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Huebner L, Warmbein A, Scharf C, Schroeder I, Manz K, Rathgeber I, Gutmann M, Biebl J, Mehler-Klamt A, Huber J, Eberl I, Kraft E, Fischer U, Zoller M. Effects of robotic-assisted early mobilization versus conventional mobilization in intensive care unit patients: prospective interventional cohort study with retrospective control group analysis. Crit Care 2024; 28:112. [PMID: 38582934 PMCID: PMC10999075 DOI: 10.1186/s13054-024-04896-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Approximately one in three survivors of critical illness suffers from intensive-care-unit-acquired weakness, which increases mortality and impairs quality of life. By counteracting immobilization, a known risk factor, active mobilization may mitigate its negative effects on patients. In this single-center trial, the effect of robotic-assisted early mobilization in the intensive care unit (ICU) on patients' outcomes was investigated. METHODS We enrolled 16 adults scheduled for lung transplantation to receive 20 min of robotic-assisted mobilization and verticalization twice daily during their first week in the ICU (intervention group: IG). A control group (CG) of 13 conventionally mobilized patients after lung transplantation was recruited retrospectively. Outcome measures included the duration of mechanical ventilation, length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months. RESULTS During the first week in the ICU, the intervention group received a median of 6 (interquartile range 3-8) robotic-assisted sessions of early mobilization and verticalization. There were no statistically significant differences in the duration of mechanical ventilation (IG: median 126 vs. CG: 78 h), length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months between the IG and CG. CONCLUSION In this study, robotic-assisted mobilization was successfully implemented in the ICU setting. No significant differences in patients' outcomes were observed between conventional and robotic-assisted mobilization. However, randomized and larger studies are necessary to validate the adequacy of robotic mobilization in other cohorts. TRIAL REGISTRATION This single-center interventional trial was registered in clinicaltrials.gov as NCT05071248 on 27/08/2021.
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Affiliation(s)
- Lucas Huebner
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Angelika Warmbein
- Clinical Nursing Research and Quality Management Unit, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christina Scharf
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ines Schroeder
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Kirsi Manz
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Ivanka Rathgeber
- Clinical Nursing Research and Quality Management Unit, LMU University Hospital, LMU Munich, Munich, Germany
| | - Marcus Gutmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Johanna Biebl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Amrei Mehler-Klamt
- Professorship for Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Jana Huber
- Professorship for Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Inge Eberl
- Professorship for Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), LMU University Hospital, LMU Munich, Munich, Germany
| | - Uli Fischer
- Clinical Nursing Research and Quality Management Unit, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Zoller
- Department of Anaesthesiology, LMU University Hospital, LMU Munich, Munich, Germany
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Warmbein A, Hübner L, Rathgeber I, Mehler-Klamt AC, Huber J, Schroeder I, Scharf C, Gutmann M, Biebl J, Manz K, Kraft E, Eberl I, Zoller M, Fischer U. Robot-assisted early mobilization for intensive care unit patients: Feasibility and first-time clinical use. Int J Nurs Stud 2024; 152:104702. [PMID: 38350342 DOI: 10.1016/j.ijnurstu.2024.104702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 01/08/2024] [Accepted: 01/22/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Early mobilization is only carried out to a limited extent in the intensive care unit. To address this issue, the robotic assistance system VEMOTION® was developed to facilitate (early) mobilization measures more easily. This paper describes the first integration of robotic assistance systems in acute clinical intensive care units. OBJECTIVE Feasibility test of robotic assistance in early mobilization of intensive care patients in routine clinical practice. SETTING Two intensive care units guided by anesthesiology at a German university hospital. PARTICIPANTS Patients who underwent elective surgery with postoperative treatment in the intensive care unit and had an estimated ventilation time over 48 h. METHODS Participants underwent robot-assisted mobilization, scheduled for twenty-minute sessions twice a day, ten times or one week, conducted by nursing staff under actual operational conditions on the units. No randomization or blinding took place. We assessed data regarding feasible cutoff points (in brackets): the possibility of enrollment (x ≥ 50 %), duration (pre- and post-setup (x ≤ 25 min), therapy duration (x = 20 min), and intervention-related parameters (number of mobilizing professionals (x ≤ 2), intensity of training, events that led to adverse events, errors or discontinuation). Mobilizing professionals rated each mobilization regarding their physical stress (x ≤ 3) and feasibility (x ≥ 4) on a 7 Point Likert Scale. An estimated sample size of at least twenty patients was calculated. We analyzed the data descriptively. RESULTS Within 6 months, we screened thirty-two patients for enrollment. 