Early activity is feasible and safe in respiratory failure patients*

Abstract

We conclude that early activity is feasible and safe in respiratory failure patients. A majority of survivors (69%) were able to ambulate >100 feet at RICU discharge. Early activity is a candidate therapy to prevent or treat the neuromuscular complications of critical illness.

Effects of a Multidisciplinary Care Program on Disability, Autonomy, and Nursing Needs in Subjects Recovering From Acute Respiratory Failure in a Chronic Ventilator Facility

“…3,11,12 In particular, patients may receive a prompt and dedicated physiotherapy rehabilitation program in chronic ventilator facilities, 1,3,13 and transfer from an ICU to a chronic ventilator facility substantially improved patients' ambulation and activities of daily life irrespective of the underlying pathophysiology, avoiding unnecessary immobilization 14 . To date, the role of comprehensive rehabilitation in critically ill adults still remains controversial 13 or not fully established 15 : patients who have survived a recent acute respiratory failure (ARF) event can benefit from an individually tailored physiotherapy rehabilitation program that improves clinical indices, respiratory and peripheral muscle strength, activities of daily life, exercise tolerance, and disability scores. 14,[16][17][18][19][20][21][22][23][24] Once the precipitating cause of the ARF episode has been solved, these chronically ill patients still require care due to their huge motor disabilities, clinical dependence (oxygen, mechanical ventilation, nutritional, and communication device needs), and nursing necessities, 3 which the care team (physiotherapist, doctor, and nurse) must measure to better guide the daily care of the patient. No study has been performed with a large patient sample to investigate patient needs with these 3 different perspectives combined.…”

The Effect of Standing up Early in the First 24 Hours After Surgery on Rapid Improvement: Systematic Review

“…13 Erken ayağa kaldırmanın hastanede yatış süresini azaltarak erken taburcu olma, ameliyat sonrası komplikasyonların görülmesinde azalma, hastane maliyetinin azalması ve hastanın konforu ve günlük yaşama erken dönme üzerinde anlamlı oranda etki ederek hızlı iyileşmeyi sağ-ladığı bilinmektedir. 13,[20][21][22][23][24][25][26][27][28][29][30] Cerrahi hastalarında mobilizasyonun etkilerinin araştırıldığı bir sistematik incelemede; uzun süren immobilizasyonun özellikle yaşlılar, derin ven trombozu olanlar ve ampütasyonlu hastalarda; fonksiyonlarda düşme ve hastaneden kaynaklı komplikasyonların artmasına neden olduğu bildirilmektedir. 25 Erken ayağa kaldırmanın olumlu etkileri dikkate alındığında; yatan hasta mobilizasyonunun, hastane ortamında klinik hemşireleri için daha yüksek öncelikle uygulanması gerektiği belirtilmektedir.…”

‘Cooperative Sedation’: Optimizing Comfort while Maximizing Systemic and Neurological Function

“…Th e investigators demonstrated that 69.4% of patients were able to walk a minimum of 200 feet, with less than 3% being incapable of activity during their ICU admission. Th is impressive level of mobilization was achieved at the expense of very few adverse events; a total of 14 occurred over 1,449 activity events, including falls to the knees without injury, acute desaturation, changes in systolic blood pressure, and removal of feeding tube [11].…”

“…Members included respiratory, physical, and occupational therapists, a nurse and a critical care technician [11][12][13][14]. In addition to the team, it was concluded that a coordinated sedation strategy was important to the success of the early mobilization intervention.…”

“…Some units may have to increase staffi ng in order to accom modate this practice; however, it may yet be a cost eff ective strategy considering the improved outcomes observed. Another intervention, early mobilization, requires a multidisciplinary team to execute safely and eff ectively, yet some investigators have found that implementing strategies for early mobilization is feasible without increase ICU staffi ng [11].…”