Abstract
BackgroundThere are numerous barriers to early mobilization (EM) in a resource-limited intensive care unit (ICU) without a specialized team or an EM culture, regarding patient stability while critically ill or in the presence of medical devices. We hypothesized that ICU physicians can overcome these barriers. The aim of this study was to investigate the safety of EM according to the Maebashi EM protocol conducted by ICU physicians.MethodsThis was a single-center prospective observational study. All consecutive patients with an unplanned emergency admission were included in this study, according to the exclusion criteria. The observation period was from June 2015 to June 2016. Data regarding adverse events, medical devices in place during rehabilitation, protocol adherence, and rehabilitation outcomes were collected. The primary outcome was safety.ResultsA total of 232 consecutively enrolled patients underwent 587 rehabilitation sessions. Thirteen adverse events occurred (2.2%; 95% confidence interval, 1.2–3.8%) and no specific treatment was needed. There were no instances of dislodgement or obstruction of medical devices, tubes, or lines. The incidence of adverse events associated with mechanical ventilation or extracorporeal membrane oxygenation (ECMO) was 2.4 and 3.6%, respectively. Of 587 sessions, 387 (66%) sessions were performed at the active rehabilitation level, including sitting out of the bed, active transfer to a chair, standing, marching, and ambulating. ICU physicians attended over 95% of these active rehabilitation sessions. Of all patients, 143 (62%) got out of bed within 2 days (median 1.2 days; interquartile range 0.1–2.0).ConclusionsEM according to the Maebashi EM protocol conducted by ICU physicians, without a specialized team or EM culture, was performed at a level of safety similar to previous studies performed by specialized teams, even with medical devices in place, including mechanical ventilation or ECMO. Protocolized EM led by ICU physicians can be initiated in the acute phase of critical illness without serious adverse events requiring additional treatment.
Highlights
There are numerous barriers to early mobilization (EM) in a resource-limited intensive care unit (ICU) without a specialized team or an EM culture, regarding patient stability while critically ill or in the presence of medical devices
Referring to existing EM protocols reported in prior studies [9, 11, 12, 14,15,16, 19, 24,25,26], we developed a novel EM program, the Maebashi EM protocol, which is conducted at the bedside by ICU physicians in our closed mixed ICU
The purpose of this study is to investigate whether EM according to this ICU physician-conducted protocol can be safely performed in the ICU without a specialized EM team or an EM culture, even though the patients have undergone the placement of a variety of medical devices
Summary
There are numerous barriers to early mobilization (EM) in a resource-limited intensive care unit (ICU) without a specialized team or an EM culture, regarding patient stability while critically ill or in the presence of medical devices. The aim of this study was to investigate the safety of EM according to the Maebashi EM protocol conducted by ICU physicians. After surviving a critical illness, many patients suffer long-term cognitive and physical dysfunction, and reduced health-related quality of life [1,2,3,4,5,6]. Several studies have shown that about half of patients cannot return to work [7, 8]. Early mobilization (EM) in the intensive care unit (ICU) has been recommended to prevent or limit cognitive and physical dysfunction [9]. EM has become an evidence-based practice and should be incorporated in daily practice, starting in the early phase of critical illness in the ICU [19]
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