23 patients were included in the study and 16 underwent mobilization using robotic assistance, 7 dropped out (enrollment eligibility = 69 %). On average, 1.9 nurses were involved per therapy unit. Participants received 5.6 robot-assisted mobilizations in mean. Pre- and post-setup had a mean duration of 18 min, therapy a mean of 21 min. The robot-assisted mobilization was started after a median of 18 h after admission to the intensive care unit. We documented two adverse events (pain), twelve errors in handling, and seven unexpected events that led to interruptions or discontinuation. No serious adverse events occurred. The mobilizing nurses rated their physical stress as low (mean 2.0 ± 1.3) and the intervention as feasible (mean 5.3 ± 1.6). CONCLUSIONS Robot-assisted mobilization was feasible, but specific safety measures should be implemented to prevent errors. Robotic-assisted mobilization requires process adjustments and consideration of unit staffing levels, as the intervention does not save staff resources or time. REGISTRATION clinicaltrials.org TRN: NCT05071248; Date: 2021/10/08; URL https://clinicaltrials.gov/ct2/show/NCT05071248. TWEETABLE ABSTRACT Robot-assisted early mobilization in intensive care patients is feasible and no adverse event occurred.
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Affiliation(s)
- Angelika Warmbein
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany.
| | - Lucas Hübner
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Ivanka Rathgeber
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany
| | - Amrei Christin Mehler-Klamt
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Jana Huber
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Ines Schroeder
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Christina Scharf
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Marcus Gutmann
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Johanna Biebl
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Kirsi Manz
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Eduard Kraft
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Inge Eberl
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Michael Zoller
- Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany
| | - Uli Fischer
- Department of Clinical Nursing Research and Quality Management, University Hospital, LMU Munich, Munich, Germany
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Ohneberg C, Stöbich N, Warmbein A, Rathgeber I, Mehler-Klamt AC, Fischer U, Eberl I. Assistive robotic systems in nursing care: a scoping review. BMC Nurs 2023; 22:72. [PMID: 36934280 PMCID: PMC10024291 DOI: 10.1186/s12912-023-01230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/03/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND The use of assistive robotic systems in care is intended to relieve nursing staff. Differentiated and literature-based findings on current application possibilities, technological developments and empirical findings are necessary to enable a goal-oriented and participatory development of assistive robotic systems of care. The aim of this review was to identify assistive robotic systems and their areas of application in nursing settings. Furthermore, an overview of existing social and nursing science findings from the research field of assistive robotic systems will be described. METHODS A systematic literature search was performed based on the JBI scoping review methodology. During the period from May to August 2020, the databases MEDLINE via PubMed, CINAHL, Cochrane Library, Web of Science, and IEEE Xplore Digital Library were searched. In order to reflect current developments and evidence in the present literature work, a supplementary search with these same requirements was conducted in January 2022. RESULTS The 47 included publications are divided into 15 studies, 23 technical articles and nine opinion-based articles (text-opinion). A total of 39 different assistive robotic systems were identified. There were 55% in the testing phase and 29% of the systems in the development phase. Assistive robotic systems can be divided into six fields of application: Information and patient data processing, assistance with activities of daily living, fetch and bring activities, telepresence and communication, monitoring, safety and navigation, and complex assistance systems. The description of the study findings is divided into "integration of technology and impact on practice" and "attitude and acceptance of elderly people towards assistive robotic systems". CONCLUSION The results of the research show that the use of assistive robotic systems in care mainly take place in the context of development and testing phases. In addition to usability and acceptance issues, implementation factors must be integrated into theory-driven research projects.
