ICU Early Mobilization

Engel, Heidi J.; Morris, Peter E.; Gropper, Michael A.

doi:10.1097/ccm.0b013e3182a240d5

Cited by 160 publications

(89 citation statements)

References 77 publications

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“…Some of the failure to progress in our study is likely attributable to the high proportion of trauma or neurology patients who were potentially unable to progress due to neurologic or traumatic injuries. However, this failure to progress with therapy parallels reported levels of therapy achieved in larger quality improvement and prevalence studies of physical therapy use in the ICU suggesting that degree of physical therapy use in clinical practice may be lower than suspected [16, 31–33]. …”

Section: Discussionmentioning

confidence: 92%

“…We opted to include day 14 variables for our physiologic parameters (vasopressor use, hemodialysis, oxygenation status) given prior mobility studies suggesting that feasibility of therapy is dependent on barriers present at time of therapy and less dependent on earlier time points [13–16]. Level of sedation was defined by highest Ramsay score in the 24 hour period (12 am–12 am) surrounding the consultation date.…”

Section: Methodsmentioning

confidence: 99%

“…An increasing number of studies, including one randomized control trial, have suggested that physical therapy (PT) in critically ill patients may confer potential long term benefits including increased independence at time of hospital discharge [25–27]. Few studies, however, have focused on patients requiring prolonged mechanical ventilation and few have reported access to therapy outside of controlled trials or targeted quality improvement projects [16, 20, 21, 28–33]. …”

Section: Background/introductionmentioning

confidence: 99%

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Factors Associated With Receipt of Physical Therapy Consultation in Patients Requiring Prolonged Mechanical Ventilation

Jolley

Caldwell

Hough

2014

Dimensions of Critical Care Nursing

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Background/Introduction Mobilization of critically ill patients in the intensive care unit (ICU) is associated with improved function at hospital discharge and reduced duration of mechanical ventilation (MV). Few studies, however, focus on physical therapy (PT) in patients on prolonged mechanical ventilation (PMV) despite their high risk of immobility and poor outcomes. Objective/Aims To identify factors associated with the receipt of PT consultation among patients requiring PMV. We hypothesized that key factors including age, severity of illness and presence of a tracheostomy are associated with PT consultation. Methods Retrospective cohort study of adults on MV for ≥14 days for acute respiratory failure at an academic medical center. Primary outcome was PT consultation by day 14 of MV. We examined associations between the following key predictors, chosen a priori, and PT consultation: age, tracheostomy, illness severity, oxygenation status, shock, hemodialysis and medical service using multivariable logistic regression. Wilcoxon rank sum testing was used to test relationship between sedation and PT. Results We identified 175 patients requiring PMV at our institution. Most were middle-aged (mean 49.7, SD 18.5) men (65%) with high illness severity (mean APACHE III 86, SD 40). Less than half of all patients requiring PMV (78/175, 45%) received PT consultation in the ICU and most failed to progress with therapy beyond range of motion exercises (86%). Failure to progress was associated with level of sedation (med Ramsay score 4.5 [IQR 3–6] v 3.5 [IQR 3–5], p=0.01). Presence of a tracheostomy and pre-hospital non-ambulatory status were associated with receipt of PT by day 14 of MV (OR 6.94 and 3.42 respectively, p=≤0.05). Conclusions In our study, we found that PT for PMV patients occurs infrequently and is generally of low intensity. Level of sedation, presence of a tracheostomy and pre-hospital non-ambulatory status were associated with receipt of PT consultation by day 14 of MV.

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Section: Discussionmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Background/introductionmentioning

confidence: 99%

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Factors Associated With Receipt of Physical Therapy Consultation in Patients Requiring Prolonged Mechanical Ventilation

Jolley

Caldwell

Hough

2014

Dimensions of Critical Care Nursing

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“…Variable practice in the ICU is a common finding in the literature 18–21 . In the absence of a consensus policy or guideline on patient participation in mobility activity with an indwelling PAC, whether or not a patient was able to transfer out of bed or ambulate was left to the discretion of the individual health care provider, typically the nurse, physician and/or therapist.…”

Section: Methodsmentioning

confidence: 99%

Mobility and Ambulation for Patients With Pulmonary Artery Catheters

Fields

Trotsky

Fernández

et al. 2015

Journal of Acute Care Physical Therapy

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Purpose The purposes of this retrospective study are to: 1) describe the amount and type of documented mobility activity for patients with an indwelling Pulmonary Artery Catheter (PAC) and 2) document the frequency and type of complications that occur with an indwelling PAC during patient participation in these activities. Methods This study is a single-center, retrospective, descriptive study including all patients (>18 years) between June 2010 and October 2012 with an indwelling PAC in the Cardiology Intensive Care Unit (CICU). Data was extracted on all documented mobility activity each of these patients performed with nursing or during skilled treatments provided by a physical therapist (PT), or occupational therapist (OT). Any notation of PAC-related complications while the PAC was in place was recorded. Results In the CICU over a 29-month period, 366 patients with indwelling PACs performed bed mobility, transfers, ambulation and climbed stairs with no reports of PAC complications during or in relation to participation in mobility activity. Conclusion The data suggests that participation in mobility activities does not place patients with an indwelling PAC at increased risk of PAC related complications. This data further supports the involvement of rehabilitation specialists in the CICU. Future prospective research is necessary to measure the effects of physical therapy treatment on patients with indwelling PAC.

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“…During the period of treatment, the patient comfortably remained under pressure support ventilation (frequency < 30). The IMT program was accompanied by an early mobilization protocol (active member exercising in bed followed by resistance exercising against gravity at the bedside, evolving to standing position and cycle ergometer activity) [13]. …”

Section: Case Reportmentioning

confidence: 99%

Mechanical Ventilation Weaning in Inclusion Body Myositis: Feasibility of Isokinetic Inspiratory Muscle Training as an Adjunct Therapy

Souza

Campos²,

Daher³

et al. 2014

Case Reports in Critical Care

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Inclusion body myositis is a rare myopathy associated with a high rate of respiratory complications. This condition usually requires prolonged mechanical ventilation and prolonged intensive care stay. The unsuccessful weaning is mainly related to respiratory muscle weakness that does not promptly respond to immunosuppressive therapy. We are reporting a case of a patient in whom the use of an inspiratory muscle-training program which started after a two-week period of mechanical ventilation was associated with a successful weaning in one week and hospital discharge after 2 subsequent weeks.

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ICU Early Mobilization

Abstract: Instituting a planned, structured ICU early mobility quality improvement project can result in improved outcomes and reduced costs for ICU patients across healthcare systems.

Cited by 160 publications

References 77 publications

Factors Associated With Receipt of Physical Therapy Consultation in Patients Requiring Prolonged Mechanical Ventilation

Factors Associated With Receipt of Physical Therapy Consultation in Patients Requiring Prolonged Mechanical Ventilation

Mobility and Ambulation for Patients With Pulmonary Artery Catheters

Mechanical Ventilation Weaning in Inclusion Body Myositis: Feasibility of Isokinetic Inspiratory Muscle Training as an Adjunct Therapy

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