Early Mobility and Walking Program for Patients in Intensive Care Units: Creating a Standard of Care

Abstract

New technologies in critical care and mechanical ventilation have led to long-term survival of critically ill patients. An early mobility and walking program was developed to provide guidelines for early mobility that would assist clinicians working in intensive care units, especially clinicians working with patients who are receiving mechanical ventilation. Prolonged stays in the intensive care unit and mechanical ventilation are associated with functional decline and increased morbidity, mortality, cost of care, and length of hospital stay. Implementation of an early mobility and walking program could have a beneficial effect on all of these factors. The program encompasses progressive mobilization and walking, with the progression based on a patient’s functional capability and ability to tolerate the prescribed activity. The program is divided into 4 phases. Each phase includes guidelines on positioning, therapeutic exercises, transfers, walking reeducation, and duration and frequency of mobility sessions. Additionally, the criteria for progressing to the next phase are provided. Use of this program demands a collaborative effort among members of the multidisciplinary team in order to coordinate care for and provide safe mobilization of patients in the intensive care unit.

Optimization of quality of functional improvement – aspects of psychomedical treatment

“…However, when an individual suffers from an injury, his fitness may visibly deteriorate, and he will immediately become a patient to whom it will be a challenge to regain functioning from another (lower than professional) level of psychophysical fitness. He faces a situation referred to in the literature as "steps of psychophysical fitness" [22].…”

“…It is referred to as the zone of reduced psychophysical fitness. In both circumstances, (1) assisting the athlete in achieving the highest possible results in professional sport and (2) "taking the patient out" from the zone of reduced psychophysical fitness biomechanics (closely related to kinesiotherapy) provide the appropriate course of action for the improvement procedure [22].…”

The Effect of Standing up Early in the First 24 Hours After Surgery on Rapid Improvement: Systematic Review

“…25 Erken ayağa kaldırmanın olumlu etkileri dikkate alındığında; yatan hasta mobilizasyonunun, hastane ortamında klinik hemşireleri için daha yüksek öncelikle uygulanması gerektiği belirtilmektedir. 13,28,[31][32][33][34] Ameliyat sonrası ilk 24 saatte erken ayağa kaldırılan hastalarla ilgili çalışmalar incelendiğinde, yoğun bakım hastaları üzerinde erken mobilizasyon ile ilgili yapılmış bir çalışmada; erken ayağa kaldırılan hastalarda yoğun bakımdan çıkış ve taburcu olmanın hızlandığı, hastanede kalış süresi-nin azaldığı bildirilmektedir. 20 Diğer bir çalışmada; erken ayağa kaldırılan hastalarda, hastanede kalış süresinin 5,7 gün, erken ayağa kaldırılmayanlarda 12,9 gün olduğunu belirtmektedir.…”

Kurzversion S2e-Leitlinie – „Lagerungstherapie und Frühmobilisation zur Prophylaxe oder Therapie von pulmonalen Funktionsstörungen“

“…Maßnahmen zur Mobilisation werden in drei Bereiche eingeteilt: die passive Mobilisation, die assistierte aktive Mobilisation und die aktive Mobilisation [3,31,32,49,57,63,77,89] …”