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Affiliation(s)
- Christoph Ohneberg
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072, Eichstätt, Germany.
| | - Nicole Stöbich
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072, Eichstätt, Germany
| | - Angelika Warmbein
- Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Ivanka Rathgeber
- Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Amrei Christin Mehler-Klamt
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072, Eichstätt, Germany
| | - Uli Fischer
- Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Inge Eberl
- Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072, Eichstätt, Germany
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Warmbein A, Rathgeber I, Seif J, Mehler-Klamt AC, Schmidbauer L, Scharf C, Hübner L, Schroeder I, Biebl J, Gutmann M, Eberl I, Zoller M, Fischer U. Barriers and facilitators in the implementation of mobilization robots in hospitals from the perspective of clinical experts and developers. BMC Nurs 2023; 22:45. [PMID: 36797701 PMCID: PMC9936640 DOI: 10.1186/s12912-023-01202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Early mobilization can help reduce severe side effects such as muscle atrophy that occur during hospitalization. However, due to time and staff shortages in intensive and critical care as well as safety risks for patients, it is often difficult to adhere to the recommended therapy time of twenty minutes twice a day. New robotic technologies might be one approach to achieve early mobilization effectively for patients and also relieve users from physical effort. Nevertheless, currently there is a lack of knowledge regarding the factors that are important for integrating of these technologies into complex treatment settings like intensive care units or rehabilitation units. METHODS European experts from science, technical development and end-users of robotic systems (n = 13) were interviewed using a semi-structured interview guideline to identify barriers and facilitating factors for the integration of robotic systems into daily clinical practice. They were asked about structural, personnel and environmental factors that had an impact on integration and how they had solved challenges. A latent content analysis was performed regarding the COREQ criteria. RESULTS We found relevant factors regarding the development, introduction, and routine of the robotic system. In this context, costs, process adjustments, a lack of exemptions, and a lack of support from the manufacturers/developers were identified as challenges. Easy handling, joint decision making between the end-users and the decision makers in the hospital, an accurate process design and the joint development of the robotic system of end-users and technical experts were found to be facilitating factors. CONCLUSION The integration and preparation for the integration of robotic assistance systems into the inpatient setting is a complex intervention that involves many parties. This study provides evidence for hospitals or manufacturers to simplify the planning of integrations for permanent use. TRIAL REGISTRATION DRKS-ID: DRKS00023848; registered 10/12/2020.
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Affiliation(s)
- Angelika Warmbein
- Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Ivanka Rathgeber
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Janesca Seif
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Amrei C. Mehler-Klamt
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Lena Schmidbauer
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Christina Scharf
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Lucas Hübner
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Ines Schroeder
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Johanna Biebl
- grid.5252.00000 0004 1936 973XDepartment of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Marcus Gutmann
- grid.5252.00000 0004 1936 973XDepartment of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Inge Eberl
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Michael Zoller
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Uli Fischer
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Ohneberg C, Warmbein A, Stöbich N, Rathgeber I, Kruppa A, Nast-Kolb J, Träger MF, Bahou A, Stahl O, Eberl I, Fischer U. Study protocol for the implementation and evaluation of a digital-robotic-based intervention for nurses and patients in a hospital: a quantitative and qualitative triangulation based on the Medical Research Council (MRC) framework for developing and evaluating complex interventions. BMC Nurs 2022; 21:349. [PMID: 36494679 PMCID: PMC9733387 DOI: 10.1186/s12912-022-01088-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/27/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Nurses spend part of their working time on non-nursing tasks. Unnecessary walking distances and the assumption of service activities and other non-care-related tasks take up a lot of space, which reduces the time for direct patient care and demonstrably increases the dissatisfaction of the persons involved. The REsPonSe project aims to relieve nursing staff by using a smartphone app for communication in combination with an autonomous service robot to reduce walking distances and service activities. The technical systems are tested on a nuclear medicine ward and are intended to reduce the radiation exposure of the staff. The aim of this study is to test and evaluate the use and intervention of the technical systems, the acceptance of the users and the change in the utilisation of the nursing service. In addition to findings on usability and manageability, effects on nursing practice, as well as facilitating and inhibiting contextual factors for implementation, will be identified. METHODS The Medical Research Council (MRC) Framework for Developing and Evaluating for Complex Interventions was chosen as the theoretical basis. The data collection in the Feasibility and Evaluation phase is a triangulation of quantitative and qualitative methods. Standardised observations are planned to collect data on non-care activities and walking distances, and a survey of utilisation by use of a questionnaire based on the NASA TLX. Qualitative individual interviews with patients and group discussions with nursing staff will be conducted. Statements on the subjective experiences, as well as the evaluation of the use of the digital-robotic system in the clinical setting, will be collected. The descriptive evaluation of the usage and retrieval data will provide information on duration, time, requests, and reduced contact times, as well as error and fault messages. DISCUSSION The evaluation study will make it possible to represent a variety of perspectives from different interest groups. The results should contribute to the definition of implementation and evaluation criteria and facilitate the integration of digital-robotic assistance systems in nursing acute inpatient settings. TRIAL REGISTRATION The trial was registered with the German Clinical Trials Register (DRKS) on 16.02.2022: DRKS00028127.
