Development of a neuro early mobilisation protocol for use in a neuroscience intensive care unit

Brissie, Megan A.; Zomorodi, Meg; Soares-Sardinha, Sharmila; Jordan, J. Dedrick

doi:10.1016/j.iccn.2017.03.007

Cited by 9 publications

(15 citation statements)

References 17 publications

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“…A recent systematic review shows that there is no consensus on the definition of the term "early mobilisation" (EM), 8 with a wide timeframe from the beginning of EM activities. Currently, there are several EM protocols [9][10][11][12][13][14][15] covering a wide range of interventions, including positioning, range-of-motion exercises (ROM), electrical muscle stimulation, cycle ergometers, tilt tables, transfer training, progressive resistance exercises, ambulating, and functional mobilisation. 15 ICU early mobility programmes (EMP) are associated with an improvement in clinical outcomes, such as decrease in days of delirium, increase of functional status, decreased hospital and ICU length of stay (LOS), decreased mortality, significant economic cost, and patient and family satisfaction with care.…”

Section: Introductionmentioning

confidence: 99%

“…A recent systematic review shows that there is no consensus on the definition of the term “early mobilisation” (EM), 8 with a wide timeframe from the beginning of EM activities. Currently, there are several EM protocols 9‐15 covering a wide range of interventions, including positioning, range‐of‐motion exercises (ROM), electrical muscle stimulation, cycle ergometers, tilt tables, transfer training, progressive resistance exercises, ambulating, and functional mobilisation 15 …”

Section: Introductionmentioning

confidence: 99%

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Can an early mobilisation programme prevent hospital‐acquired pressure injures in an intensive care unit?: A systematic review and meta‐analysis

Nieto-García

Carpio-Pérez

Moreiro-Barroso

et al. 2020

International Wound Journal

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A systematic review and meta-analysis were conducted to clarify the effect of an early mobilisation programme on the prevention of hospital-acquired pressure injuries in an intensive care unit as opposed to standard care. We searched a total of 11 databases until 1 May 2020 and included seven studies (n = 7.520) related to the effect of early mobilisation protocol in the prevention of hospital-acquired pressure injuries (five quasi-experimental and two random comparative). The five quasi-experimental studies were significantly heterogeneous (P = .02 for Q test and 66% for I 2), and the odds ratio was 0.97 (95% CI: 0.49-1.91) with a nonsignificant statistical difference between both groups (P = .93). Our study shows inconclusive outcomes related to the effect of the implementation of an early mobility programme in the prevention of pressure injuries in critical patients. Future research is needed considering the small number of articles on the topic.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Can an early mobilisation programme prevent hospital‐acquired pressure injures in an intensive care unit?: A systematic review and meta‐analysis

Nieto-García

Carpio-Pérez

Moreiro-Barroso

et al. 2020

International Wound Journal

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“…Increased ICP has been reported to compromise early mobilization in patients with traumatic brain injury as exercise is associated with further increases in cranial pressure 35 . However, there are published guidelines that can be used for safe mobilization of neurosurgical patients, with minimisation of adverse events 36,37 . The early mobilization of neurosurgical patients requires close monitoring and continuous adjustments in respect of the type and intensity of exercise prescribed, with the patient's clinical condition being continuously monitored 38 .…”

Section: Discussionmentioning

confidence: 99%

Organizational structures and early mobilization practices in South African public sector intensive care units—A cross‐sectional study

Tadyanemhandu

Aswegen

Ntsiea

2020

Evaluation Clinical Practice

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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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“…It is recommended to perform non-vertical positioning (handling for children) for ICU patients of all ages within the 1 st day in the ICU. It should be made by changing the position of limbs and body of the patient in relation to the horizontal plane depending on the status of verticalization not rarer than every two hours (except for night sleep) to prevent complications after therapeutic immobilization [59,62] (level of evidence -3, grade of recommendation -B). [65].…”

Section: Comments Stop-signs Include Signs That Show the Maximal Rate...mentioning

confidence: 99%

Rehabilitation in the intensive care unit (RehabICU). Clinical practice recommendations of the national Union of Physical and Rehabilitation Medicine Specialists of Russia and of the national Federation of Anesthesiologists and Reanimatologists

Белкин

Belkin

et al. 2022

Annals of Critical Care

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Выписываясь из отделения анестезиологии, реанимации и интенсивной терапии, более 50 % пациентов испытывают патологические симптомы, не имеющие отношения к первичному неотложному состоянию, но снижающие качество жизни и требующие реабилитации. Совокупность таких симптомокомплексов называется «синдром последствий интенсивной терапии» (ПИТC). ПИТС включает: комплекс инфекционно-трофических, вегетативно-метаболических (хронизирующийся болевой синдром, нарушение циркадных ритмов, гравитационного градиента, нейромышечных (полимионейропатия критических состояний, респираторная нейропатия, дисфагия бездействия), эмоционально-когнитивных осложнений (депрессия, делирий, снижение памяти и пр.). Патофизиологической основой ПИТС является феномен «наученного неиспользования» (learned non-use), состояние искусственного ограничения двигательной и когнитивной активности пациента в результате применения анальгоседации, постельного режима и иммобилизации. Клиническая картина ПИТС определяется выраженностью отдельных его компонентов, детализируемых с применением пакета клиниметрических шкал. На основе результатов динамического тестирования рассчитывается индекс тяжести ПИТС. Сумма баллов в диапазоне от 0 до 10 отражает как факт наличия ПИТС, так и степень тяжести и потенциал реабилитационных мероприятий. Для профилактики ПИТС Союзом реабилитологов России совместно с Федерацией анестезиологов и реаниматологов России разработан реабилитационный комплекс РеабИТ. В англоязычной литературе такой комплекс называется “Awakening and Breathing Coordination, Delirium monitoring/management, and Early exercise/mobility” (ABCDEF bundle). РеабИТ — комплекс технологически лечебно-диагностических модулей «позиционирование и мобилизация», «профилактика дисфагии и нутритивного дефицита», «профилактика эмоционально-когнитивных нарушений и делирия», «профилактика утраты навыков самообслуживания». В соответствии с федеральным Порядком организации реабилитационной помощи для реализации РеабИТ предусмотрена организация отделения ранней реабилитации. Основу отделения составляет мультидисциплинарная реабилитационная команда, в которую входит врач по медицинской реабилитации, не менее 2 специалистов по физической реабилитации, специалист по эргореабилитации, медицинский психолог/врач-психотерапевт, медицинский логопед, медицинская сестра по медицинской реабилитации. Деятельность отделения ранней реабилитации оценивается на основании критериев качества и достижении основной цели РеабИТ — сохранение преморбидного статуса социализированности пациента. Пациенты с развившимся ПИТС маршрутизируются на этапы реабилитационного лечения с использованием шкалы реабилитационной маршрутизации на основе телемедицинских технологий.

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Development of a neuro early mobilisation protocol for use in a neuroscience intensive care unit

Cited by 9 publications

References 17 publications

Can an early mobilisation programme prevent hospital‐acquired pressure injures in an intensive care unit?: A systematic review and meta‐analysis

Can an early mobilisation programme prevent hospital‐acquired pressure injures in an intensive care unit?: A systematic review and meta‐analysis

Organizational structures and early mobilization practices in South African public sector intensive care units—A cross‐sectional study

Rehabilitation in the intensive care unit (RehabICU). Clinical practice recommendations of the national Union of Physical and Rehabilitation Medicine Specialists of Russia and of the national Federation of Anesthesiologists and Reanimatologists

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