The Economic and Clinical Impact of Sustained Use of a Progressive Mobility Program in a Neuro-ICU*

Hester, Jeannette; Guin, Peggy; Danek, Gale; Thomas, Jaime R.; Titsworth, W. Lee; Reed, Richard; Vasilopoulos, Terrie; Fahy, Brenda G.

doi:10.1097/ccm.0000000000002305

Cited by 18 publications

(6 citation statements)

References 26 publications

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“…These results may be associated with an insufficient sample size to detect a statistical difference for these secondary outcomes. Accordingly, a retrospective study with a large sample size (1118 neurocritical patients) demonstrated the significant impact of early rehabilitation for shortening ICU and hospital stays with a mean difference of 0.7 and 2.7 days respectively [53].…”

Section: Discussionmentioning

confidence: 99%

Neuromuscular electrical stimulation in critically ill traumatic brain injury patients attenuates muscle atrophy, neurophysiological disorders, and weakness: a randomized controlled trial

Silva¹,

Marqueti²,

Livino-de-Carvalho³

et al. 2019

j intensive care

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BackgroundCritically ill traumatic brain injury (TBI) patients experience extensive muscle damage during their stay in the intensive care unit. Neuromuscular electrical stimulation (NMES) has been considered a promising treatment to reduce the functional and clinical impacts of this. However, the time needed for NMES to produce effects over the muscles is still unclear. This study primarily aimed to assess the time needed and effects of an NMES protocol on muscle architecture, neuromuscular electrophysiological disorder (NED), and muscle strength, and secondarily, to evaluate the effects on plasma systemic inflammation, catabolic responses, and clinical outcomes.MethodsWe performed a randomized clinical trial in critically ill TBI patients. The control group received only conventional physiotherapy, while the NMES group additionally underwent daily NMES for 14 days in the lower limb muscles. Participants were assessed at baseline and on days 3, 7, and 14 of their stay in the intensive care unit. The primary outcomes were assessed with muscle ultrasound, neuromuscular electrophysiology, and evoked peak force, and the secondary outcomes with plasma cytokines, matrix metalloproteinases, and clinical outcomes.ResultsSixty participants were randomized, and twenty completed the trial from each group. After 14 days, the control group presented a significant reduction in muscle thickness of tibialis anterior and rectus femoris, mean of − 0.33 mm (− 14%) and − 0.49 mm (− 21%), p < 0.0001, respectively, while muscle thickness was preserved in the NMES group. The control group presented a higher incidence of NED: 47% vs. 0% in the NMES group, p < 0.0001, risk ratio of 16, and the NMES group demonstrated an increase in the evoked peak force (2.34 kg/f, p < 0.0001), in contrast to the control group (− 1.55 kg/f, p < 0.0001). The time needed for the NMES protocol to prevent muscle architecture disorders and treat weakness was at least 7 days, and 14 days to treat NED. The secondary outcomes exhibited less precise results, with confidence intervals that spanned worthwhile or trivial effects.ConclusionsNMES applied daily for fourteen consecutive days reduced muscle atrophy, the incidence of NED, and muscle weakness in critically ill TBI patients. At least 7 days of NMES were required to elicit the first significant results.Trial registrationThe trial was registered at ensaiosclinicos.gov.br under protocol RBR-8kdrbz on 17 January 2016.

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Section: Discussionmentioning

confidence: 99%

Neuromuscular electrical stimulation in critically ill traumatic brain injury patients attenuates muscle atrophy, neurophysiological disorders, and weakness: a randomized controlled trial

Silva¹,

Marqueti²,

Livino-de-Carvalho³

et al. 2019

j intensive care

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“…High protocol compliance resulted in a significant 9-hour LOS reduction per hospitalization as well as a shift in unit culture 19 . This result was supported by a separate study that implemented the Progressive Upright Mobility Protocol Plus, emphasizing nursing education implementation in neurosurgical care 28 . Additional outcomes included decreased hospital-acquired infections and associated medical costs 19 …”

Section: Resultsmentioning

confidence: 91%

“…27 There are studies pertaining to nurse-driven teamwork. 7,16,17,19,20,28,29 Researchers developed a protocol to mobilize neurosurgical spine patients, in which nurses and patient care technicians independently led mobilization. Nurse practitioners or physicians adjusted medications if pain hindered mobility efforts.…”

Section: Teamwork In Mobilizationmentioning

confidence: 99%

“…19 This result was supported by a separate study that implemented the Progressive Upright Mobility Protocol Plus, emphasizing nursing education implementation in neurosurgical care. 28 Additional outcomes included decreased hospitalacquired infections and associated medical costs. 19 Researchers implemented mobilization in 3 phases among patients with SAHs and EVDs.…”

Section: Teamwork In Mobilizationmentioning

confidence: 99%

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Mobilizing Ventilated Neurosurgery Patients: An Integrative Literature Review

