Early Mobilization of Patients in Intensive Care: Organization, Communication and Safety Factors that Influence Translation into Clinical Practice

Abstract

not result in improved patient-centered outcomes when tested in a larger trial [7, 8]. More importantly, it has been difficult to test this complex intervention, with several randomized trials delivering significantly less early mobilization than specified in the study protocol [2, 9] and observational studies reporting very low rates of early mobilization during the ICU stay [10, 11]. This chapter summarizes the considerations for patient safety during early mobilization; including the physiological assessment of the patient, the consideration of invasive lines and monitoring, the management of sedation, strategies to educate and manage the multidisciplinary team and environmental factors. Importantly, we will consider the long-term effect of early mobilization on patient outcome and the future directions for this important area of work for ICU clinicians. Safety of Early Mobilization in the ICU: Short-Term Consequences Early mobilization is a complex intervention that requires careful patient assessment and management, as well as interdisciplinary team cooperation and training [12]. Patient safety is one of the most commonly reported barriers to delivering early mobilization, including respiratory, cardiovascular and neurological stability and the integrity of invasive lines. In a recent systematic review and metaanalysis of patient safety during early mobilization, 48 studies were identified that reported data on safety during early mobilization, including falls, removal of endotracheal tubes (ETT), removal or dysfunction of intravascular catheters, removal of catheters or tubes, cardiac arrest, hemodynamic changes and oxygen desaturation [13]. Five studies were not included as their data were reported in other included publications. The 43 included studies had different descriptions of safety events and, in most, the criteria for ceasing early mobilization were the same

Post‐intensive care syndrome: its pathophysiology, prevention, and future directions

“…The J‐SCCG 2016 recommended against neuromuscular electrical stimulation as an ICU‐AW preventative measure . The dose–response of physical rehabilitation for clinical outcomes is unknown . High‐dose rehabilitation might lead to a higher quality of life than that for low‐dose rehabilitation; however, further studies are needed to clarify this point.…”

Embolic Septic Emboli with MRSA: A different source

“…The physiology and complications of bed rest are well understood, and for our ICU team is one of the primary preventive goals. Intensive care unit-acquired weakness and functional dependency are recognized as unfortunate consequences of prolonged ICU admissions and many of them requiring mechanical ventilation [15]. In our case early mobility rehabilitation protocol was a major priority for which the patient received active reassurance by the mobility team as well by physicians on charge of the case.…”

Respiratory Muscle Rehabilitation in Patients with Prolonged Mechanical Ventilation: A Targeted Approach

“…If patients are too sedated, they cannot benefit. In the landscape of reducing sedation to facilitate early rehabilitation in the ICU [1], this provides yet another imperative to minimize (or eliminate) sedation as early as possible.…”

“…Early and proactive rehabilitation of intensive care unit (ICU) patients is essential to reverse or minimize the impact of ICU-acquired weakness [1]. While ICU clinicians have largely focused on whole-body exercise to address limb muscle weakness (e.g., early mobilization), we now know that respiratory muscle weakness is twice as prevalent as limb muscle weakness in ICU patients [2].…”