Early Mobilization In Intensive Care Unit Research Articles

Early mobilisation practice in intensive care units: A large-scale cross-sectional survey in China.

The field of early rehabilitation has developed slowly in mainland China and there are limited data on the implementation of early mobilisation (EM) practice in intensive care unit (ICUs) in China. To investigate the implementation of EM in ICUs in mainland China and to analyse its influencing factors. A cross-sectional electronic survey was conducted in 444 ICUs across 11 provinces in China. Head nurses provided data on institutional characteristics and EM practice in ICUs. Logistic regression models were used to identify factors associated with the implementation of EM. In all, 56.98% (253/444) of ICUs implemented EM with comprehensive or complete implementation in 86 ICUs. Of the 191 ICUs that did not use EM, 136 planned to implement EM in the near future. Of the 253 ICUs that used EM, 21.34% of ICUs implemented EM for all eligible patients, while 24.90% would evaluate and carry out EM within 48 h after ICU admission, 39.13% had collaborative EM teams, 34.39% reported the use of EM protocols, 14.63% reported multidisciplinary rounds and 17.39% had medical orders and charging standards for all EM activities. Only 18.18% of ICUs conducted frequent professional training for EM, and abnormal events occurred in 15.41% of ICUs during EM practice. Multivariate logistic regression analysis revealed that an economically strong province, the presence of a dedicated therapist team, more ICU beds and a higher staff-to-bed ratio favoured the implementation of EM. Furthermore, multidisciplinary rounds, well-established medical orders and charging standards, and a high frequency of professional training can lead to the comprehensive promotion and development of EM practice in ICUs. Both the implementation rate and quality of EM practice for critically ill patients require improvement. EM practice in Chinese ICUs is still nascent and requires development in a variety of domains. To facilitate the implementation of EM in ICUs, more human resources, especially the involvement of a professional therapist team, should be deployed. In addition, health providers should actively organize multidisciplinary rounds and professional training and formulate appropriate EM medical orders and charging standards.

Enhancing the awakening to family engagement bundle with music therapy.

Survivors of prolonged intensive care unit (ICU) admissions may present undesirable long-term outcomes. In particular, physical impairment and cognitive dysfunction have both been described in patients surviving episodes requiring mechanical ventilation and sedation. One of the strategies to prevent the aforementioned outcomes involves the implementation of a bundle composed by: (1) Spontaneous awakening trial; (2) Spontaneous breathing trial; (3) Choosing proper sedation strategies; (4) Delirium detection and management; (5) Early ICU mobility; and (6) Family engagement (ABCDEF bundle). The components of this bundle contribute in shortening length of stay on mechanical ventilation and reducing incidence of delirium. Since the first description of the ABCDEF bundle, other relevant therapeutic factors have been proposed, such as introducing music therapy. This mini-review describes the current evidence supporting the use of the ABCDEF bundle, as well as current knowledge on the implementation of music therapy.

Early mobilization in intensive care unit in Latin America: A survey based on clinical practice.

The application of early mobilization (EM) in intensive care units (ICUs) has shown to improve the physical and ventilatory status of critically ill patients, even after ICU stay. This study aimed to describe the practices regarding EM in ICUs in Latin America. We conducted an observational, cross-sectional study of professionals from all countries in Latin America. Over 3 months, professionals working in ICU units in Latin America were invited to answer the survey, which was designed by an expert committee and incorporated preliminary questions based on studies about EM recommendations. As many as 174 health professionals from 17 countries completed the survey. The interventions carried out within each ICU were active mobilization (90.5%), passive mobilization (85.0%), manual and instrumental techniques for drainage of mucus secretion (81.8%), and positioning techniques (81%). The professionals who most participated in the rehabilitation process in ICUs were physiotherapists (98.7%), intensive care physicians (61.6%), nurses (56.1%), and respiratory therapists (43.8%). In only 36.1% of the ICUs, protocols were established to determine when a patient should begin EM. In 38.1% of the cases, the onset of EM was established by individual evaluation, and in 25.0% of the cases, it was the medical indication to start rehabilitation and EM. This report shows us that EM of critically ill patients is an established practice in our ICUs like in other developed countries.

