%). The type of ventilation was found to have a significant positive relationship with out-of-bed patient mobilization (P = .000). CONCLUSIONS A small proportion of patients attained their highest level of mobilization in ICU. The type of ventilation influenced early mobilization practices in public sector ICUs in South Africa.
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Affiliation(s)
- Cathrine Tadyanemhandu
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Prolonged Mechanical Ventilation: The Journey Toward the Goal. Crit Care Med 2020; 47:1666-1667. [PMID: 31609266 DOI: 10.1097/ccm.0000000000003987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Timenetsky KT, Neto AS, Assunção MSC, Taniguchi L, Eid RAC, Corrêa TD. Mobilization practices in the ICU: A nationwide 1-day point- prevalence study in Brazil. PLoS One 2020; 15:e0230971. [PMID: 32240249 PMCID: PMC7117707 DOI: 10.1371/journal.pone.0230971] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 03/12/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mobilization of critically ill patients is safe and may improve functional outcomes. However, the prevalence of mobilization activities of ICU patients in Brazil is unknown. METHODS A one-day point prevalence prospective study with a 24-hour follow-up period was conducted in Brazil. Demographic data, ICU characteristics, prevalence of mobilization activities, level of patients' mobilization, and main reasons for not mobilizing patients were collected for all adult patients with more than 24hs of ICU stay in the 26 participating ICUs. Mobilization activity was defined as any exercise performed during ICU stay. RESULTS In total, 358 patients were included in this study. Mobilization activities were performed in 87.4% of patients. Patients received mobilization activities while under invasive mechanical ventilation (44.1%), noninvasive ventilation (11.7%), or without any ventilatory support (44.2%). Passive exercises were more frequently performed [46.5% in all patients; 82.3% in mechanically ventilated patients]. Mobilization activities included in-bed exercise regimen (72.2%). Out-of-bed mobility was reported in 39.9% of mobilized patients, and in 16.3% of patients under invasive mechanical ventilation. The presence of an institutional early mobility protocol was associated with early mobilization (OR, 3.19; 95% CI, 1.23 to 8.22; p = 0.016), and with out-of-bed exercise (OR, 5.80; 95% CI, 1.33 to 25.30; p = 0.02). CONCLUSION Mobilization activities in critically ill patients in Brazil was highly prevalent, although there was almost no active mobilization in the mechanically ventilated patients. Moreover, the presence of an institutional early mobility protocol was associated with a threefold higher chance of ICU mobilization during that day.
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Affiliation(s)
- Karina T. Timenetsky
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- * E-mail:
| | - Ary Serpa Neto
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
- Department of Pneumology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Murillo S. C. Assunção
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Leandro Taniguchi
- Department of Pneumology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Department of Intensive Care, Hospital Sírio Libanês, São Paulo, São Paulo, Brazil
| | - Raquel A. C. Eid
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Thiago D. Corrêa
- Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
- Brazilian Research in Intensive Care Network (BRICNet), São Paulo, Brazil
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Lima EAD, Rodrigues G, Peixoto Júnior AA, Sena RDS, Viana SMDNR, Mont’Alverne DGB. Mobility and clinical outcome of patients admitted to an intensive care unit. FISIOTERAPIA EM MOVIMENTO 2020. [DOI: 10.1590/1980-5918.032.ao67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction: The hospital environment exacerbates the effects of immobility due to several exposure factors, and the functional assessment of individuals using reliable instruments is vital. Objective: To determine the relationship between functional mobility and the clinical outcome of patients admitted to an intensive care unit. Method: This is a prospective quantitative longitudinal study, approved by the institutional research ethics committee, carried out in the intensive care unit of a University Hospital. Clinical data and the Acute Physiology and Chronic Health Evaluation (APACHE II) score were collected 24 hours after admission. The Perne Score was used to analyze patient mobility. Results: 33 patients participated, 63% female. With respect to mobility and transfers, 69.7% required total assistance from the supine to the sitting position and 70% to maintain balance, 9.1% needed minimum assistance from sitting to standing, and 100% total assistance for walking and endurance exercises. The main barriers to mobility were invasive ventilation (60%), assistive devices and intravenous infusion (100%). The following Perne Score domains were significantly associated with the outcome: mental status (p = 0.040), barriers to mobility (p = 0.016), strength (p = 0.010), mobility in bed (p = 0.024) and the total Perme Score ( p = 0.002). There were also significant associations between invasive ventilation and low Perme Scores (p = 0.000), and the Richmond Agitation-Sedation Scale (RASS) (-5 and -4) and death in 66.7% of patients (p = 0.011). The Perme Score and RASS (R = 0.745) were moderately correlated and APACHE II and Perme Score inversely moderately correlated (R = -0.526). Conclusion: Mobility assessed by the Perme Score was related to the clinical outcome and strongly associated with sedation level and patient severity.
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