S2e guideline: positioning and early mobilisation in prophylaxis or therapy of pulmonary disorders

Abstract

The German Society of Anesthesiology and Intensive Care Medicine (DGAI) commissioneda revision of the S2 guidelines on “positioning therapy for prophylaxis or therapy of pulmonary function disorders” from 2008. Because of the increasing clinical and scientificrelevance the guidelines were extended to include the issue of “early mobilization”and the following main topics are therefore included: use of positioning therapy and earlymobilization for prophylaxis and therapy of pulmonary function disorders, undesired effects and complications of positioning therapy and early mobilization as well as practical aspects of the use of positioning therapy and early mobilization. These guidelines are the result of a systematic literature search and the subsequent critical evaluation of the evidence with scientific methods. The methodological approach for the process of development of the guidelines followed the requirements of evidence-based medicine, as defined as the standard by the Association of the Scientific Medical Societies in Germany. Recently published articles after 2005 were examined with respect to positioning therapy and the recently accepted aspect of early mobilization incorporates all literature published up to June 2014.

Long-term outcome after the acute respiratory distress syndrome: different from general critical illness?

“…Early mobilization therapy has been mentioned in order to prevent or attenuate physical function impairment in critically ill patients [ 11 ]. However, as studies showed an improved physical function associated to protocol-based early mobilization in a surgical ICU cohort [ 12 ], this could not be proven in patients with acute respiratory failure.…”

The standard of care of patients with ARDS: ventilatory settings and rescue therapies for refractory hypoxemia

“…In ECMO patients a specific strategy in terms of anticoagulation is mandatory [ 88 ]. Backrest elevated position (20–45°) is the preferred supine position for ARDS patients, since it may contribute to an improvement of oxygenation and respiratory mechanics [ 89 ] compared to “flat” supine, but limitations for backrest elevation (e.g., hemodynamic impairment) must be considered.…”

Establishment of an enhanced recovery after surgery protocol in minimally invasive heart valve surgery

“…This pilot study shows that such a protocol is feasible and safe in minimally-invasive cardiac surgery. Historically, so-called fast-track protocols in cardiac surgery were implemented 20 years ago during the evolution phase of the modern minimally invasive heart surgery [16][17][18]. These early protocols addressed primarily the intraoperative phase and showed the potential for an early extubation on the ICU, shortening of the ICU stay and cost containment in the cardiac surgical setting.…”

“…The decision to mobilize the patient is made in consensus with the responsible anaesthetist. During this monitor-guided mobilization, we followed the break-off /stop criteria according to the recommendations of S2 guideline of the German Society of Anaesthesiology and Intensive Care Medicine [17]. First, the physiotherapist checks motoric and sensory functions of upper and lower extremities in supine position as well as the postoperative pain level.…”