The safety of a novel early mobilization protocol conducted by ICU physicians: a prospective observational study

Abstract

BackgroundThere are numerous barriers to early mobilization (EM) in a resource-limited intensive care unit (ICU) without a specialized team or an EM culture, regarding patient stability while critically ill or in the presence of medical devices. We hypothesized that ICU physicians can overcome these barriers. The aim of this study was to investigate the safety of EM according to the Maebashi EM protocol conducted by ICU physicians.MethodsThis was a single-center prospective observational study. All consecutive patients with an unplanned emergency admission were included in this study, according to the exclusion criteria. The observation period was from June 2015 to June 2016. Data regarding adverse events, medical devices in place during rehabilitation, protocol adherence, and rehabilitation outcomes were collected. The primary outcome was safety.ResultsA total of 232 consecutively enrolled patients underwent 587 rehabilitation sessions. Thirteen adverse events occurred (2.2%; 95% confidence interval, 1.2–3.8%) and no specific treatment was needed. There were no instances of dislodgement or obstruction of medical devices, tubes, or lines. The incidence of adverse events associated with mechanical ventilation or extracorporeal membrane oxygenation (ECMO) was 2.4 and 3.6%, respectively. Of 587 sessions, 387 (66%) sessions were performed at the active rehabilitation level, including sitting out of the bed, active transfer to a chair, standing, marching, and ambulating. ICU physicians attended over 95% of these active rehabilitation sessions. Of all patients, 143 (62%) got out of bed within 2 days (median 1.2 days; interquartile range 0.1–2.0).ConclusionsEM according to the Maebashi EM protocol conducted by ICU physicians, without a specialized team or EM culture, was performed at a level of safety similar to previous studies performed by specialized teams, even with medical devices in place, including mechanical ventilation or ECMO. Protocolized EM led by ICU physicians can be initiated in the acute phase of critical illness without serious adverse events requiring additional treatment.Electronic supplementary materialThe online version of this article (10.1186/s40560-018-0281-0) contains supplementary material, which is available to authorized users.

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

“…Forty one of 76 included studies provided the information on intubation type in patients undertaking EM-MV activities. Patients using tracheostomy undertaking EM-MV were reported in 33 studies [24, 36–40, 42, 48, 51, 52, 57, 61, 63–83]. The use of endotracheal tube (ETT) during EM-MV activities was reported in 32 studies [24, 35–40, 47, 48, 52, 54, 57, 61, 63, 65–71, 77, 78, 80–88].…”

“…Several studies reported that EM-MV was initiated using a protocol or an order. EM-MV was automatically triggered by a protocol to initiate activities following patients’ admissions to ICU in 31 studies [24–26, 35–40, 42, 46, 49, 58, 60, 66, 67, 72, 74–76, 80, 83, 84, 87, 93, 94, 101–105]. Across the studies reporting the requirement of a formal order to initiate EM-MV, staff prescribing the order varied from physicians [43, 47, 64, 79, 86], PTs [48, 51, 68, 85], PTs and OTs [44, 71] to the care team [45].…”

ABCDEF Bundle and Supportive ICU Care Practices for patients with COVID-19 infection: An international point prevalence study ~The ISIIC Study~

“…A mobilization protocol for other patient populations might apply to patients with COVID-19 infections. In this setting, the aggressive involvement of intensivists, which was lower in this study, and a specialized mobilization program for patients with COVID-19 infections, considering the severity and phases of the lung injury, might facilitate the delivery of safe and e cient rehabilitation with appropriate considerations of risk [45]. Incorporating the dedicated use of ergometers and electrical muscle stimulation into the protocol may also promote rehabilitation.…”

Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit

“…Safety criteria also include termination criteria that indicate discontinuation of the early mobilization session and allow the patients to rest [ 61 ]. Studies performed by Liu et al [ 62 ] and Perme and Chandrashekar [ 63 ] have suggested criteria for termination of mobilization, which are stated in Table 8 .…”