Frühmobilisierung

Nydahl, Peter; Dewes, Michael; Dubb, Rolf; Filipovic, Silke; Hermes, Carsten; Jüttner, F.; Kaltwasser, Arnold; Klarmann, S.; Klas, Karin; Mende, Hendrik; Rothaug, Oliver; Schuchhardt, Danny; Frühmobilisierung, Netzwerk

doi:10.1007/s00063-015-0073-4

Cited by 23 publications

(15 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Nydahl et al [225] reported in their study of 116 German ICUs that the implementation of early mobilisation in daily clinical practice is still considerably limited, despite its broad indication. This study found that only 8% of endotracheally-intubated patients were mobilised out-of-bed, while 15% were not mobilised at all.…”

Section: Weaning Strategiesmentioning

confidence: 99%

Prolonged Weaning: S2k Guideline Published by the German Respiratory Society

et al. 2020

View full text Add to dashboard Cite

Mechanical ventilation (MV) is an essential part of modern intensive care medicine. MV is performed in patients with severe respiratory failure caused by respiratory muscle insufficiency and/or lung parenchymal disease; that is, when other treatments such as medication, oxygen administration, secretion management, continuous positive airway pressure (CPAP), or nasal high-flow therapy have failed. MV is required for maintaining gas exchange and allows more time to curatively treat the underlying cause of respiratory failure. In the majority of ventilated patients, liberation or “weaning” from MV is routine, without the occurrence of any major problems. However, approximately 20% of patients require ongoing MV, despite amelioration of the conditions that precipitated the need for it in the first place. Approximately 40–50% of the time spent on MV is required to liberate the patient from the ventilator, a process called “weaning”. In addition to acute respiratory failure, numerous factors can influence the duration and success rate of the weaning process; these include age, comorbidities, and conditions and complications acquired during the ICU stay. According to international consensus, “prolonged weaning” is defined as the weaning process in patients who have failed at least 3 weaning attempts, or require more than 7 days of weaning after the first spontaneous breathing trial (SBT). Given that prolonged weaning is a complex process, an interdisciplinary approach is essential for it to be successful. In specialised weaning centres, approximately 50% of patients with initial weaning failure can be liberated from MV after prolonged weaning. However, the heterogeneity of patients undergoing prolonged weaning precludes the direct comparison of individual centres. Patients with persistent weaning failure either die during the weaning process, or are discharged back to their home or to a long-term care facility with ongoing MV. Urged by the growing importance of prolonged weaning, this Sk2 Guideline was first published in 2014 as an initiative of the German Respiratory Society (DGP), in conjunction with other scientific societies involved in prolonged weaning. The emergence of new research, clinical study findings and registry data, as well as the accumulation of experience in daily practice, have made the revision of this guideline necessary. The following topics are dealt with in the present guideline: Definitions, epidemiology, weaning categories, underlying pathophysiology, prevention of prolonged weaning, treatment strategies in prolonged weaning, the weaning unit, discharge from hospital on MV, and recommendations for end-of-life decisions. Special emphasis was placed on the following themes: (1) A new classification of patient sub-groups in prolonged weaning. (2) Important aspects of pulmonary rehabilitation and neurorehabilitation in prolonged weaning. (3) Infrastructure and process organisation in the care of patients in prolonged weaning based on a continuous treatment concept. (4) Changes in therapeutic goals and communication with relatives. Aspects of paediatric weaning are addressed separately within individual chapters. The main aim of the revised guideline was to summarize both current evidence and expert-based knowledge on the topic of “prolonged weaning”, and to use this information as a foundation for formulating recommendations related to “prolonged weaning”, not only in acute medicine but also in the field of chronic intensive care medicine. The following professionals served as important addressees for this guideline: intensivists, pulmonary medicine specialists, anaesthesiologists, internists, cardiologists, surgeons, neurologists, paediatricians, geriatricians, palliative care clinicians, rehabilitation physicians, intensive/chronic care nurses, physiotherapists, respiratory therapists, speech therapists, medical service of health insurance, and associated ventilator manufacturers.

