Respiratory Support Adjustments and Monitoring of Mechanically Ventilated Patients Performing Early Mobilization: A Scoping Review

Abstract

Objectives: This scoping review is aimed to summarize current knowledge on respiratory support adjustments and monitoring of metabolic and respiratory variables in mechanically ventilated adult patients performing early mobilization. Data Sources: Eight electronic databases were searched from inception to February 2021, using a predefined search strategy. Study Selection: Two blinded reviewers performed document selection by title, abstract, and full text according to the following criteria: mechanically ventilated adult patients performing any mobilization intervention, respiratory support adjustments, and/or monitoring of metabolic/respiratory real-time variables. Data Extraction: Four physiotherapists extracted relevant information using a prespecified template. Data Synthesis: From 1,208 references screened, 35 documents were selected for analysis, where 20 (57%) were published between 2016 and 2020. Respiratory support settings (ventilatory modes or respiratory variables) were reported in 21 documents (60%). Reported modes were assisted (n = 11) and assist-control (n = 9). Adjustment of variables and modes were identified in only seven documents (20%). The most frequent respiratory variable was the Fio 2, and only four studies modified the level of ventilatory support. Mechanical ventilator brand/model used was not specified in 26 documents (74%). Monitoring of respiratory, metabolic, and both variables were reported in 22 documents (63%), four documents (11%) and 10 documents (29%), respectively. These variables were reported to assess the physiologic response (n = 21) or safety (n = 13). Monitored variables were mostly respiratory rate (n = 26), pulse oximetry (n = 22), and oxygen consumption (n = 9). Remarkably, no study assessed the work of breathing or effort during mobilization. Conclusions: Little information on respiratory support adjustments during mobilization of mechanically ventilated patients was identified. Monitoring of metabolic and respiratory variables is also scant. More studies on the effects of adjustments of the level/mode of ventilatory support on exercise performance and respiratory muscle activity monitoring for safe and efficient implementation of early mobilization in mechanically ventilated patients are needed.

Current Physiotherapy Practice in Intensive Care Units Needs Cultural and Organizational Changes: An Observational Cross-Sectional Study in Two Albanian University Hospitals

“…One of the challenges of the mobilization teams, especially the physiotherapists, is to adjust the exercise dose and respiratory support during mobilization to avoid overload of respiratory muscle and improve exercise performance. 26 The recent study results were similar to European survey results, although made two decades ago, revealing that physiotherapy in critical care was often inadequate. 27 There exists essential heterogeneity among different countries concerning early mobilization practice, 22 and respiratory care in ICU patients.…”

“…A recent review highlighted the importance of performing ventilator adjustments to facilitate mobility, improving performance and duration; 26 however, there are no guidelines on the adjustments of ventilator assistance during early mobilization. One of the challenges of the mobilization teams, especially the physiotherapists, is to adjust the exercise dose and respiratory support during mobilization to avoid overload of respiratory muscle and improve exercise performance.…”

“…One of the challenges of the mobilization teams, especially the physiotherapists, is to adjust the exercise dose and respiratory support during mobilization to avoid overload of respiratory muscle and improve exercise performance. 26 …”

Physical and respiratory therapy in the critically ill patient with obesity: a narrative review

“…During early mobilization, adjustments in mechanical ventilation programming may be necessary to enhance exercise tolerance ( 43 ). For improved comfort and appropriate functional progress, conventional spontaneous ventilatory modes like pressure support (PSV) are recommended ( 44 ).…”

Respiratory drive, inspiratory effort, and work of breathing: review of definitions and non-invasive monitoring tools for intensive care ventilators during pandemic times

“…Para la selección de documentos de esta revisión se utilizaron referencias de la búsqueda de un scoping review previamente publicado, relacionado con este tópico [21]. Primero, se realizó una actualización de la búsqueda simple en PubMed/ MEDLINE combinando palabras clave como: "respiratory drive", "respiratory effort", "work of breathing", "assisted ventilation", "intensive care unit" y "mechanical ventilation".…”