Lall

Behan

2021

Journal of Neuroscience Nursing

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BACKGROUND: Lack of mobilization in ventilated neurosurgery patients is problematic due to significant consequences. Although early mobility addresses these complications, few studies have been conducted in this population, resulting in infrequent mobilization efforts. Nurses prioritize and implement patient care interventions, including mobilization, with multidisciplinary teams. This integrative literature review examines what is known regarding nursing perceptions on mobilization and their role within a multidisciplinary team for mobilization in ventilated neurosurgery patients. METHODS: A comprehensive literature search was conducted using online databases to identify research articles on early mobility studies in ventilated critically ill and neurosurgical patients from 2010 to 2020. RESULTS: Twenty studies were identified and indicated a paucity of research specific to mobilizing ventilated neurosurgery patients. Nurses understand the purpose and benefits of early mobility in critically ill and mechanically ventilated patients. Mixed perceptions exist regarding the responsibility for prioritizing and initiating mobilization. Main barriers include patient safety concerns, untimeliness due to limited resources, unit culture, lack of nursing knowledge, and need for improved teamwork. Associations between teamwork-based interventions and decreased length of stay, increased rates of mobility, and faster time to early mobilization exist. Nurse-led interventions showed additional benefits including positive perceptions such as empowerment, confidence, increased knowledge, and a progressive shift in unit culture. CONCLUSION: This review demonstrates a continued need for understanding nursing perceptions and role in teamwork to mobilize ventilated neurosurgery patients. Future research should focus on testing nurse-led mobility interventions so higher rates of mobilization and provision of holistic patient care can be achieved.

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“…The dissemination of our objective review will be imperative to enhance clinical practice and evaluate the different components of the ABCDEF bundle, and hopefully to quantify the impact of bundle implementation to the various outcomes we have described. Some bundle components have been shown to have an economic benefit [ 61 ], and as researchers contribute to the collective growing body of knowledge, we anticipate that changes in practice will soon become the standard of care.…”

Section: Discussionmentioning

confidence: 99%

Challenges of pain management in neurologically injured patients: systematic review protocol of analgesia and sedation strategies for early recovery from neurointensive care

et al. 2018

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BackgroundA recent paradigm shift within the intensive care discipline has led to implementation of protocols to drive early recovery from the intensive care unit (ICU). These protocols belong to a large knowledge, translation and quality improvement initiative lead by the Society of Critical Care Medicine, aiming to “liberate” patients from the ICU. They “bundle” evidence-based elements shown to lower ICU stay and mortality and optimize pain management. The bundled elements focus on Assessing, preventing and managing pain; Both spontaneous awakening trials and spontaneous breathing trials; Choice of analgesia and sedation; assessment, prevention, and management of Delirium; Early mobility and exercise; and Family engagement and empowerment (ABCDEF). It is evident that analgesia and sedation protocols either directly relate to or influence most of the bundle elements. A paucity of literature exists for neurologically injured patients, who create unique challenges to bundle implementation and often have limited external validity in existent studies. We will systematically search the literature, present the unique challenges of neurointensive care patients, conduct a stratified analysis of subgroups of interest, and disseminate the evidence of analgesia and sedation protocols in the neurointensive care unit (NICU). We hope the relevant stakeholders can adapt this information through knowledge translation—to make formal recommendations in clinical practice guidelines or a position statement.Methods/designThe authors will search MEDLINE (PubMed), EMBASE, Cochrane Library, Cochrane Clinical Trials Registry, World Health Organization International Clinical Trials Registry Platform Search Portal, and the National Institutes for Health Clinical Trials Registry. The title, abstract, and full-text screening will be completed in duplicate, and a Cohen’s Kappa coefficient of agreement will be reported. Provided the data retrieved from studies is suitable, results will be combined statistically using meta-analysis. We aim to evaluate the impact of ABCDEF bundle components on multiple endpoints of NICU recovery. Our primary outcomes will be time to successful discontinuation of mechanical ventilation and time to early mobility. The authors will guide the methodological design of the study using the PRISMA-statement and the checklist compliance will be available.DiscussionUsing the evidence from this systematic review, we anticipate disseminating knowledge of analgesia and sedation protocols in the NICU. The results of this systematic review are imperative to close the knowledge gap in a patient population that is often excluded from studies, and to add to the body of literature aiming to enhance early recovery from the NICU and mitigate iatrogenic harm.Systematic review registrationPROSPERO CRD42017078909

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The Economic and Clinical Impact of Sustained Use of a Progressive Mobility Program in a Neuro-ICU*

Abstract: An ongoing progressive mobility program in the neurocritical care population has clinical and financial benefits associated with its implementation and should be considered.

Cited by 18 publications

References 26 publications

Neuromuscular electrical stimulation in critically ill traumatic brain injury patients attenuates muscle atrophy, neurophysiological disorders, and weakness: a randomized controlled trial

Neuromuscular electrical stimulation in critically ill traumatic brain injury patients attenuates muscle atrophy, neurophysiological disorders, and weakness: a randomized controlled trial

Mobilizing Ventilated Neurosurgery Patients: An Integrative Literature Review

Challenges of pain management in neurologically injured patients: systematic review protocol of analgesia and sedation strategies for early recovery from neurointensive care

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