Effect of early mobilization on sedation practices in the neurosciences intensive care unit: A preimplementation and postimplementation evaluation

Witcher, Robert; Stoerger, Lauren; Dzierba, Amy; Silverstein, Amy; Rosengart, Axel J.; Brodie, Daniel; Berger, Karen

doi:10.1016/j.jcrc.2014.12.003

Cited by 19 publications

(46 citation statements)

References 16 publications

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“…Recently, Witcher et al, 28 in a retrospective study conducted in a neurological ICU, demonstrated that the implementation of an early mobilization program did not change duration of MV, length of ICU stay, or length of hospital stay, a finding that is similar to that of the present study. Schweickert et al, 14 in a pioneering, prospective randomized controlled trial, submitted 49 ICU patients on MV to an early active and passive mobilization program for 28 days.…”

Section: Discussionsupporting

confidence: 90%

Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial

et al. 2017

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Objective: To evaluate the effects that passive cycling exercise, in combination with conventional physical therapy, have on peripheral muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients admitted to the ICU of a tertiary care university hospital. Methods: This was a randomized clinical trial involving 38 patients (≥ 18 years of age) on mechanical ventilation who were randomly divided into two groups: control (n = 16), receiving conventional physical therapy; and intervention (n = 22), receiving conventional physical therapy and engaging in passive cycling exercise five days per week. The mean age of the patients was 46.42 ± 16.25 years, and 23 were male. The outcomes studied were peripheral muscle strength, as measured by the Medical Research Council scale, duration of mechanical ventilation, and length of hospital stay. Results: There was a significant increase in peripheral muscle strength (baseline vs. final) in both groups (control: 40.81 ± 7.68 vs. 45.00 ± 6.89; and intervention: 38.73 ± 11.11 vs. 47.18 ± 8.75; p < 0.001 for both). However, the range of increase in strength was higher in the intervention group than in the control group (8.45 ± 5.20 vs. 4.18 ± 2.63; p = 0.005). There were no significant differences between the groups in terms of duration of mechanical ventilation or length of hospital stay. Conclusions: The results suggest that the performance of continuous passive mobilization on a cyclical basis helps to recover peripheral muscle strength in ICU patients.

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Section: Discussionsupporting

confidence: 90%

Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial

et al. 2017

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“…Indeed, a bidirectional case-control study showed that early mobilization and sitting upright could be favourable for patients admitted to NICUs (12), whereas a prospective intervention trial and a comparative study revealed that early rehabilitation in patients with severe acquired brain injury (sABI) might lead to a shorter length of hospital stay (LOS), fewer restraint days, and fewer hospital-acquired infections (13,14). On the other hand, a recent retrospective chart review conducted during a 6-month pre-mobilization and 6-month post-mobilization period concluded that, despite an increase in the amount of physical therapy and occupational therapy, no change in hospital and ICU LOS or duration of mechanical ventilation was observed (15).…”

mentioning

confidence: 99%

Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study

Bartolo¹,

Bargellesi

Castioni

et al. 2017

J Rehabil Med

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“…Among the neurological criteria, assessments of intracranial pressure (ICP) and level of consciousness stood out. Witcher et al ( 52 ) considered that patients with elevated IPC and in whom deep sedation is combined with neuromuscular blockers are not candidates for participation in EM protocols and daily sedation interruption. Other reasons hindering EM are paralysis or paresis, cognitive dysfunction and abnormal brain perfusion, in addition to the use of devices for continuous brain monitoring.…”

Section: Discussionmentioning

confidence: 99%

Safety criteria to start early mobilization in intensive care units. Systematic review

Conceição¹,

Gonzáles²,

Figueiredo³

et al. 2017

Revista Brasileira De Terapia Intensiva

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Mobilization of critically ill patients admitted to intensive care units should be performed based on safety criteria. The aim of the present review was to establish which safety criteria are most often used to start early mobilization for patients under mechanical ventilation admitted to intensive care units. Articles were searched in the PubMed, PEDro, LILACS, Cochrane and CINAHL databases; randomized and quasi-randomized clinical trials, cohort studies, comparative studies with or without simultaneous controls, case series with 10 or more consecutive cases and descriptive studies were included. The same was performed regarding prospective, retrospective or cross-sectional studies where safety criteria to start early mobilization should be described in the Methods section. Two reviewers independently selected potentially eligible studies according to the established inclusion criteria, extracted data and assessed the studies' methodological quality. Narrative description was employed in data analysis to summarize the characteristics and results of the included studies; safety criteria were categorized as follows: cardiovascular, respiratory, neurological, orthopedic and other. A total of 37 articles were considered eligible. Cardiovascular safety criteria exhibited the largest number of variables. However, respiratory safety criteria exhibited higher concordance among studies. There was greater divergence among the authors regarding neurological criteria. There is a need to reinforce the recognition of the safety criteria used to start early mobilization for critically ill patients; the parameters and variables found might contribute to inclusion into service routines so as to start, make progress and guide clinical practice.

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Effect of early mobilization on sedation practices in the neurosciences intensive care unit: A preimplementation and postimplementation evaluation

Cited by 19 publications

References 16 publications

Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial

Effects that passive cycling exercise have on muscle strength, duration of mechanical ventilation, and length of hospital stay in critically ill patients: a randomized clinical trial

Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study

Safety criteria to start early mobilization in intensive care units. Systematic review

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