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Affiliation(s)
- Christoph Ohneberg
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072 Eichstätt, Germany
| | - Angelika Warmbein
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Nicole Stöbich
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072 Eichstätt, Germany
| | - Ivanka Rathgeber
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Astrid Kruppa
- Cliniserve GmbH, Balanstr. 73/10, 81541 Munich, Germany
| | | | | | - Aissam Bahou
- Robotise AG, Otto-Hahn-Ring 6, Building 60, 81739 Munich, Germany
| | - Oliver Stahl
- Robotise AG, Otto-Hahn-Ring 6, Building 60, 81739 Munich, Germany
| | - Inge Eberl
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072 Eichstätt, Germany
| | - Uli Fischer
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Warmbein A, Schroeder I, Mehler-Klamt A, Rathgeber I, Huber J, Scharf C, Hübner L, Gutmann M, Biebl J, Lorenz A, Kraft E, Zoller M, Eberl I, Fischer U. Robot-assisted early mobilization of intensive care patients: a feasibility study protocol. Pilot Feasibility Stud 2022; 8:236. [PMCID: PMC9636622 DOI: 10.1186/s40814-022-01191-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Early mobilization positively influences the outcome of critically ill patients, yet in clinical practice, the implementation is sometimes challenging. In this study, an adaptive robotic assistance system will be used for early mobilization in intensive care units. The study aims to evaluate the experience of the mobilizing professionals and the general feasibility of implementing robotic assistance for mobilization in intensive care as well as the effects on patient outcomes as a secondary outcome.
Methods
The study is single-centric, prospective, and interventional and follows a longitudinal study design. To evaluate the feasibility of robotic-assisted early mobilization, the number of patients included, the number of performed VEM (very early mobilization) sessions, and the number and type of adverse events will be collected. The behavior and experience of mobilizing professionals will be evaluated using standardized observations (n > 90) and episodic interviews (n > 36) before implementation, shortly after, and in routine. Patient outcomes such as duration of mechanical ventilation, loss of muscle mass, and physical activity will be measured and compared with a historical patient population. Approximately 30 patients will be included.
Discussion
The study will provide information about patient outcomes, feasibility, and the experience of mobilizing professionals. It will show whether robotic systems can increase the early mobilization frequency of critically ill patients. Within ICU structures, early mobilization as therapy could become more of a focus. Effects on the mobilizing professionals such as increased motivation, physical relief, or stress will be evaluated. In addition, this study will focus on whether current structures allow following the recommendation of mobilizing patients twice a day for at least 20 min.
Trial registration
ClinicalTrials.gov, NCT05071248. Date: 2021/10/21
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Huebner L, Schroeder I, Kraft E, Gutmann M, Biebl J, Klamt AC, Frey J, Warmbein A, Rathgeber I, Eberl I, Fischer U, Scharf C, Schaller SJ, Zoller M. [Early mobilization in the intensive care unit-Are robot-assisted systems the future?]. Anaesthesiologie 2022; 71:795-800. [PMID: 35925160 DOI: 10.1007/s00101-022-01130-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/30/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Intensive care unit (ICU) acquired weakness is associated with reduced physical function, increased mortality and reduced quality of life, and affects about 43% of survivors of critical illness. Lacking therapeutic options, the prevention of known risk factors and implementation of early mobilization is essential. Robotic assistance devices are increasingly being studied in mobilization. OBJECTIVE This qualitative review synthesizes the evidence of early mobilization in the ICU and focuses on the advantages of robotic assistance devices. RESULTS Active mobilization should begin early during critical care. Interventions commencing 72 h after admission to the ICU are considered early. Mobilization interventions during critical care have been shown to be safe and reduce the time on mechanical ventilation in the ICU and the length of delirious episodes. Protocolized early mobilization interventions led to more active mobilization and increased functional independence and mobility at hospital discharge. In rehabilitation after stroke, robot-assisted training increases the chance of regaining independent walking ability, especially in more severely impaired patients, seems to be safe and increases muscle strength and quality of life in small trials. CONCLUSION Early mobilization improves the outcome of the critically ill. Robotic devices support the gait training after stroke and are the subject of ongoing studies on early mobilization and verticalization in the intensive care setting.