Effectiveness of a quality improvement strategy with implementation of a specific visual tool to promote ICU early mobilization

Early progressive mobilization is a safe strategy in the intensive care unit (ICU), however, it is still considered challenging by the inherent barriers and poor adherence to early mobilization protocol. The aim of this study was to evaluate the effectiveness of a quality improvement (QI) multifaceted strategy with implementation of a specific visual tool, the “mobility clock”, in reducing non-compliance with the institutional early mobilization (EM) protocol in adult ICUs. A single-center QI with a retrospective before-after comparison study was conducted using data from medical records and hospital electronic databases. Patients from different periods presented similar baseline characteristics. After the QI strategy, a decline in “non-compliance” with the protocol was observed compared to the previous period (10.11% vs. 26.97%, p < 0.004). The proportion of patients walking was significantly higher (49.44% vs. 29.21%, p < 0.006) and the ICU readmission rate was lower in the “after” period (2.25% vs. 11.24%; p = 0.017). The multifaceted strategy specifically designed considering institutional barriers was effective to increase out of bed mobilization, to reduce the “non-compliance” rate with the protocol and to achieve a higher level of mobility in adult ICUs of a tertiary hospital.

A bibliometric and visualized analysis of early mobilization in intensive care unit from 2000 to 2021.

BackgroundEarly mobilization in the intensive care unit (ICU) is a hotspot. This study aims to provide a bibliometric perspective of the progress in this field.MethodsWe extracted publications on ICU early mobilization published in the Web of Science Core Collection database from 2000 to 2021. VOSviewer was used to construct co-occurrence and co-citation relationships for authors, references, and keywords; Citespace was used to visualize knowledge mapping of subject categories, countries, and keywords with the strongest citation bursts.ResultsA total of 4,570 publications were analyzed, with a steady increase in publications in the field of ICU early mobilization. From a macro perspective, research on ICU early mobilization involves multidisciplinary involvement, including critical care medicine, neurology, and nursing; as for the meso perspective, the United States is the major contributor. Needham DM and Schweickert WD are the key researchers in this field. Moreover, the core journal is Critical Care Medicine, with the most publications and citations. The microscopic level, dominated by references and keywords, illustrates that the hotspot and frontier of research on ICU early mobilization focus on ICU-acquired weakness, delirium, the prognosis of critical illness, and severe COVID-19.ConclusionThis study presents a research landscape of ICU early mobilization from different perspectives. These findings will contribute to a better understanding of the current state of research in critical care medicine and provide the available information for future research ideas.

Development of Physiotherapist-Led Diagnostic Lung Ultrasound in Hong Kong

In the past 10-15 years, major developments in critical care physiotherapy have been witnessed in Hong Kong (HK), such as the provision of early mobilization and ventilator hyperinflation to the critically ill in Intensive Care Units (ICUs) with the aims of avoiding ICU-acquired weakness, weaning the patients off ventilators and shortening the patients’ hospitalization time. In respect of the development of early mobilization in ICU, protocols have been established. The benefits brought to patients by these protocols are well recognized and appreciated by medical practitioners in many local ICUs. Relevant resources have been increasingly allocated to this area. Equipment, staff training and manpower are improved.

Impact of an early mobilization protocol on outcomes in trauma patients admitted to the intensive care unit: A retrospective pre-post study.

Prolonged immobility has detrimental consequences for critically ill patients admitted to the intensive care unit (ICU). Previous work has shown that early mobilization of ICU patients is a safe, feasible and effective strategy to improve outcomes; however, few of these studies focused on trauma ICU patients. Our objective was to assess the impact of implementing an ICU early mobilization protocol (EMP) on trauma outcomes. We conducted a retrospective pre-post study of adult trauma patients (>18 years old) admitted to ICU at a Level I trauma center over a 2-year period prior to and following EMP implementation, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared outcomes (mortality, length of stay [LOS], ventilator-free days) between patients admitted during pre-EMP and post-EMP periods, and assessed for factors associated with outcomes using binary logistic regression and generalized linear models. Overall, 526 patients were included in the analysis (292 pre-EMP, 234 post-EMP). Ages ranged from 18 years to 92 years (mean, 49.0 ± 20.4 years) and 74.3% were men. The post-EMP group had lower ICU mortality (21.6% vs. 12.8%; p = 0.009) and in-hospital mortality (25.3% vs. 17.5%; p = 0.031). After controlling for confounders, patients in the post-EMP group were less likely to die in the ICU (odds ratio, 0.43; 95% confidence interval, 0.24-0.79; p = 0.006) or in-hospital (odds ratio, 0.55; 95% confidence interval; 0.32-0.94; p = 0.03). In-hospital LOS, ICU LOS, ICU-free days, and number of ventilator-free days were similar between the two groups. Trauma patients admitted to ICU during the post-EMP period had decreased odds of ICU mortality and in-hospital mortality. This is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol. Therapeutic, level III.

