Rethinking mobility and intensive care patients.

Abstract

IMMOBILITY HAS LONG BEEN a well-known risk factor of adverse patient outcomes such as venous thromboembolisim, urinary stasis, pulmonary insufficiency, pressure ulcer development, decreased gastric motility/constipation, orthostasis, and muscle weakness. 1 Mooris P.E. Goad A. Thompson C. et al. Early intensive care mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008; 36: 2238-2243 Crossref PubMed Scopus (808) Google Scholar , 2 Timmerman R.A. A mobility protocol for critically ill adults. Dimens Crit Care Nurs. 2007; 26: 175-179 Crossref PubMed Scopus (32) Google Scholar , 3 Asher A. Equipment used for safe mobilization of the ICU patient. Crit Care Nurs Q. 2013; 36: 101-108 Crossref PubMed Scopus (4) Google Scholar , 4 Perme C. Chandrashekar R. Early mobility and walking program for patients in intensive care units: creating as standard of care. Am J Crit Care. 2009; 18: 212-221 Crossref PubMed Scopus (112) Google Scholar , 5 Brower R.G. Consequences of bed rest. Crit Care Med. 2009; 37: S422-S428 Crossref PubMed Scopus (212) Google Scholar Furthermore, studies have reported that 60% of patients in intensive care who were prescribed bed rest experienced muscular weakness for up to a year after discharge. 1 Mooris P.E. Goad A. Thompson C. et al. Early intensive care mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008; 36: 2238-2243 Crossref PubMed Scopus (808) Google Scholar , 5 Brower R.G. Consequences of bed rest. Crit Care Med. 2009; 37: S422-S428 Crossref PubMed Scopus (212) Google Scholar Bed rest has frequently been ordered or maintained for critically ill patients due to false assumptions that limited movement improved comfort and conserved metabolic resources essential for healing. 5 Brower R.G. Consequences of bed rest. Crit Care Med. 2009; 37: S422-S428 Crossref PubMed Scopus (212) Google Scholar The postanesthesia patient provides additional risk factors associated with immobility intraoperatively. Perianesthesia nurses are in an optimal position to rethink how we mobilize intensive care patients initiating progressive steps toward mobilization to reduce adverse patient outcomes. Mary Beth Flynn Makic, PhD, RN, CNS, CCNS, FAAN, Research Nurse Scientist, Critical Care, University of Colorado Hospital; Associate Professor Adjoint, University of Colorado, College of Nursing, Aurora, CO