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Affiliation(s)
- Lucas Huebner
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
| | - Ines Schroeder
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Eduard Kraft
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, München, Deutschland
| | - Marcus Gutmann
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, München, Deutschland
| | - Johanna Biebl
- Klinik für Orthopädie und Unfallchirurgie, Muskuloskelettales Universitätszentrum München (MUM), Klinikum der Universität München, LMU München, München, Deutschland
| | - Amrei Christin Klamt
- Professur für Pflegewissenschaften, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Jana Frey
- Professur für Pflegewissenschaften, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Angelika Warmbein
- Klinische Pflegeforschung & Qualitätsmanagement, LMU Klinikum, München, Deutschland
| | - Ivanka Rathgeber
- Klinische Pflegeforschung & Qualitätsmanagement, LMU Klinikum, München, Deutschland
| | - Inge Eberl
- Professur für Pflegewissenschaften, Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Uli Fischer
- Klinische Pflegeforschung & Qualitätsmanagement, LMU Klinikum, München, Deutschland
| | - Christina Scharf
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
| | - Stefan J Schaller
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Michael Zoller
- Klinik für Anästhesiologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
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Mehler-Klamt AC, Huber J, Schmidbauer L, Warmbein A, Rathgeber I, Fischer U, Eberl I. Der Einsatz von robotischen und technischen Systemen zur Frühmobilisation von Intensivpatient_innen. Pflege 2022; 36:156-167. [DOI: 10.1024/1012-5302/a000891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Hintergrund: Intensivpatient_innen sind oft einer langen Immobilität ausgesetzt. Wenn sie aber frühzeitig mobilisiert werden, lassen sich positive Effekte auf ihr Outcome, wie z.B. eine Verbesserung der körperlichen Funktion, nachweisen. Einer der Gründe für die späte Mobilisation ist, dass zu wenig Hilfsmittel zur Verfügung stehen. Fragestellungen/Ziel: Dieser Beitrag gibt einen Überblick über den Einsatz von robotischen oder technischen Systemen als Hilfsmittel für die Frühmobilisation. Welche robotischen und technischen Hilfsmittel werden in Studien zur Frühmobilisation von erwachsenen Intensivpatient_innen durch Pflegefachpersonen oder Physiotherapeut_innen untersucht? Über welche Effekte von Frühmobilisation mittels robotischem und technischem System auf die Patientenoutcomes wird in den Studien berichtet? Methoden: Die Datenbanken Medline, Web of Science, CINAHL, Cochrane Library, Embase, IEEE Xplore, Scopus und WTI wurden zwischen Mai und Juli 2020 und im Januar 2022 systematisch durchsucht. Zusätzlich wurde im ersten Suchlauf eine Randsuche über GoogleScolar und ResearchGate durchgeführt. Ergebnisse: Es wurden 27 Veröffentlichungen eingeschlossen (9 RCTs, 7 Expertenmeinungen, 3 quantitative Querschnittstudien, 2 Fall-Kontroll-Studien, 2 Literaturreviews, 2 klinische Einzelfallstudien, 2 Interventionsstudien im Prä-Post-Design). Hier zeigte sich, dass als Hilfsmittel vor allem elektronische Bettfahrräder und Kipptische eingesetzt werden. Es war eine uneinheitliche Datenlage in Bezug auf verschiedene Patientenoutcomes nachweisbar. Schlussfolgerungen: Weitere Forschung zum Einsatz von technischen und robotischen Systemen zur Frühmobilisation ist vor allem in Bezug auf unterschiedliche Studienpopulationen notwendig. Frühmobilisationsrobotik ist noch nicht Teil der Regelversorgung.
