Hemodynamic Instability: Is It Really a Barrier to Turning Critically Ill Patients?

Vollman, Kathleen M.

doi:10.4037/ccn2012765

Cited by 19 publications

(12 citation statements)

References 36 publications

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“…While resting data could be collected pre-or post-exercise, it would always occur after a period of observed rest. As cytokines and vital signs (VS) typically return to baseline well within the minimal observed time of 30 minutes at rest (Winkelman et al, 2007; Vollman, 2012), one would not expect differing results from resting values as long as the values reflect a period of no exercise or other inflammatory intervention.…”

Section: Methodsmentioning

confidence: 99%

Examining the positive effects of exercise in intubated adults in ICU: A prospective repeated measures clinical study

Winkelman

Johnson

Hejal

et al. 2012

Intensive and Critical Care Nursing

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Summary Background Determining the optimal timing and progression of mobility exercise has the potential to affect functional recovery of critically ill adults. This study compared standard care with care delivered using a mobility protocol. We examined the effects of exercise on vital signs and inflammatory biomarkers and the effects of the nurse-initiated mobility protocol on outcomes. Methods Prospective, repeated measures study with a control (standard care) and intervention (protocol) period. Results 75 heterogeneous subjects admitted to a Medical or Surgical intensive care unit (ICU) were enrolled. In <5% of exercise periods, there was a concerning alteration in respiratory rate or peripheral oxygen saturation; no other adverse events occurred. Findings suggested the use of a protocol with one 20 minute episode of exercise daily for 2 or more days reduced ICU length of stay. Duration of exercise was linked to increased IL-10, suggesting brief episodes of low intensity exercise positively altered inflammatory dysregulation in this sample. Conclusion A growing body of evidence demonstrates that early, progressive exercise has significant benefits to intubated adults. These results should encourage clinicians to add mobility protocols to the care of ICU adults and lead to future studies to determine optimal “dosing” of exercise in ICU patients.

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Section: Methodsmentioning

confidence: 99%

Examining the positive effects of exercise in intubated adults in ICU: A prospective repeated measures clinical study

Winkelman

Johnson

Hejal

et al. 2012

Intensive and Critical Care Nursing

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“…[39][40][44][45][46][47][48][49][50][51][52][53][54][55][56] The final body of evidence is the most recent and includes studies conducted on early mobility in critically ill patients that provided data on feasibility, safety, and care processes. The evidence comes from 3 specific areas.…”

Section: Understanding the Physiologic Response To Movementmentioning

confidence: 99%

“…56 Commonly, patients are unstable when turned or the head of bed is raised after long intervals in a stationary position in the operating room, ICU, emergency department, and computerized axial tomographic scan whether on a vasoactive drip or not. If we train patients early to turn or sit thus preventing the concept "prolonged gravitational equilibration," less instability with mobilization may result.…”

Section: Cardiovascular Response To Bed Rest and Posture Changementioning

confidence: 99%

Understanding Critically Ill Patients Hemodynamic Response to Mobilization

Vollman¹

2013

Critical Care Nursing Quarterly

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In today's critical care environment, we face a difficult but essential task. We must provide comprehensive, compassionate, complex, technological care without causing harm to our patients. To foster a patient-safe environment, we must examine care practices and processes to reduce the chance of error. Successful early mobilization of critically ill patients can reduce several complications including atelectasis and ventilator-associated pneumonia and shorten ventilator time along with cognitive and functional limitations that linger 1 to 5 years after discharge from the intensive care unit. A long-standing challenge to successful mobilization of critically ill patients is the safety concern of hemodynamic instability. An in-depth exploration of what happens to a critically ill patient physiology during mobilization was done to foster a better understanding of strategies that promote adaptation. The article examines the evidence supporting the need to assess readiness for mobilization to reduce the risk of adverse events. Evidence-based tools and techniques to help clinicians prevent hemodynamic instability before, during, and after in-bed or out-of-bed mobilization are discussed. With safety serving as the overriding goal, we can overcome the barriers and succeed in creating and sustaining a culture of early progressive mobility programs within the intensive care unit.

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“…Prevention of PIs generally involves routine skin assessment, frequent repositioning, and use of appropriate support surfaces . However, frequent off‐loading and repositioning of the occiput region of patients who are receiving ECMO, or are mechanically ventilated and have limited head movements, is a challenge . Specifically, repositioning these patients may not be safe because of potentially fatal hemodynamic instability, increased pain, and concern for the safety of tubing and devices .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study

Barakat‐Johnson

Lai

Gefen

et al. 2018

International Wound Journal

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This pilot study aimed to evaluate the clinical efficacy and feasibility of a fluidised positioning device to reduce occipital pressure injuries (PIs). A post‐test design with a historical control group was used in a 54‐bed intensive care unit between September 2017 and August 2018. Patients who were receiving either extracorporeal membrane oxygenation, were mechanically ventilated, or had raised intracranial pressure (≥20) were recruited. The intervention consisted of a fluidised positioning device under the patient's head, and a skin assessment every 8 h. Outcome measures included the occurrence of occipital PIs and registered nurses (RNs)' perspectives of the intervention. Data collected from patients in the intervention group were compared with data obtained from the historical control group between May 2016 and April 2017. Sixty‐four patients were recruited in the intervention phase and 63 were in the historical control group. Results showed a statistically significant reduction in occipital PIs by 87.7% (16/63; 25.4% historical control vs 2/64; 3.13% interventional group). Bedside RNs provided positive evaluation of the fluidised positioning device. The findings demonstrate that the fluidised positioning device is a feasible and effective intervention in reducing the risk of occipital PIs in intensive care patients, which merits the continuation of use and further evaluation through a larger‐scale study.

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Hemodynamic Instability: Is It Really a Barrier to Turning Critically Ill Patients?

Cited by 19 publications

References 36 publications

Examining the positive effects of exercise in intubated adults in ICU: A prospective repeated measures clinical study

Examining the positive effects of exercise in intubated adults in ICU: A prospective repeated measures clinical study

Understanding Critically Ill Patients Hemodynamic Response to Mobilization

Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study

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