The safety of mobilisation and its effect on haemodynamic and respiratory status of intensive care patients

Stiller, Kathy; Phillips, Anna; Lambert, Paul M.

doi:10.1080/09593980490487474

Cited by 127 publications

(123 citation statements)

References 10 publications

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“…Araştırmacılar, mobilizasyon öncesi ve sonrası vital parametreler ve (16)(17)(18)(19). Yaptığımız çalışmada, medikal veya postoperatif hastalar, yatışlarının ilk günü yatak içi veya yatak dışı kademeli mobilize edilmiş, herhangi bir advers olayla karşılaşılmamıştır.…”

Section: Discussionunclassified

Administration of Early Mobilization in Intensive Care Unit Patients and Effects of Early Mobilization on Patient Hemodynamics

Özçelik¹,

Uçar²,

Yılmaz³

et al. 2017

tybdd

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ÖZ Amaç: Yoğun bakıma kabul edilen her hasta, yoğun bakımda zorunlu yatak istirahati gerektiren bir dönem geçirmektedir. Bu durum mekanik ventilasyon süresinin, yoğun bakım ve hastane kalış sürelerinin uzamasına, venöz tromboemboli gelişmesine ve mortalitede artışa yol açmaktadır. Erken mobilizasyonun, yoğun bakım hastalarında, oksijen transportunu arttırdığı ve daha az pulmoner komplikasyonlara yol açtığı, yoğun bakım kalış süresi ve mortaliteyi azalttığı düşünülmektedir. Çalışmamızda yatak içi ve yatak dışı erken mobilizasyonun yoğun bakım hasta hemodinamiğine etkisinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmamıza Hacettepe Üniversitesi Anestezi Yoğun Bakım Ünitesi 1 ve 2'den Ekim 2014-Mart 2015 tarihleri arasında izlenen toplam 324 hastadan 72 hasta, yatışının ilk 24 saati içinde yatak içi veya yatak dışı mobilize edildi. Kalp hızı, ortalama arter basıncı, solunum sayısı, ve arter oksijen satürasyonu (SaO 2 ) değerleri sağ, sol lateral pozisyonda ve oturur ve yatak dışı mobilizasyonda basamak basamak kaydedildi. Bulgular: Katılan 72 hastanın %41'i erkek ve %59'u kadındı. Ortalama yaş 53±19'du. Hastaların %70'i postoperatifti. Yirmi yedi hasta (%37) yatak içi mobilize edilirken, 45 hasta (%63) yatak dışı mobilize edildi. Yatak içi mobilizasyonda supin pozisyona göre elde edilen veriler kıyaslandığında kalp hızı ve ortalama arter basıncında istatistiksel açıdan anlamlı fakat klinik olarak anlamsız bir artış (p<0,05), yatak dışı pozisyonda yine supin pozisyona göre veriler kıyaslandığında yatağın yanında ayakta durma ve sandalyeye oturma sırasında solunum sayısında istatistiksel açıdan anlamlı klinik olarak anlamsız (p<0,05) bir artış saptadık. Sonuç: Yoğun bakım hastalarının, yatışlarının ilk 24 saatinde erken mobilizasyonunun güvenli ve uygulanabilir olduğu sonucuna vardık. Anah tar Ke li me ler: Erken mobilizasyon, kritik hastalık, hemodinami Administration of Early Mobilization in Intensive Care Unit Patients and Effects of Early Mobilization on Patient Hemodynamics Yoğun Bakım Hastalarında Erken Mobilizasyon Uygulanması ve Erken Mobilizasyonun Hasta Hemodinamiğine EtkileriABSTRACT Objective: Every patient admitted to intensive care unit passes through a period in which intensive care requires obligatory bed rest. This leads to a longer duration of mechanical ventilation, intensive care and hospital stay, development of venous thromboembolism and increased mortality. Early mobilization is thought to reduce intensive care unit stay and mortality in intensive care patients, increasing oxygen transport and leading to fewer pulmonary complications.In our study, it was aimed to investigate the effect of in-bed and out-of-bed early mobilization on intensive care patient hemodynamics. Materials and Methods:In this study, 72 patients from 324 patients who were followed up between October 2014 and March 2015 at Hacettepe University Anesthesiology Intensive Care Unit 1 and 2 were mobilized in bed or out of bed within the first 24 hours of their stay. Heart rate,

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Section: Discussionunclassified

