Mobilization of prolonged mechanical ventilation patients: An integrative review

Abstract

Mobilization of mechanical ventilation patients has broadened to include patients requiring prolonged mechanical ventilation (PMV). A previous systematic review outlined methodological flaws in the literature. The purpose of this integrative review is to evaluate existing publications to determine if mobilization interventions in PMV patients improve physical function, weaning rates, pulmonary mechanics, and hospital outcomes. An electronicsearch covering 2005-2016, included five bibliographic databases: CINHAL, PubMed, PEDro, EMBASE, and Web of Science. Key terms: PMV, mobilization, therapy, and rehabilitation. Eight research studies were identified; 3 RCT's, 3 medical records reviews, 1 prospective cohort, and 1 undefined prospective interventional. Improvements in functional status, shorter duration of mechanical ventilation and hospitalization, decreased mortality, and superior 1-year survival rates in mobilized PMV patients were reported. Persistent methodological limitations impair the ability to determine if these outcomes were the result of improvements in pulmonary mechanics, overall functional status, or a combination of both.

Early mobilisation in mechanically ventilated patients: a systematic integrative review of definitions and activities

“…Most of the studies reported an explicit list of included activities such as cycle ergometry exercises [58, 59, 63], sitting on the edge of bed [24, 35, 38–40, 52, 59, 61], sitting out of bed (in a chair) [24, 35, 38–40, 51, 52, 55, 57, 59], standing using a tilt table [35, 39, 52], standing [35, 39, 40, 52, 55, 59], marching [61] and walking [24, 35, 38–40, 52, 55, 57, 59, 61, 63]. The general descriptions of the activities were exercises involving axial loading exercises [35, 52], movements against gravity [35, 52, 61], active activities [37, 48, 55, 58, 59, 63] and activities requiring energy expenditure of patients [62]. ‘Active’ was indicated in the EM-MV definitions as patients having muscle strength and an ability to control the activities [48], a conscious muscle activation (except breathing) [63] and as certain types of activities such as activities with physiological benefits [55], strengthening and mobility exercise [58] and assisted exercise [59].…”

“…Expectation of outcome reflects the descriptions of the desired effects of EM-MV including preventing ICU complications, maintaining patient’s mobility and improving impairment. Two studies referred to specific preventions such as joint contractures [46] and delirium [44], and one study referred to general prevention which was to counteract immobilisation [62]. Patient’s mobility was targeted at achieving the highest functional level or regaining the functional status before ICU admission [37, 41, 44, 53, 56].…”

Negotiated mobilisation: An ethnographic exploration of nurse–patient interactions in an intensive care unit

“…Early mobilization is usually initiated 2-5 days after ICU admission, using passive or active movement or position change (Hodgson et al, 2015). Early mobilization is beneficial to reducing ICU delirium and increasing muscle mass, strength, quality of life, and functional capacity at hospital discharge (Dunn et al, 2017;Schweickert et al, 2009). Vincent et al (2016) introduced the early Comfort using Analgesia, minimal Sedatives and maximal Human care (eCASH) philosophy and highlighted how less or no sedation, patient-centered care, patient involvement and early mobilization are core components in achieving comfort and recovery in the ICU.…”

Assessment of the effects of a multi-component, individualized physiotherapy program in patients receiving hospice services in the home

“…The goal of physiotherapy in this group of patients is to minimize the negative effects of the disease or invasive treatment. Rehabilitation in palliative care must be individualized and it should include various actions, such as a training of mobility, transfer, and balance, a program improving respiratory functions, a lymphoedema therapy, strengthening exercises, pain relief programs, education, and psychological support [2]. Initially, physiotherapy was aimed at providing general support to hospice patients.…”