Exercise interventions are delayed in critically ill patients: a cohort study in an Australian tertiary intensive care unit

Nickels, Marc; Aitken, Leanne M.; Walsham, James; Crampton, L.; Barnett, Adrian; McPhail, Steven

doi:10.1016/j.physio.2019.06.011

Cited by 7 publications

(7 citation statements)

References 39 publications

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“…Therefore, our findings corroborate those in recent studies by Sibilla 12 and Nickels, 37 reporting that ratios of 1:4 are common where patients are less critically ill or likely to recover faster and mobilization is therefore much easier.…”

Section: Discussionsupporting

confidence: 92%

“…Given that there is no current consensus about vasoactive drug levels and safe mobilization, 36 we understand that vasoactive therapy could be a barrier to mobilization. However, when analysing the 1443 patient‐days without vasoactive agents on ICU days 4 to 7, only 10.7% were actively mobilized, in line with a recent study by Nickels et al 37 Conversely, Rebel et al 23 reported active mobilization on 37.5% of all vasoactive days.…”

Section: Discussionsupporting

confidence: 73%

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Variables associated with mobility levels in critically ill patients: A cohort study

Raurell-Torredà

Arias-Rivera

Martí³

et al. 2021

Nursing in Critical Care

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Background: Early mobilization in the intensive care unit (ICU) helps improve patients' functional status at discharge. However, many barriers hinder this practice.Aim and objectives: To identify mobility levels acquired by critically ill patients and their variables.Design: A multi-centre cohort study was conducted in adult patients receiving invasive mechanical ventilation for at least 48 hours. Methods:The primary outcome was level of mobility according to the ICU mobility scale. The secondary outcome was human resource availability and existence of ABCDEF bundle guidelines. A logistic regression was performed, based on days 3 to 5 of the ICU stay and significant association with active mobility.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 73%

Variables associated with mobility levels in critically ill patients: A cohort study

Raurell-Torredà

Arias-Rivera

Martí³

et al. 2021

Nursing in Critical Care

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“…A recent systematic review concluded that early rehabilitation may improve mobility, strength, and increase the number of days alive and out of hospital over a six-month timeframe [15]. However, the initiation of exercise interventions with critically ill patients is frequently delayed [16]. In-bed cycling is a promising intervention that can be introduced before a patient can follow commands [17].…”

Section: Introductionmentioning

confidence: 99%

Effect of in-bed cycling on acute muscle wasting in critically ill adults: A randomised clinical trial

Nickels

Aitken

Barnett

et al. 2020

Journal of Critical Care

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We would like to thank physiotherapy management (especially Cherie Hearn, Peter Tonks and Tony Cassar) and radiology management (Angela McNeill) for their support and provision of clinical staffing to enable this study to be conducted. Intensive care management for actively supporting clinical research within the Princess Alexandra Intensive Care Unit. Research nurse Chelsea Davis, RN, for assistance with pre-trial governance, Rod Hurford, RN, Computer Information Systems Administrator, for assisting to set-up screening and data reports, Chantale Tremblay (sonographer) for data collection, and A/Prof. Jeremy Cohen (Intensivist) for safety monitoring.We would also like to thank the dedicated staff of the Princess Alexandra Hospital Physiotherapy Department and Intensive Care Unit for supporting this study.

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“…Only 39% of non-elective patients met green criteria while 50% ful lled red criteria. Higher mobility levels in elective surgical patients were also reported in an Australian cohort study [24] A such, studies focusing solely on elective surgical patients should not be generalised to the broader critical care population. There may be scope for increasing mobility levels in the green non-mobilised group.…”

Section: Discussionmentioning

confidence: 77%

Feasibility of ICU mobilisation within the first 48-72 hours: A multi-centre point prevalence study of mobility practices in the United Kingdom

Black

Sanger

Battle

et al. 2023

Preprint

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Background: Early mobilisation in critical care is recommended within clinical guidance however prevalence across the United Kingdom (UK) is unknown. The study aimed to determine the proportion of patients mobilised within 48-72 hours, to describe their physiological status, and to compare this to published consensus safety recommendations for out-of-bed activity. Methods: A UK cross-sectional, multi-centre, observational study of adult critical care mobility practices was conducted. Demographic and physiological data, mobility level, and rationale for not mobilising were collected for all patients on one day. Patients were analysed in one of 3 groups;mobilised; not mobilised; or excluded. Regression analysis was used to compare the physiological parameters of the mobilised versus not-mobilised groups. Patients were stratified using published safety criteria; ‘low-risk’ of an adverse event, ‘potential-risk’, ‘high-risk’. Rationale for the decision to not mobilise was collected qualitatively. Results: Data were collected for 960 patients across 84 UK critical care units. Of these 393 (41%) mobilised, 416 (43%) were not mobilised and 151 (16%) were excluded. A total of 371 patients had been admitted for ≤3 days, of whom 180 (48%) were mobilised, 140 (38%) were not mobilised and 51 (14%) were excluded. Of the 809 patients included, 367 (45%) had a green rating and 120 (15%) were rated amber, of whom 309 (84%) and 78 (65%) mobilised respectively. Mobility was associated with a Richmond Agitation-Sedation Scale of -1 to +1, lower doses of vasoactive agents, a lower inspired oxygen requirement. Conclusion: Although only 40% of patients mobilised out-of-bed, 89% of those defined ‘low-risk’ did so. There is significant overlap in physiological parameters for mobilisation versus non-mobilisation groups, suggesting a comprehensive physiological assessment is vital in decision making rather than relying on arbitrary time points. Clinical Trials registration: NCT05281705 Registered March 16, 2022. Retrospectively registered.

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Exercise interventions are delayed in critically ill patients: a cohort study in an Australian tertiary intensive care unit

Cited by 7 publications

References 39 publications

Variables associated with mobility levels in critically ill patients: A cohort study

Variables associated with mobility levels in critically ill patients: A cohort study

Effect of in-bed cycling on acute muscle wasting in critically ill adults: A randomised clinical trial

Feasibility of ICU mobilisation within the first 48-72 hours: A multi-centre point prevalence study of mobility practices in the United Kingdom

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