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Early MobilizationIn the Intensive Care Setting
Lauren Wesson-Stout
University of South Florida, College of Nursing
Objectives
Define early mobilization within the intensive care setting
Identify benefits of early mobilization
Discuss current evidence-based research supporting the use of early mobilization in the ICU
What is early mobilization?
Getting patients moving!
Includes sitting, moving to a chair, ambulating, and AROM and PROM exercises based on patient status
Evaluate patients individually to determine if they are stable for mobilization
Risks of Immobility
Increased length of hospital stay
Increased mortality
Increased muscle atrophy
Increased risk of aspiration
Increased rate of return to ICU
Benefits of Early Mobilization
Improved functional independence
Reduced ICU delirium
Reduced duration of mechanical ventilation
Reduced ICU (and hospital) length of stay
Improved walk distance
Improved muscle strength
Goals of Mobility for TGH
Reduce bounceback
Patients should be out of bed before transfer to floor
Patient should maintain pre-hospital mobility
Prevent pressure ulcers
Resource Solutions
Interdisciplinary Involvement Physician GroupsRespiratory TherapyPhysical TherapyLift TeamPatient Care Technicians
Mobility Technician (MT)
Turn patients every two hours
Responsible for PROM exercise
Ambulate stable patients
Delegation
Level 1 Passive ROM – MT Turn every 2 hours – Lift Team/MT
Level 2 Active resistance exercise – PT Sitting position for 20 minutes – Lift Team/MT
Level 3 Active transfer to chair – PT/MT/RT
Level 4 Stand at bedside – PT/MT/RT Ambulating in hallway – PT/MT/RT
References and Research
Bourdin, G., Barbier, J., Burlem, J., Durante, G., Passant, S., Vincent, B., Badet, M., & Guerin, C. (2010). The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respiratory Care, 55(4), 400-407. Retrieved from http://rc.rcjournal.com/content/55/4/400.short
Clark, D., Lowman, J., Griffin, R., Matthews, H., & Reiff, D. (2013). Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. American Physical Therapy Association, 93(2), 186-196. doi: 10.2522/ ptj.20110417
Engel, H., Needham, D., Morris, P., & Gropper, M. (2013). Icu early mobilization: from recommendation to implementation at three medical centers. Critical Care Medicine, 41. doi: 10.1097/CCM.0b013e3182a240d5
Hopkins, R. (2010). Early activity in the icu: beyond safety and feasibility. Respiratory Care, 55(4), 481-484. Retrieved from http://rc.rcjournal.com/content/55/4/481.short
Leditschke, I., Green, M., Irvine, J., Bissett, B., & Mitchell, I. (2012). What are the barriers to mobilizing intensive care patients?. Cardiopulmonary Physical Therapy Journal, 23(1), 26-29. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286497/
Mah, J., Staff, I., Fichandler, D., & Butler, K. (2012). Resource-efficient mobilization programs in the intensive care unit: who stands to win?. The American Journal of Surgery, 206(4), 488-493. doi: 10.1016/j.amjsurg.2013.03.001
Meyer, M., Stanislaus, A., Lee, J., Waak, K., Ryan, C., Saxena, R., Ball, S., & Eikermann, M. (2013). Surgical intensive care unit optimal mobilisation score (soms) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical icu patients. BMJ Open, 3(8). doi: 10.1136/bmjopen-2013-003262
Morris, P., Goad, A., Thompson, C., Taylor, K., Harry, B., Passmore, L., Ross, A., & Haponik, E. (2008). Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 36(8), 2238-43. doi: 10.1097/CCM.0b013e318180b90e
Pires-Neto, R., Kawaguchi, Y., Hirota, A., Fu, C., Tanaka, C., Caruso, P., Park, M., & Carvalho, C. (2013). Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects - a case series. PLoS One, 8(9). doi: 10.1371/journal.pone.0074182
Schweickert, W., & Kress, J. (2011). Implementing early mobilization interventions in mechanically ventilated patients in the icu. Chest, 140(6), 1612-17. doi: 10.1378/chest.10-2829
Schweickert, W., Pohlman, M., Pholman, A., Nigos, C., Pawlik, A., Esbrook, C., Spears, L., & Kress, J. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet, 373(9678), 1874-82. doi: 10.1016/S0140-6736(09)60658-9
Zomorodi, M., Topley, D., & McAnaw, M. (2012). Developing a mobility protocol for early mobilization of patients in a surgical/trauma icu. Critical Care Research and Practice. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539434/