Early mobilization on continuous renal replacement therapy is safe and may improve filter life

Abstract

IntroductionDespite studies demonstrating benefit, patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization. No researchers have reported filter pressures during mobilization, and it is unknown whether mobilization is safe or affects filter lifespan. Our objective in this study was to test the safety and feasibility of mobilization in this population.MethodsA total of 33 patients undergoing continuous renal replacement therapy via femoral, subclavian or internal jugular vascular access catheters at two general medical-surgical intensive care units in Australia were enrolled. Patients underwent one of three levels of mobilization intervention as appropriate: (1) passive bed exercises, (2) sitting on the bed edge or (3) standing and/or marching. Catheter dislodgement, haematoma and bleeding during and following interventions were evaluated. Filter pressure parameters and lifespan (hours), nursing workload and concern were also measured.ResultsNo episodes of filter occlusion or failure occurred during any of the interventions. No adverse events were detected. The intervention filters lasted longer than the nonintervention filters (regression coefficient = 13.8 (robust 95% confidence interval (CI) = 5.0 to 22.6), P = 0.003). In sensitivity analyses, we found that filter life was longer in patients who had more position changes (regression coefficient = 2.0 (robust 95% CI = 0.6 to 3.5), P = 0.007). The nursing workloads between the intervention shift and the following shift were similar.ConclusionsMobilization during renal replacement therapy via a vascular catheter in patients who are critically ill is safe and may increase filter life. These findings have significant implications for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12611000733976 (registered 13 July 2011)Electronic supplementary materialThe online version of this article (doi:10.1186/cc14001) contains supplementary material, which is available to authorized users.

Usual Care Physiotherapy During Acute Hospitalization in Subjects Admitted to the ICU: An Observational Cohort Study

“…35 The results of other empirical studies should also be used to address longstanding barriers to early mobilization in the ICU, such as renal replacement therapy delivered via vascath. 59,60 It was also impossible to tell from the medical records whether the therapy that individuals received was the maximum intensity that they could tolerate, which may be important in the evaluation and interpretation of the effects of rehabilitation. 61 A consensus is urgently needed to define mobility outcomes of interest that can be routinely collected by all ICUs within the clinical and research settings to facilitate comparison of data from multiple outcome sets more accurately.…”

Early mobilization in the critical care unit: A review of adult and pediatric literature

“…A variety of active mobilization protocols have been utilized, including active or resistive range of motion (ROM) exercises, sitting on a bed or chair, bed exercise (eg, cycling), dangling, transfers, tilting up (arms supported or unsupported), and ambulating (either assisted or unassisted) [3,29,30,35,37,38]. Early mobilization can be safely initiated on the first day of ICU admission and even during mechanical ventilation [29,35], administration of vasopressors [32,39,48], continuous renal replacement therapy (CRRT) [49,50], and with femoral catheters in situ [51,52]. The rate of adverse events ranges between 0% and 3%, and the reported adverse events are not usually serious [3,29,30,35,37,38].…”

“…Parameters varied widely between studies (Tables 2 and 3) but typically included limits in heart rate, blood pressure, and respiratory rate. Exercise programs have been questioned in ICU patients with raised intracranial pressure [28,34], active gastrointestinal blood loss [34], active myocardial ischemia [32,34], intermittent or continuous renal replacement therapy [29,34,48], and vasoactive medication requirements [3,32,34,48]; however, research has indicated that early mobilization in adult ICU patients receiving vasopressor infusions [32,39,48] or CRRT [49,50] can be safe. As such, further research is warranted to find ways to alleviate perceived barriers to early mobility.…”

Monitoring of Potential Safety Events and Vital Signs during Active Mobilization of Patients Undergoing Continuous Renal Replacement Therapy in a Medical Intensive Care Unit

“…In addition to the concerns regarding device-associated complications, it has been suggested that patient movement during CRRT can alter hemodynamics [10] , which might result in potential safety events if the patients underwent active mobilization PT. Although previous studies showed that serious adverse events did not occur during active mobilization PT in the patients undergoing CRRT [11][12][13][14] , there are several limitations in these studies. First, few data on vital signs during active mobilization PT in patients undergoing CRRT were provided, since 2 previous studies enrolled a relatively small number of patients undergoing CRRT [11,14] .…”

“…First, few data on vital signs during active mobilization PT in patients undergoing CRRT were provided, since 2 previous studies enrolled a relatively small number of patients undergoing CRRT [11,14] . Recently, Wang et al [12] provided informative data that there was no ceased session of PT with CRRT, thus, no pre-specified significant vital sign changes occurred during active mobilization PT with CRRT. However, the actual measured values of vital sign changes were not provided.…”