Importance of early mobilisation in critical care patients.

Abstract

of any critical care team is to minimise length of admission and expedite safe discharge from hospital. In reality, the journey for a critical care patient is fraught with risks involving both predictable and some unforeseen complications. From my experiences on critical care units, it quickly became apparent that maintaining a progressive path towards recovery was one of the greatest challenges in patient care. This could be attributed to the complex and systemic nature of critical illness, which will inevitably result in continual changes in the patient’s condition. These circumstances often leave the patient with life-changing chronic conditions, such as psychological issues or functional disabilities after weeks or months of immobility. Indeed, research strongly suggests that lean muscle mass is significantly diminished after only 10 days of bed rest, which, while it did not always affect functional ability, did have a detrimental effect on muscle power and stamina (Kortebein et al, 2008). Unsurprisingly, this effect was magnified in older patients, where muscle mass is lost at a greater rate than in their younger counterparts (English and Paddon-Jones, 2010). Every critical care nurse will be familiar with this process. It is always distressing to observe a patient overcome with exhaustion while attempting the most simple of movements, such as rolling in bed. However, we must not forget that we are only observing the early stages of their difficulties and for some the road to recovery may never be fully travelled. There is evidence to suggest that critical care patients remain unemployed 12 months after hospital discharge with a significant proportion still struggling to sustain employment after 5 years (Schweickert and Kress, 2011). The reason is that muscle-mass loss has left them with a chronic reduction in exercise tolerance, Importance of early mobilisation in critical care patients