Early Mobilization of Mechanically Ventilated Patients

Nydahl, Peter; Ruhl, A. Parker; Bartoszek, Gabriele; Dubb, Rolf; Filipovic, Silke; Flohr, Hans Jürgen; Kaltwasser, Arnold; Mende, Hendrik; Rothaug, Oliver; Schuchhardt, Danny; Schwabbauer, Norbert; Needham, Dale M.

doi:10.1097/ccm.0000000000000149

Cited by 274 publications

(284 citation statements)

References 31 publications

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“…There was a median of one ICU (IQR, 1-3) present in the hospitals surveyed. There were a median of 13 ICU beds (IQR, [9][10][11][12][13][14][15][16][17][18][19][20]. Most ICUs were mixed medical-surgical units (67% overall), and 27% were medical ICUs.…”

Section: Resultsmentioning

confidence: 99%

“…This is important to note, given that in recent point prevalence studies done in the United States, Australia and New Zealand, and Germany, actual ambulation of ventilated patients occurred rarely (12)(13)(14)(15), thus demonstrating a gap between reported perceived delivery and actual implementation. In addition, social desirability bias may play a role in respondents' answers.…”

Section: Limitationsmentioning

confidence: 99%

“…Despite this evidence, surveys and point prevalence studies of EM practice have shown limited penetration, particularly in patients undergoing MV (12)(13)(14)(15). For those interested in implementing this practice in routine care, representation of regional variation may help to better contextualize the working environment and may aid in analysis of relevant barriers.…”

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confidence: 99%

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Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Bakhru¹,

et al. 2016

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Rationale: Early mobilization (EM) improves outcomes for mechanically ventilated patients. Variation in structure and organizational characteristics may affect implementation of EM practices.Objectives: We queried intensive care unit (ICU) environment and standardized ICU practices to evaluate organizational characteristics that enable EM practice. Methods:We recruited 151 ICUs in France, 150 in Germany, 150 in the United Kingdom, and 500 in the United States by telephone. Survey domains included respondent characteristics, hospital and ICU characteristics, and ICU practices and protocols. Measurements and Main Results:We surveyed 1,484 ICU leaders and received a 64% response rate (951 ICUs). Eighty-eight percent of respondents were in nursing leadership roles; the remainder were physiotherapists. Surveyed ICUs were predominantly mixed medicalsurgical units (67%), and 27% were medical ICUs. ICU staffing models differed significantly (P , 0.001 each) by country for high-intensity staffing, nurse/patient ratios, and dedicated physiotherapists. ICU practices differed by country, with EM practices present in 40% of French ICUs, 59% of German ICUs, 52% of U.K. ICUs, and 45% of U.S. ICUs. Formal written EM protocols were present in 24%, 30%, 20%, and 30%, respectively, of those countries' ICUs. In multivariate analysis, EM practice was associated with multidisciplinary rounds (odds ratio [OR], 1.77; P = 0.001), setting daily goals for patients (OR, 1.62; P = 0.02), presence of a dedicated physiotherapist (OR, 2.48; P , 0.001), and the ICU's being located in Germany (reference, United States; OR, 2.84; P , 0.001). EM practice was also associated with higher nurse staffing levels (1:1 nurse/patient ratio as a reference; 1:2 nurse/patient ratio OR, 0.59; P = 0.05; 1:3 nurse/patient ratio OR, 0.33; P = 0.005; 1:4 or less nurse/patient ratio OR, 0.37; P = 0.005). Those responding rarely cited ambulation of mechanically ventilated patients, use of a bedside cycle, or neuromuscular electrical stimulation as part of their EM practice. Physical therapy initiation, barriers to EM practice, and EM equipment were highly variable among respondents. Conclusions:International ICU structure and practice is quite heterogeneous, and several factors (multidisciplinary rounds, setting daily goals for patients, presence of a dedicated physiotherapist, country, and nurse/patient staffing ratio) are significantly associated with the practice of EM. Practice and barriers may be far different based upon staffing structure. To achieve successful implementation, whether through trials or quality improvement, ICU staffing and practice patterns must be taken into account.