PENGETAHUAN DAN SIKAP PERAWAT TENTANG MOBILISASI DINI PASIEN DI ICU RSUD PANEMBAHAN SENOPATI BANTUL YOGYAKARTA

Background: Early mobilization is necessary in critically ill patients in Intensive Care Unit (ICU) to prevent hypovolemia which endangers patient’s life. The role of nurses in early mobilization is important by providing explanations and motivating patients to achieve the purpose of healing. Guidance and intensive intervention from nurses can reduce the recurrence of disease.&#x0D; Objective: To investigate the level of knowledge and attitude of nurses on patients early mobilization in ICU of RSUD Panembahan Senopati Bantul.&#x0D; Method: A descriptive, cross sectional study, was applied on 20 nurses in ICU of RSUD Panembahan Senopati Bantul. Univariate data analysis was administered to characteristics of respondents, knowledge, attitudes, and cross-tabulations.&#x0D; Result: Most of nurses have good level of knowledge (70%), and on attitude domain, most nurses are being supportive (75%) in terms of early mobilization to patients. Nurses whose age are  22-35 years old (10%), male (10%), have been working for 1 month up to 5 years (10%), have background of 3 years diploma in nursing (10%)  fall into poor knowledge category. Similar characteristics contribute to attitude domain where nurses whose age are 22-35 years old (25%), male (15%), have been working for 1 month up to 5 years (25%), have background of 3 years diploma in nursing (35%) are placed into unsupportive category.&#x0D; Conclusion: The level of knowledge of nurses on patients early mobilization is in good category where the attitude is in supportive category.&#x0D; Keywords: Knowledge, attitude of nurses, early mobilization.

(27) Pediatric Intensive Care Unit Early Mobilization and Impact on Parent Stress

(27) Pediatric Intensive Care Unit Early Mobilization and Impact on Parent Stress

27) Pediatric Intensive Care Unit Early Mobilization and Impact on Parent Stress

Purpose: Early mobilization is novel in the Pediatric Intensive Care Unit (PICU). A goal-directed mobilization protocol adjusted for age and severity of illness has been in place in our PICU for >2 years with parent refusal identified as a barrier to compliance. We sought to understand parent stress related to mobilization by identifying parent, child, and therapy related factors and how parent mobilization …

The effect of early mobilization for critical ill patients requiring mechanical ventilation: a systematic review and meta-analysis

Background: In recent years, there are increasing number of new studies and researches about early mobilization, an update meta-analysis based on high quality studies and focusing on the effectiveness of early mobilization is quite necessary. The purpose of the article is to explore the effect and safety of early mobilization on reducing the length of stay (LOS) and duration of mechanical ventilation in patients undergoing mechanical ventilation in intensive care unit. Methods: The databases PubMed, Scopus, EBSCO and Embase were systematically searched. We designed a search strategy for PubMed that consists of terms related to early mobilization and intensive care unit (ICU). We reported mean difference (MD) and 95% CI for LOS in ICU and hospital, the duration of mechanical ventilation, and reported odds ratio (OR) and 95% CI for mortality at hospital discharge. Results: In total, there were 18 research articles included in the meta-analysis. The early mobilization in intervention group appeared to have positive influence on hospital outcomes with the LOS in ICU (MD =−1.75, 95% CI: −2.70 to −0.79; P=0.0003) and duration of mechanical ventilation (MD =−1.64, 95% CI: −2.41 to −0.87; P Conclusions: Early mobilization in ICU has positive and safe influence on hospital outcomes in mechanical ventilation patients. It confers significant benefit in decreasing the duration of mechanical ventilation and the LOS in ICU. Furthermore, the early mobilization therapy in ICU will not increase mortality at hospital discharge in a research setting.

