Influence of the initial level of consciousness on early, goal-directed mobilization: a post hoc analysis

Schaller, Stefan J.; Scheffenbichler, Flora T.; Bose, Somnath; Mazwi, Nicole; Deng, Hao; Krebs, Franziska; Seifert, Christian L.; Kasotakis, George; Grabitz, Stephanie D.; Latronico, Nicola; Houle, Timothy T.; Blobner, Manfred; Eikermann, Matthias

doi:10.1007/s00134-019-05528-x

Cited by 30 publications

(26 citation statements)

References 41 publications

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“…No significant differences in estimated mobilization levels among health care professionals were present in scenarios with coma, with delirium, with non-invasive ventilation, with pulmonary instability or with a subarachnoid hemorrhage. For impaired consciousness [ 31 ] and delirium [ 5 , 12 ] evidence of benefits of early mobilization is available in the literature. Early mobilization is typically recommended during non-invasive ventilation [ 32 , 33 ] and mechanical ventilation [ 5 , 12 ] while for subarachnoid hemorrhage the evidence in critically ill patients is scarce [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The selected mobilization level was 6 [5][6][7][8], representing marching in place, with significant differences between nurses and physical therapists (p<0.001. Fig 1).…”

Section: Scenario 1 -Awake and Stablementioning

confidence: 99%

“…Early mobilization is defined according to the German S2e guideline "positioning and early mobilization in prophylaxis or therapy of pulmonary disorders" as mobilization within 72 hours after admission to an intensive care unit (ICU) [1]. Due to its proven benefits, such as shorter duration of mechanical ventilation [2], improved functionality [3], and possibly shorter duration of delirium [4][5][6][7][8], while being safe [9] and cost-effective [10], early mobilization is a highly recommended but hardly implemented therapy during intensive care.…”

Section: Introductionmentioning

confidence: 99%

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

Hermes¹,

Nydahl

Blobner

et al. 2020

PLoS ONE

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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.

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Section: Discussionmentioning

confidence: 99%

“…The selected mobilization level was 6 [5][6][7][8], representing marching in place, with significant differences between nurses and physical therapists (p<0.001. Fig 1).…”

Section: Scenario 1 -Awake and Stablementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Hermes¹,

Nydahl

Blobner

et al. 2020

PLoS ONE

Self Cite

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“…Moreover, data in stroke patients may not apply to critically ill neurological patients admitted to the ICU; indeed, early mobilization is safe in this setting and might be beneficial 80, 81 because immobility is a common consequence of neurological impairments. A recent post-hoc analysis of a randomized controlled trial also showed that early, goal-directed mobilization is not harmful in patients with impaired consciousness and might be effective in achieving higher mobility levels and better functional status at hospital discharge 82 .…”

Section: Early Mobilization and Icu-awmentioning

confidence: 99%

Intensive care unit–acquired weakness: unanswered questions and targets for future research

2019

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Intensive care unit–acquired weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients. We discuss critical aspects of ICU-AW that have not been completely defined or that are still under discussion. Critical illness polyneuropathy, myopathy, and muscle atrophy contribute in various proportions to ICU-AW. Diagnosis of ICU-AW is clinical and is based on Medical Research Council sum score and handgrip dynamometry for limb weakness and recognition of a patient’s ventilator dependency or difficult weaning from artificial ventilation for diaphragmatic weakness (DW). ICU-AW can be caused by a critical illness polyneuropathy, a critical illness myopathy, or muscle disuse atrophy, alone or in combination. Its diagnosis requires both clinical assessment of muscle strength and complete electrophysiological evaluation of peripheral nerves and muscles. The peroneal nerve test (PENT) is a quick simplified electrophysiological test with high sensitivity and good specificity that can be used instead of complete electrophysiological evaluation as a screening test in non-cooperative patients. DW, assessed by bilateral phrenic nerve magnetic stimulation or diaphragm ultrasound, can be an isolated event without concurrent limb muscle involvement. Therefore, it remains uncertain whether DW and limb weakness are different manifestations of the same syndrome or are two distinct entities. Delirium is often associated with ICU-AW but a clear correlation between these two entities requires further studies. Artificial nutrition may have an impact on ICU-AW, but no study has assessed the impact of nutrition on ICU-AW as the primary outcome. Early mobilization improves activity limitation at hospital discharge if it is started early in the ICU, but beneficial long-term effects are not established. Determinants of ICU-AW can be many and can interact with each other. Therefore, future studies assessing early mobilization should consider a holistic patient approach with consideration of all components that may lead to muscle weakness.

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“…The benefits and safety of early mobilization in the intensive care unit (ICU) are well established. However, in a sub-study of 200 patients from the Surgical ICU Optimal Mobilization Score (SOMS) trial [5], patients with an admission Glasgow Coma Scale (GCS) < 8 tended to be mobilized later, even while the benefits of mobilization were also present in this subgroup with severe neurological impairment. The management of respiratory failure can be challenging in patients with acute brain injury, especially when there is concern about increased intracranial pressure (ICP) or secondary brain injury.…”

mentioning

confidence: 99%

Focus on neuro-critical care: combined interventions to improve relevant outcomes

2020

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Influence of the initial level of consciousness on early, goal-directed mobilization: a post hoc analysis

Cited by 30 publications

References 41 publications

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

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

Intensive care unit–acquired weakness: unanswered questions and targets for future research

Focus on neuro-critical care: combined interventions to improve relevant outcomes

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