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Section: Resultsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

mentioning

confidence: 99%

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Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Bakhru¹,

et al. 2016

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“…However, despite these potential benefits, adoption of early mobility into clinical practice remains poor and delivery of activity to patients on mechanical ventilation remains low. A single-day prevalence study across German ICUs reported that only 24% of a total of 185 patients receiving mechanical ventilation mobilized out of bed in a 24-hour study period (20). A similar single-day prevalence study across Australian and New Zealand ICUs reported that no patient among 224 requiring mechanical ventilation mobilized out of bed on the study date (21).…”

mentioning

confidence: 93%

Hospital-Level Factors Associated with Report of Physical Activity in Patients on Mechanical Ventilation across Washington State

Jolley

Dale²,

Hough

2015

Annals ATS

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Rationale: Use of physical and/or occupational therapy in the intensive care unit (ICU) is safe, feasible, and demonstrates improvements in functional status with early administration. Access to physical and/or occupational therapy in the ICU is variable, with little known regarding its use in community ICUs.Objectives: Determine what proportion of hospitals across Washington State report use of physical activity in mechanically ventilated patients and investigate process of care factors associated with reported activity delivery.Methods: Cross-sectional telephone interview survey study of nurse managers in hospitals caring for patients on mechanical ventilation across Washington State in 2013. Survey responses were linked with hospital-level data available in the Washington State Department of Health Comprehensive Hospital Abstract Reporting System database. Chi-square testing was used to explore unadjusted associations between potential process of care factors and report on activity delivery. Two multivariable logistic regression models were developed to explore the association between presence of a mobility protocol and report on delivery of activity. Measurements and Main Results:We identified 54 hospitals caring for patients on mechanical ventilation; 47 participated in the survey (response rate, 85.5%). Nurse managers from 36 (76.6%) hospitals reported use of physical activity in patients on mechanical ventilation, with 22 (46.8%) reporting use of high-level physical activity (transferring to chair, standing or ambulating) and 24 (51.1%) reporting use in high-severity patients (patients requiring mechanical ventilation and/or vasopressors). Presence of a written ICU activity protocol (odds ratio [OR], 5.54; 95% confidence interval [CI], 1.60-19.18; P = 0.006), hospital volume (OR, 5.33; 95% CI, 1.54-18.48; P = 0.008), and academic affiliation (OR, 4.40; 95% CI, 1.23-15.63; P = 0.02) were associated with report of higher level activity. Presence of a written ICU activity protocol (OR, 6.00; 95% CI, 1.69-21.14; P = 0.005) and academic affiliation (OR, 4.50; 95% CI, 1.21-16.46; P = 0.02) were associated with report of delivery of physical activity to high-severity patients.Conclusions: Nurse managers at three-fourths (76.6%) of eligible hospitals across Washington State reported use of physical activity in patients on mechanical ventilation. Hospital-level factors including hospital volume, academic affiliation, and presence of a mobility protocol were associated with report of higher level activity and delivery of activity to high-severity patients.Keywords: early mobilization; critical illness myopathy; physical therapy; intensive care unit-acquired weakness

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“…As it is clear that excessively sustained sedation unnecessarily prolongs mechanical ventilation periods due to factors such as the onset of ventilator‐associated pneumonia and unsuccessful weaning trials,233, 234, 235, 236 the mainstream approach is shifting from “hypnosis‐focused sedation” to a “minimum sedation.” Preventing hallucinations and delusions is also important, and to do this, attending physicians should “avoid unnecessary sedation.” The safety of early‐stage rehabilitation in critically‐ill patients has also been pointed out,237 but reports made around the same time have highlighted how rehabilitation measures are infrequently implemented 238, 239. The issue of “excessive sedation” has been raised as a possible reason.…”

Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Early Mobilization of Mechanically Ventilated Patients

Cited by 274 publications

References 31 publications

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Hospital-Level Factors Associated with Report of Physical Activity in Patients on Mechanical Ventilation across Washington State

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

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