Mobilization in the evening to prevent delirium: A pilot randomized trial

Nydahl, Peter; McWilliams, David; Weiler, Norbert; Borzikowsky, Christoph; Howroyd, Fiona; Brobeil, Angelika; Lindner, Matthias; Haken, Rebecca von

doi:10.1111/nicc.12638

Cited by 17 publications

(10 citation statements)

References 40 publications

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“…33 The physical activity in the evening (18:00-21:30) can reflect nurse interventions to cause natural sleep and maintain day-and-night rhythm which might prevent or relieve delirium. 38 The strength of our study was the use of two accelerometers to objectively measure MV patients physical activity, including detecting lying/not-lying, during their stay in two mixed ICUs in a prospective study design. We had a high continuity and precision in data collecting and a high validity in data and analysis.…”

Section: Discussionmentioning

confidence: 99%

Daily variation in physical activity during mechanical ventilation and stay in the intensive care unit

Lehmkuhl

Olsen

Brønd

et al. 2023

Acta Anaesthesiol Scand

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Background Early mobilisation of mechanically ventilated patients during their stay at an intensive care unit (ICU) can improve physical recovery. Yet, an objective and specified description of physical activities while in the ICU is lacking. Therefore, our aim was to describe the objectively assessed type, quantity, and daily variation of physical activity among mechanically ventilated patients while in the ICU. Method In an observational study in two mixed medical/surgical ICUs, we measured body posture in 39 patients on mechanical ventilation using a thigh‐ and chest‐worn accelerometer while in the ICU. The accelerometer describes time spent lying, sitting, moving, in‐bed cycling, standing and walking. Descriptive analysis of physical activity and daily variation was done using STATA. Results We found that mechanically ventilated patients spend 20/24 h lying in bed, 3 h sitting and only 1 h standing, moving, walking or bicycling while in the ICU. Intervals of non‐lying time appeared from 9.00 to 12.00 and again from 18.00 to 21.30, with peaks at the hours of 9.00 and 18.00. Conclusion ICU patients on mechanical ventilation were primarily sedentary. Physical activity of mechanically ventilated patients seems to be related to nurse‐ and/or physiotherapy‐initiated activities. There is a need to create an awareness of improving clinical routines, towards active mobilisation throughout the day, for this vulnerable patient population during their stay in the ICU.

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Section: Discussionmentioning

confidence: 99%

Daily variation in physical activity during mechanical ventilation and stay in the intensive care unit

Lehmkuhl

Olsen

Brønd

et al. 2023

Acta Anaesthesiol Scand

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“…One of the papers included was identified and found in pre-print as part of the ROB assessments given its relevance to the question of interest 37 . Post ROB completion it has now been published with a change in methodological approach from an RCT to a pilot RCT therefore investigating evening mobilisation feasibility as its primary aim rather than proving the effect of mobilisation on delirium outcomes 47 . This means the primary outcomes also changed from delirium duration to feasibility measures.…”

Section: Discussionmentioning

confidence: 99%

“…37 Post ROB completion it has now been published with a change in methodological approach from an RCT to a pilot RCT therefore investigating evening mobilisation feasibility as its primary aim rather than proving the effect of mobilisation on delirium outcomes. 47 This means the primary outcomes also changed from delirium duration to feasibility measures. Therefore, results presented for this study should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 99%

Investigating the impact of physical activity interventions on delirium outcomes in intensive care unit patients: A systematic review and meta-analysis

Jarman

Chapman

Vollam

et al. 2022

Journal of the Intensive Care Society

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Background To investigate the impact of physical activity interventions, including early mobilisation, on delirium outcomes in critically ill patients. Methods Electronic database literature searches were conducted, and studies were selected based on pre-specified eligibility criteria. Cochrane Risk of Bias-2 and Risk Of Bias In Non-randomised Studies-of Interventions quality assessment tools were utilised. Grading of Recommendations, Assessment, Development and Evaluations was used to assess levels of evidence for delirium outcomes. The study was prospectively registered on PROSPERO (CRD42020210872). Results Twelve studies were included; ten randomised controlled trials one observational case-matched study and one before-after quality improvement study. Only five of the included randomised controlled trial studies were judged to be at low risk of bias, with all others, including both non-randomised controlled trials deemed to be at high or moderate risk. The pooled relative risk for incidence was 0.85 (0.62–1.17) which was not statistically significant in favour of physical activity interventions. Narrative synthesis for effect on duration of delirium found favour towards physical activity interventions reducing delirium duration with median differences ranging from 0 to 2 days in three comparative studies. Studies comparing varying intervention intensities showed positive outcomes in favour of greater intensity. Overall levels of evidence were low quality. Conclusions Currently there is insufficient evidence to recommend physical activity as a stand-alone intervention to reduce delirium in Intensive Care Units. Physical activity intervention intensity may impact on delirium outcomes, but a lack of high-quality studies limits the current evidence base.

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“…This highlights the RCT as a useful method when assessing the effectiveness of education interventions more objectively. The second is a pilot RCT conducted in Germany by Nydahl et al 4 examining how feasible it was to mobilize intensive care Patients in the evening. A pilot RCT is “a miniature version” of the main study to test whether it can work and is feasible to undertake 7 .…”

mentioning

confidence: 99%

“…The four trials in this issue, 3–6 include a pilot RCT 2 . In the first trial by Siebert et al 3 paediatric critical care staff in a Swiss tertiary hospital were randomized to either receive a face to Face or a blended learning approach to the use of a manual defibrillator.…”

mentioning

confidence: 99%