BackgroundEarly mobilization in critically ill patients has been shown to prevent bed-rest-associated morbidity. Reported reasons for not mobilizing patients, thereby excluding or delaying such intervention, are diverse and comprise safety considerations for high-risk critically ill patients with multiple organ support systems. This study sought to demonstrate that early mobilization performed within the first 24 h of ICU admission proves to be feasible and well tolerated in the vast majority of critically ill patients.ResultsGeneral practice data were collected for 171 consecutive admissions to our ICU over a 2-month period according to a local, standardized, early mobilization protocol. The total period covered 731 patient-days, 22 (3 %) of which met our local exclusion criteria for mobilization. Of the remaining 709 patient-days, early mobilization was achieved on 86 % of them, bed-to-chair transfer on 74 %, and at least one physical therapy session on 59 %. Median time interval from ICU admission to the first early mobilization activity was 19 h (IQR = 15–23). In patients on mechanical ventilation (51 %), accounting for 46 % of patient-days, 35 % were administered vasopressors and 11 % continuous renal replacement therapy. Within this group, bed-to-chair transfer was achieved on 68 % of patient-days and at least one early mobilization activity on 80 %. Limiting factors to start early mobilization included restricted staffing capacities, diagnostic or surgical procedures, patients’ refusal, as well as severe hemodynamic instability. Hemodynamic parameters were rarely affected during mobilization, causing interruption in only 0.8 % of all activities, primarily due to reversible hypotension or arrhythmia. In general, all activities were well tolerated, while patients were able to self-regulate their active early mobilization. Patients’ subjective perception of physical therapy was reported to be enjoyable.ConclusionsMobilization within the first 24 h of ICU admission is achievable in the majority of critical ill patients, in spite of mechanical ventilation, vasopressor administration, or renal replacement therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0184-y) contains supplementary material, which is available to authorized users.
Supplemental Digital Content is available in the text.
Background: Dysphagia occurs commonly in the intensive care unit (ICU). Despite the clinical relevance, there is little worldwide research on prevention, assessment, evaluation, and/or treatment of dysphagia for ICU patients. We aimed to gain insight into this international knowledge gap. Methods:We conducted a multi-center, international online cross-sectional survey of adult ICUs. Local survey distribution champions were recruited through professional and personal networks. The survey was administered from November 2017 to June 2019 with three email and a final telephone reminder. Results:Responses were received from 746 ICUs (26 countries). In patients intubated >48 hours, 17% expected a >50% chance that dysphagia would develop. This proportion increased to 43% in patients intubated >7 days, and to 52% in tracheotomized patients. Speech-language pathologist (SLP) consultation was available in 66% of ICUs, only 4% reported a dedicated SLP.Although 66% considered a routine post-extubation dysphagia protocol important, most (67%) did not have a protocol. Few ICUs routinely assessed for dysphagia after 48 hours intubation (30%) or tracheostomy (41%). A large proportion (46%) used water swallow screening tests to determine aspiration, few (8%) used instrumental assessments (i.e., flexible endoscopic evaluation of swallowing). Swallowing exercises were used for dysphagia management by 30% of ICUs.Conclusions: There seems to be limited awareness among ICU practioners that patients are at risk of dysphagia, particularly as ventilation persists, protocols, routine assessment and instrumental assessments are generally not used. We recommend the development of a research agenda to increase the quality of evidence and ameliorate the implementation of evidence-based dysphagia protocols by dedicated SLPs.
The critically ill have increased REE according to inflammation defined by CRP. Increased energy requirement for physical activity was only present for active exercise and seems to differ from that in the healthy population. For the exercise duration and intensity tested, nutritional adjustment is not indicated.
physique et réadaptation (SOFMER), du Groupe francophone de réanimation et urgences pédiatriques (GFRUP). J. Roeseler • T. Sottiaux • V. Lemiale • M. Lesny, pour le groupe d'experts Groupe d'experts : G. Beduneau (Rouen), E. Bialais (Bruxelles), N. Bradaï (Paris), V. Castelain (Strasbourg), M. Dinomais (Angers), N. Dousse (Genève), L. Fontaine (Bruxelles), C. Guérin (Lyon), C. Hickmann (Bruxelles), M. Jougleux (Corbeil-Essonnes), S. Kouki (Paris), F. Leboucher (Corbeil-Essonnes), M. Lemaire (Bruxelles), A. Nassaj (Le Havre), J. Nunes (Corbeil-Essonnes), G. Robain (Paris), F. Thiollière (Lyon), A. Thivellier (Corbeil-Essonnes), X. Wittebole (Bruxelles) Comité d'organisation pour la commission des référentiels et de l'évaluation de la SRLF : D.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.