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Affiliation(s)
| | - Jana Huber
- Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | - Lena Schmidbauer
- Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
| | | | | | | | - Inge Eberl
- Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Deutschland
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Ohneberg C, Stöbich N, Warmbein A, Rathgeber I, Fischer U, Eberl I. Potential Uses of Assistive Robotic Systems in Acute Inpatient Care. Stud Health Technol Inform 2022; 294:801-802. [PMID: 35612207 DOI: 10.3233/shti220587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Potential uses of assistive robotic systems in acute inpatient care were defined based on the Framework for Complex Interventions developed by the Medical Research Council (MRC). This process of definition requires the consideration of personal-related and contextual factors.
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Affiliation(s)
| | | | | | - Ivanka Rathgeber
- Hospital of the Ludwig-Maximilians-University (LMU) Munich, Germany
| | - Uli Fischer
- Hospital of the Ludwig-Maximilians-University (LMU) Munich, Germany
| | - Inge Eberl
- Catholic University of Eichstätt-Ingolstadt, Germany
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10
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Klamt AC, Schmidbauer L, Warmbein A, Rathgeber I, Fischer U, Eberl I. Very Early Robot-Assisted Mobilization of Intensive Care Patients - A Scoping Review. Stud Health Technol Inform 2021; 281:1073-1074. [PMID: 34042843 DOI: 10.3233/shti210350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This scoping review gives an overview of current research activities in the field of very early mobilization with robotic devices of intensive care patients. It presents the effect of very early, robot-assisted mobilization on intensive care patients based on their outcomes.
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Affiliation(s)
- Amrei C Klamt
- Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072 Eichstätt, Germany
| | - Lena Schmidbauer
- Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072 Eichstätt, Germany
| | - Angelika Warmbein
- Hospital of the Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Ivanka Rathgeber
- Hospital of the Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Uli Fischer
- Hospital of the Ludwig-Maximilians-University (LMU) Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Inge Eberl
- Catholic University of Eichstätt-Ingolstadt, Kapuzinergasse 2, 85072 Eichstätt, Germany
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11
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Ohneberg C, Stöbich N, Warmbein A, Rathgeber I, Fischer U, Eberl I. Service Robotics in Nursing Care. The Preliminary Results of a Scoping Review. Stud Health Technol Inform 2021; 281:1075-1076. [PMID: 34042844 DOI: 10.3233/shti210351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A scoping review was prepared in the first study phase of the REsPonSe project. The objective was to gain an overview of existing literature and available evidence on the subject of service robotics in nursing care. The systematic literature search took place using the following databases: PubMed, CINAHL, Cochrane, Web of Science and IEEE Xplore. The titles and abstracts of 2.761 references were screened based on the inclusion criteria. A total of 31 articles were identified as relevant for the study.
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Affiliation(s)
| | | | | | - Ivanka Rathgeber
- Hospital of the Ludwig-Maximilians-University (LMU) Munich, Germany
| | - Uli Fischer
- Hospital of the Ludwig-Maximilians-University (LMU) Munich, Germany
| | - Inge Eberl
- Catholic University of Eichstätt-Ingolstadt, Germany
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12
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Rathgeber I. [Respirators in intensive care medicine. Fundamentals]. Anaesthesist 1993; 42:396-417. [PMID: 8342752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Microprocessor-controlled intensive care ventilators combine controls of pressure, flow, volume, and timing to generate various breathing modes and differentiated breathing patterns that will meet the respiratory needs of the patient. This is essential when respirator-supported ventilation is performed. Graphic representation of ventilatory parameters is another important feature, facilitating subtle adjustments. The future may bring even more desirable options to improve monitoring of respiratory mechanics and make management easier. Modern ventilators differ less in technical features than do the accessories with different options. Most of these options are costly without any corresponding benefit in terms of treatment or diagnosis; nevertheless, future upgrading possibilities should be borne in mind when hardware is purchased. There is no ideal ventilator, and the success of respiratory treatment will therefore continue to be dependent on the patient's underlying disease and the therapist's level of training and experience rather than on the choice of respirator.
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Affiliation(s)
- I Rathgeber
- Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen
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