Teamwork enables high level of early mobilization in critically ill patients

Abstract

BackgroundEarly mobilization in critically ill patients has been shown to prevent bed-rest-associated morbidity. Reported reasons for not mobilizing patients, thereby excluding or delaying such intervention, are diverse and comprise safety considerations for high-risk critically ill patients with multiple organ support systems. This study sought to demonstrate that early mobilization performed within the first 24 h of ICU admission proves to be feasible and well tolerated in the vast majority of critically ill patients.ResultsGeneral practice data were collected for 171 consecutive admissions to our ICU over a 2-month period according to a local, standardized, early mobilization protocol. The total period covered 731 patient-days, 22 (3 %) of which met our local exclusion criteria for mobilization. Of the remaining 709 patient-days, early mobilization was achieved on 86 % of them, bed-to-chair transfer on 74 %, and at least one physical therapy session on 59 %. Median time interval from ICU admission to the first early mobilization activity was 19 h (IQR = 15–23). In patients on mechanical ventilation (51 %), accounting for 46 % of patient-days, 35 % were administered vasopressors and 11 % continuous renal replacement therapy. Within this group, bed-to-chair transfer was achieved on 68 % of patient-days and at least one early mobilization activity on 80 %. Limiting factors to start early mobilization included restricted staffing capacities, diagnostic or surgical procedures, patients’ refusal, as well as severe hemodynamic instability. Hemodynamic parameters were rarely affected during mobilization, causing interruption in only 0.8 % of all activities, primarily due to reversible hypotension or arrhythmia. In general, all activities were well tolerated, while patients were able to self-regulate their active early mobilization. Patients’ subjective perception of physical therapy was reported to be enjoyable.ConclusionsMobilization within the first 24 h of ICU admission is achievable in the majority of critical ill patients, in spite of mechanical ventilation, vasopressor administration, or renal replacement therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0184-y) contains supplementary material, which is available to authorized users.

Diagnósticos de enfermagem em pós-operatório de neurocirurgia

“…Different reasons were found in a previous study in which the surgical procedure itself, hemodynamic instability and patient refusal restricted the removal of the bed. 34 Functional decline can also lead to decreased mobility, and this has often been associated with worse outcomes in hospitalized patients. It is suggested by researchers that both physiological and neurological instability in the acute postoperative phase may increase the chances of bed restriction.…”

Dynamic physiotherapy for all patients admitted to the ICU according to their clinical status-describing a quality improvement program

“…Early mobilization strategies in the ICU may result in the prevention and reduction of critical illness polyneuropathy, delirium, ICU and hospital length of stay, may decrease mortality during hospitalization, and improve the patient's quality of life after hospital discharge [1][2][3][4][7][8][9][10]. The early mobilization for critical patient, according to the literature, is defi ned as a series of progressive physical activities that may induce an acute physiological response (improving ventilation, central and peripheral circulation, muscle metabolism and attention) [10][11][12], which begin the day after admission to the ICU.…”

“…There is no unanimity for the optimal time for initiate mobilization on ICU, but it is generally considered appropriate to start it when physiological stabilization is achieved, which considers neurological, respiratory and cardiovascular stability [9,13]. The systematic use of mobilization protocols is one of the strategies used by multidisciplinary teams to facilitate the progression of mobilization activities during the hospitalization of a patient, in addition to ensuring greater safety in therapeutics [2,8,10,11,13].…”

“…Mobilization of critical patients is safe; in all published studies, the percentage of serious complications resulting from mobilization is less than 1% [1,10,11]. But upon initiation of mobilization activities, it is necessary to assess whether the patient meets the inclusion criteria and especially if he does not present contraindications for it, which should be evaluated on a daily basis, taking into account the warning signs of complications or instability [10,11].…”

“…Mobilization of critical patients is safe; in all published studies, the percentage of serious complications resulting from mobilization is less than 1% [1,10,11]. But upon initiation of mobilization activities, it is necessary to assess whether the patient meets the inclusion criteria and especially if he does not present contraindications for it, which should be evaluated on a daily basis, taking into account the warning signs of complications or instability [10,11]. It is also recommended that a broader assessment that includes the medical history, review of prior and current medication, prior activity and mobilization capacity, cardiovascular and respiratory reserve, and a daily assessment of other factors that may hinder or counterproductive mobilization (neurological, hemodynamic and respiratory instability, hemoglobin <7.0g/dL, platelet count <20,000 cells, fever, glycerite, agitation, pain, fatigue, emotional state, orthopedic contraindications, etc.)…”