Out-of-the-ICU Mobilization in Critically Ill Patients: The Safety of a New Model of Rehabilitation

Abstract

OBJECTIVES: Early mobilization of ICU patients has been reported to be safe and feasible. Recently, our ICU implemented out-of-the-ICU wheelchair excursions as a daily rehabilitation practice. The aim of this study is to investigate the safety of participation in the out-of-the-ICU program for early mobilization. DESIGN: Retrospective cohort study. SETTING: Single general ICU in a tertiary teaching hospital. PATIENTS: Adult patients who were admitted to the ICU and underwent the out-of-the-ICU program as an early mobilization intervention was investigated. INTERVENTIONS: The out-of-the-ICU activities include visiting indoor area, visiting our outdoor garden, and bathing. MEASUREMENTS AND MAIN RESULTS: Medical records of ICU patients who participated in the out-of-the-ICU program were reviewed. The primary outcome was the occurrence rate of physical safety events, defined as unintentional removal of medical devices, patient agitation, a fall, or an injury. The secondary outcome was the occurrence rate of adverse physiologic changes, defined as hypotension, hypertension, bradycardia, tachycardia, desaturation, bradypnea, tachypnea, an increase in F io 2 , or an increase in doses of vasoactive drugs. In total, 99 adult patients participated in the program, comprising a total of 423 out-of-the-ICU sessions. Among them, one session resulted in a physical safety event, the dislodgement of a tracheostomy tube. In 23 sessions, one or two adverse physiologic changes occurred. None of these events required additional treatment nor resulted in serious sequelae. CONCLUSIONS: An out-of-the-ICU program can be provided safely to adult ICU patients, provided that it is supervised by a dedicated intensivist with an appropriately trained multiprofessional staff and equipment on-site. It appears to contribute to the promotion of humanizing intensive care.

Quadriplegia after ECMO therapy with sluggish recovery in a COVID‐19 patient: A case report with a 14‐month follow‐up

“… 14 Human interactions especially with family members in a pleasurable outdoor activity, as in this case, appear to be beneficial for cognitive stimulation, reorientation, a sense of normalcy, and reassurance to patients during their ICU stay, since contact isolation has been associated with depression and anxiety. 21 We have reported the safety of out‐of‐the‐ICU mobilization 22 and show evidence suggesting that out‐of‐the‐ICU activities contributed to this critically ill patient's psychological orientation and his family's motivation to undertake a long course of rehabilitation. Numerous reports have shown that subsequent post‐acute rehabilitation programs need to be established in a holistic and seamless manner to support COVID‐19 survivors.…”

Análise Do Conhecimento De Profissionais Da Saúde Acerca Da Prática Da Mobilização Precoce Em Um Hospital Universitário De Belém Do Pará

“…Ressalta-se que a presença de um quantitativo profissional treinado no turno da manhã e de um contingente escalado para a tarde permite uma melhor atuação para com a prática de MP, favorecendo a aplicação continuada dos protocolos e obtendo resultados satisfatórios 10,11 .…”

“…Tais informações concordam com a presente pesquisa, na qual 80% dos entrevistados, a grande maioria, conhece a MP e suas funções nesse método enquanto profissionais; 62,82% afirmaram redução no tempo de ventilação mecânica; e 64,10%, aumento da força muscular periférica. A interação multiprofissional é essencial na abordagem da MP, de forma a potencializar a eficácia e o benefício do tratamento, minimizando o surgimento de complicações, diminuindo o tempo de internação, custos hospitalares e acelerando o retorno do paciente ao convívio familiar e social 11 . Em adultos, a MP está associada com desfechos positivos em curto e longo prazo, como melhora da força muscular periférica 12,13 .…”