Administration of Early Mobilization in Intensive Care Unit Patients and Effects of Early Mobilization on Patient Hemodynamics

Özçelik¹,

Uçar²,

Yılmaz³

et al. 2017

tybdd

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“…[38][39][40][41][42] Studies that provide direction on how to safely turn and position patients with an intra-aortic balloon pump in place are lacking. The hemodynamic concerns are similar to the concerns in patients with low cardiac reserve.…”

Section: Feasibility Safety and Processes Of Carementioning

confidence: 99%

“…21,22,[26][27][28][29][30][31][32] The third body of evidence is the most recent and includes studies of early mobility in critically ill patients that included data on feasibility, safety, and processes of care. [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] responsiveness, contributing to postural hypotension and tachycardia as a result of reductions in stroke volume and cardiac output. 8,9 Head motion alone can reduce cardiac reflex response to central stimulation of the carotid baroreceptors by 30%.…”

mentioning

confidence: 99%

Hemodynamic Instability: Is It Really a Barrier to Turning Critically Ill Patients?

Vollman¹

2012

Critical Care Nurse

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“…Pioneering studies have demonstrated the feasibility and safety of early exercise, particularly in patients with respiratory failure undergoing mechanical ventilation (MV) (3)(4)(5)(6)(7)(8)(9)(10). Prospective trials, most conducted in single centers in U.S. and Australian intensive care units (ICUs), have yielded mixed outcomes.…”

mentioning

confidence: 99%

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Bakhru¹,

et al. 2016

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Rationale: Early mobilization (EM) improves outcomes for mechanically ventilated patients. Variation in structure and organizational characteristics may affect implementation of EM practices.Objectives: We queried intensive care unit (ICU) environment and standardized ICU practices to evaluate organizational characteristics that enable EM practice. Methods:We recruited 151 ICUs in France, 150 in Germany, 150 in the United Kingdom, and 500 in the United States by telephone. Survey domains included respondent characteristics, hospital and ICU characteristics, and ICU practices and protocols. Measurements and Main Results:We surveyed 1,484 ICU leaders and received a 64% response rate (951 ICUs). Eighty-eight percent of respondents were in nursing leadership roles; the remainder were physiotherapists. Surveyed ICUs were predominantly mixed medicalsurgical units (67%), and 27% were medical ICUs. ICU staffing models differed significantly (P , 0.001 each) by country for high-intensity staffing, nurse/patient ratios, and dedicated physiotherapists. ICU practices differed by country, with EM practices present in 40% of French ICUs, 59% of German ICUs, 52% of U.K. ICUs, and 45% of U.S. ICUs. Formal written EM protocols were present in 24%, 30%, 20%, and 30%, respectively, of those countries' ICUs. In multivariate analysis, EM practice was associated with multidisciplinary rounds (odds ratio [OR], 1.77; P = 0.001), setting daily goals for patients (OR, 1.62; P = 0.02), presence of a dedicated physiotherapist (OR, 2.48; P , 0.001), and the ICU's being located in Germany (reference, United States; OR, 2.84; P , 0.001). EM practice was also associated with higher nurse staffing levels (1:1 nurse/patient ratio as a reference; 1:2 nurse/patient ratio OR, 0.59; P = 0.05; 1:3 nurse/patient ratio OR, 0.33; P = 0.005; 1:4 or less nurse/patient ratio OR, 0.37; P = 0.005). Those responding rarely cited ambulation of mechanically ventilated patients, use of a bedside cycle, or neuromuscular electrical stimulation as part of their EM practice. Physical therapy initiation, barriers to EM practice, and EM equipment were highly variable among respondents. Conclusions:International ICU structure and practice is quite heterogeneous, and several factors (multidisciplinary rounds, setting daily goals for patients, presence of a dedicated physiotherapist, country, and nurse/patient staffing ratio) are significantly associated with the practice of EM. Practice and barriers may be far different based upon staffing structure. To achieve successful implementation, whether through trials or quality improvement, ICU staffing and practice patterns must be taken into account.

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The safety of mobilisation and its effect on haemodynamic and respiratory status of intensive care patients

Cited by 127 publications

References 10 publications

Administration of Early Mobilization in Intensive Care Unit Patients and Effects of Early Mobilization on Patient Hemodynamics

Administration of Early Mobilization in Intensive Care Unit Patients and Effects of Early Mobilization on Patient Hemodynamics

Hemodynamic Instability: Is It Really a Barrier to Turning Critically Ill Patients?

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

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