A Descriptive Report of Early Mobilization for Critically Ill Ventilated Patients With Cancer

Abstract

Background Early mobilization protocols have been successfully implemented to improve function in critically ill patients; however, no study has focused on the oncology population. Objectives To investigate the feasibility of early mobilization and describe the rehabilitation interventions and discharge outcomes in a cohort of critically ill patients with cancer. Design Retrospective review. Methods A retrospective analysis of patients with cancer who participated in occupational and physical therapy while on mechanical ventilation utilizing an institutional early mobilization protocol from June 2010 – July 2011, was completed. Demographic and clinical variables were abstracted, as well as occupational and physical therapy interventions. Results A cohort of 42 cancer patients on mechanical ventilation in the mixed medical/surgical intensive care unit of a comprehensive cancer center received early mobilization during the study period. The majority of participants demonstrated improved cognitive and functional status from the intensive care unit to hospital discharge. There were no reported adverse events during the occupational and physical therapy sessions. Among the 30 hospital survivors, 53% required continued rehabilitation services in their home environment and 40% were transferred to a rehabilitation facility. Limitations Due to the small sample size, these findings are not generalizable to all critically ill cancer patients. There was no post-acute care follow-up of cognitive and physical functional performance. Conclusion Early mobilization appears feasible in addressing the cognitive and functional needs of oncology patients in the intensive care unit.

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

“…The team was diverse and comprised of clinical and non-clinical staff. The clinical staff involved were physiotherapists (PTs) [24, 37, 43, 44], occupational therapists (OTs) [43, 44], respiratory therapists (RTs) [24, 44] and nurses [24, 43, 44]. The non-clinical staff were technicians [24].…”

“…The non-clinical staff were technicians [24]. PTs and OTs were reported as key professional groups in evaluating a patient’s readiness for EM-MV [37, 44].…”

“…Expectation of outcome reflects the descriptions of the desired effects of EM-MV including preventing ICU complications, maintaining patient’s mobility and improving impairment. Two studies referred to specific preventions such as joint contractures [46] and delirium [44], and one study referred to general prevention which was to counteract immobilisation [62]. Patient’s mobility was targeted at achieving the highest functional level or regaining the functional status before ICU admission [37, 41, 44, 53, 56].…”

“…Two studies referred to specific preventions such as joint contractures [46] and delirium [44], and one study referred to general prevention which was to counteract immobilisation [62]. Patient’s mobility was targeted at achieving the highest functional level or regaining the functional status before ICU admission [37, 41, 44, 53, 56]. The expected responses of EM-MV in improving impairment were stated in the definitions by describing affected body systems including muscular, respiratory, circulatory and nervous systems [42, 46, 53].…”

“…EM-MV activities were reported taking place during mechanical ventilation with two apparent categories of duration, namely short term and long term. The short-term duration was described as within 48 h [25, 43, 52, 58, 84, 90, 91], within 72 h [44, 45, 87, 92] or after 48–72 h [57, 80, 82, 90, 93–95]. Long-term duration was beyond 7–21 days [39, 40, 47, 53, 72, 73, 75, 96, 97].…”