Understanding Critically Ill Patients Hemodynamic Response to Mobilization

Abstract

In today's critical care environment, we face a difficult but essential task. We must provide comprehensive, compassionate, complex, technological care without causing harm to our patients. To foster a patient-safe environment, we must examine care practices and processes to reduce the chance of error. Successful early mobilization of critically ill patients can reduce several complications including atelectasis and ventilator-associated pneumonia and shorten ventilator time along with cognitive and functional limitations that linger 1 to 5 years after discharge from the intensive care unit. A long-standing challenge to successful mobilization of critically ill patients is the safety concern of hemodynamic instability. An in-depth exploration of what happens to a critically ill patient physiology during mobilization was done to foster a better understanding of strategies that promote adaptation. The article examines the evidence supporting the need to assess readiness for mobilization to reduce the risk of adverse events. Evidence-based tools and techniques to help clinicians prevent hemodynamic instability before, during, and after in-bed or out-of-bed mobilization are discussed. With safety serving as the overriding goal, we can overcome the barriers and succeed in creating and sustaining a culture of early progressive mobility programs within the intensive care unit.

Effects of early mobilization protocol performed after cardiac surgery on patient care outcomes

“…This was created using the cardiac surgical fast‐track protocol (Freeman & Maley, ), early mobilization protocols (Dammeyer, Dickinson, Packard, Baldwin, & Ricklemann, ; Vollman, ), and results of previous studies (Ahmed et al, ; Gagnon Cardiovascular Institute, ; Korkut, ; Mulkey, Bena, & Albert, ; Sarıkaya, ; Yıldırım & Yavuz, ; Yıldırım & Yavuz, ).…”

Evaluation of a fluidised positioner to reduce occipital pressure injuries in intensive care patients: A pilot study

“…However, frequent off‐loading and repositioning of the occiput region of patients who are receiving ECMO, or are mechanically ventilated and have limited head movements, is a challenge . Specifically, repositioning these patients may not be safe because of potentially fatal hemodynamic instability, increased pain, and concern for the safety of tubing and devices . Therefore, a pressure‐relieving device for the occiput region is an important consideration.…”

“…[37][38][39] Specifically, repositioning these patients may not be safe because of potentially fatal hemodynamic instability, increased pain, and concern for the safety of tubing and devices. 14,[38][39][40] Therefore, a pressure-relieving device for the occiput region is an important consideration.…”

Registered nurse intent to promote physical activity for hospitalised liver transplant recipients

“…An early mobility protocol may help create the environment and provide the support for motivated RNs to act on their intention and provide PA interventions during hospitalisation. Lack of RN knowledge and human and physical resources have been identified as barriers to mobilising patients in the intensive care unit (Vollman, ). The nurse manager can serve a pivotal role in designing an early mobility protocol that takes into account intrinsic and extrinsic motivation factors.…”

“…The literature supporting the effects of early mobility protocols in LTRs is limited; however, there is evidence that early mobilisation can positively benefit critically ill patients in intensive care units. For critically ill patients, early mobilisation can impact long‐term weakness and physical dysfunction (Vollman, ). Early mobilisation in medical/surgical inpatient populations contributes to reduced length of stay, maintained or improved functional status, faster recovery time and reduced postoperative symptoms (Pashikanti & Von Ah, ).…”