The Influence of Progressive Mobilization on Pneumonia and Decubitus Occurrences in Critical Patients Using Mechanical Ventilator

Abstract

Background: The short-term impact felt by critically ill patients and ventilators are Ventilator-Associated Pneumonia (VAP), which is added to the health mechanism due to muscle weakness and the occurrence of pressure sores or decubitus. Prevention of pneumonia in intubation patients is crucial because it can prevent hospital-acquired or nosocomial infections, which is a severe complication. Extensive skin destruction or pressure can cause depression in the blood supply and tissue damage. Decubitus will disturb the blood that enters the depressed (stressed) area and results in tissue death. Physical activity in ICU for critical patients is needed. Progressive mobilization of patients is one of the nurse interventions for patients. Objective: This research aims to identify the effect of progressive mobilization on the formation of pneumonia and (decubitus) in critically ill patients. Method: This research is a literature review accessed from internet database searches named PubMed, Pro-Quest, and Science direct with the keywords mobilization progressive, pneumonia, pressure sores. From the PubMed database, 12473 articles were found, 28986 articles from Pro Quest and Sciencedirect resulted in 51077 articles. After going through the screening process and eligibility, 7 articles fit the inclusion criteria. Results: The stages of progressive mobilization in preventing the risk of pressure sores were developed according to the level of mobility in the Early Mobilization Protocol. Based on the results of a review of 7 articles, mobilization exercises were carried out progressively from Level 1 -Level VI with Head of Bed (HOB) activity 30˚-45˚ until the patient can walk for 2 hours, starting in the first 48 hours after entering critical care and performed every day until 7 to 13-day treatment. Conclusion: This literature review shows that progressive mobilization reduces the incidence of pneumonia in ICU care and the risk of pressure sores. Training for nurses working in critical services is needed to increase knowledge and civilize clinical practices related to progressive mobilization I.

Mobilisasi Progresif Meningkatkan Status Hemodinamika Pada Pasien Kritis Di Intensive Care Unit: Literature Review

“…American Association of Critical Care Nurses (AACN) memperkenalkan intervensi mobilisasi progresif yang terdiri dari beberapa tahapan: Head of Bed (HOB), latihan Range of Motion (ROM) pasif dan aktif, terapi lanjutan rotasi lateral, posisi tengkurap, pergerakan melawan gravitasi, posisi duduk, posisi kaki menggantung, berdiri dan berjalan (Mokorimban & Chayati, 2021).…”

“…Pada sistem respirasi mobilisasi berfungsi meningkatkan frekuensi dan kedalaman pernapasan, meningkatkan ventilasi alveolar, menurunkan kerja pernapasan dan meningkatkan pengembangan diafragma. Sehingga pemberian mobilisasi diharapkan mampu meningkatkan transport oksigen ke seluruh tubuh (Mokorimban & Chayati, 2021).…”

Effects of Progressive Mobilization on Hemodynamic Status of Bedridden Patients in the Intensive Care Unit (ICU)

“…Research conducted by Needham et al showed that patients treated in the ICU experience hemodynamic imbalances, one of which is caused by bed rest for a long time. One of the efforts made by nurses to improve the functional and hemodynamic status of patients is to mobilize (Mokorimban, (2021).…”

“…Mobilization interventions performed on patients in the ICU have a good effect, including increasing muscle strength, reducing the patient's length of stay, reducing the patient's dependence on delirium, and accelerating the weaning process in patients who are on a ventilator (Mokorimban, 2021). Research conducted by Rebbel et al showed the results that mobilization had an effect on the hemodynamic status of patients, including breathing, blood pressure, pulse, and temperature.…”