show abstract

Section: Weaning Strategiesmentioning

confidence: 99%

Prolonged Weaning: S2k Guideline Published by the German Respiratory Society

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Interestingly, different professions report different barriers to early mobilization, e.g. nurses often report hemodynamic instability on continuous renal replacement therapy as barriers, while physical therapists report neurological impairments or inability to follow commands [16][17][18][19][20][21][22][23][24]. Hence, different professions may estimate the mobility of ICU patients differently.…”

Section: Introductionmentioning

confidence: 99%

Assessment of mobilization capacity in 10 different ICU scenarios by different professions

Hermes¹,

Nydahl

Blobner

et al. 2020

PLoS ONE

View full text Add to dashboard Cite

Background Mobilization of intensive care patients is a multi-professional task. Aim of this study was to explore how different professions working at Intensive Care Units (ICU) estimate the mobility capacity using the ICU Mobility Score in 10 different scenarios. Methods T en fictitious patient-scenarios and guideline-related knowledge were assessed using an online survey. Critical care team members in German-speaking countries were invited to participate. All datasets including professional data and at least one scenario were analyzed. Kruskal Wallis test was used for the individual scenarios, while a linear mixed-model was used over all responses. Results In total, 515 of 788 (65%) participants could be evaluated. Physicians (p = 0.001) and nurses (p = 0.002) selected a lower ICU Mobility Score (-0.7 95% CI -1.1 to -0.3 and -0.4 95% CI -0.7 to -0.2, respectively) than physical therapists, while other specialists did not (p = 0.81). Participants who classified themselves as experts or could define early mobilization in accordance to the “S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders” correctly selected higher mobilization levels (0.2 95% CI 0.0 to 0.4, p = 0.049 and 0.3 95% CI 0.1 to 0.5, p = 0.002, respectively). Conclusion Different professions scored the mobilization capacity of patients differently, with nurses and physicians estimating significantly lower capacity than physical therapists. The exact knowledge of guidelines and recommendations, such as the definition of early mobilization, independently lead to a higher score. Interprofessional education, interprofessional rounds and mobilization activities could further enhance knowledge and practice of mobilization in the critical care team.

show abstract

“…B. Sicherung der Zu-und Ableitungen, Zielvorgaben, Abbruch usw.). 75 In den vorliegenden Studien gab es erhebliche Abweichungen, teilweise waren ausschließlich Physiotherapeuten für die Mobilisierung zuständig oder Pflegende oder das gesamte Team. Eine gute interdisziplinäre Kooperation, auch mit den Angehörigen, optimiert die Rehabilitation und hilft den Patienten wie auch ihren Angehörigen, alle Stufen ihrer Bedürfnisse zu erfüllen und in ihrer ganzheitlichen Rehabilitation unterstützt zu werden.…”

Section: Schlussfolgerungunclassified

Machbarkeit und Grenzen der Frühmobilisierung

Nydahl

Margraf²

2016

intensiv

View full text Add to dashboard Cite

Zusammenfassung Ein Patient erkrankt an einem Guillain-Barr?-Syndrom. Innerhalb kurzer Zeit erreichte die Krankheit ihr Maximum und der Patient war gerade noch in der Lage, seinen Unterkiefer zu bewegen. Kann er von einer m?glichst fr?hen Mobilisation profitieren? Was kann man ihm zumuten? Wann n?tzt die Fr?hmobilisierung und wann schadet sie? Unser Autorenteam hat die Studienlage zum Thema gesichtet und pr?sentiert hier die Ergebnisse

show abstract

Frühmobilisierung

Cited by 23 publications

References 28 publications

Prolonged Weaning: S2k Guideline Published by the German Respiratory Society

Prolonged Weaning: S2k Guideline Published by the German Respiratory Society

Assessment of mobilization capacity in 10 different ICU scenarios by different professions

Machbarkeit und Grenzen der Frühmobilisierung

Contact Info

Product

Resources

About