Making of a Successful Early Mobilization Program for a Medical Intensive Care Unit.

To provide a guideline for intensive care unit (ICU) early mobilization program development and implementation and to describe the patient characteristics and endpoints for those who participated in our hospital's early mobilization program. An ICU early mobilization program was developed with five guiding principles: analgesia/sedation optimization, sedation minimization, protocol of progressive mobility, physical therapy and occupational therapy recruitment, and nursing education. This program began in April 2014, and the initial 32 patients who ambulated while receiving mechanical ventilation were retrospectively assessed and their characteristics described. After program implementation, more than 50 mechanically ventilated patients ambulated in the first year following early mobilization initiation. Patients with an FiO2 as high as 1.0 and on nonconventional modes of mechanical ventilation successfully ambulated without adverse events. The mean ambulation distance was 102 ± 152 f. and usually required three ICU staff members with 5 to 10 minutes of preparation before ambulation. After implementation, a retrospective analysis revealed a decrease in the average length of ICU stay, from 4.8 to 4.1 days. Addressing analgesia and sedation practices, along with instituting a progressive mobility protocol and recruiting physical and occupational therapy, may serve as a guide to the creation of a successful early mobilization program. This study provides additional supportive evidence that early mobilization in the ICU is safe and effective.

On “Physical therapist–established intensive care unit early mobilization program…” Engel HJ, Tatebe S, Alonzo PB, et al. Phys Ther. 2013;93:975–985.

Engel et al1 present an excellent overview of their physical therapist–established intensive care unit (ICU) early mobilization program. Through the selection of appropriate outcome measures, the reader is able to assess the impact of early rehabilitation on both patient outcomes (functional capacity, mobility status) and health care resource utilization (ICU and hospital length of stay, discharge disposition). The study's positive findings also were achieved without any recorded serious adverse events, providing further evidence that rehabilitation can be safely initiated in patients who are critically ill. As …

Physical Therapist–Established Intensive Care Unit Early Mobilization Program: Quality Improvement Project for Critical Care at the University of California San Francisco Medical Center

Long-term weakness and disability are common after an intensive care unit (ICU) stay. Usual care in the ICU prevents most patients from receiving preventative early mobilization. The study objective was to describe a quality improvement project established by a physical therapist at the University of California San Francisco Medical Center from 2009 to 2011. The goal of the program was to reduce patients' ICU length of stay by increasing the number of patients in the ICU receiving physical therapy and decreasing the time from ICU admission to physical therapy initiation. This study was a 9-month retrospective analysis of a quality improvement project. An interprofessional ICU Early Mobilization Group established and promoted guidelines for mobilizing patients in the ICU. A physical therapist was dedicated to a 16-bed medical-surgical ICU to provide physical therapy to selected patients within 48 hours of ICU admission. Patients receiving early physical therapy intervention in the ICU in 2010 were compared with patients receiving physical therapy under usual care practice in the same ICU in 2009. From 2009 to 2010, the number of patients receiving physical therapy in the ICU increased from 179 to 294. The median times (interquartile ranges) from ICU admission to physical therapy evaluation were 3 days (9 days) in 2009 and 1 day (2 days) in 2010. The ICU length of stay decreased by 2 days, on average, and the percentage of ambulatory patients discharged to home increased from 55% to 77%. This study relied upon the retrospective analysis of data from 6 collectors, and the intervention lacked physical therapy coverage for 7 days per week. The improvements in outcomes demonstrated the value and feasibility of a physical therapist-led early mobilization program.

Acquired Neuromuscular Weakness and Early Mobilization in the Intensive Care Unit

Survival from critical illness has improved in recent years, leading to increased attention to the sequelae of such illness. Neuromuscular weakness in the intensive care unit (ICU) is common, persistent, and has significant public health implications. The differential diagnosis of weakness in the ICU is extensive and includes critical illness neuromyopathy. Prolonged immobility and bedrest lead to catabolism and muscle atrophy, and are associated with critical illness neuromyopathy and ICU-acquired weakness. Early mobilization therapy has been advocated as a mechanism to prevent ICU-acquired weakness. Early mobilization is safe and feasible in most ICU patients, and improves outcomes. Implementation of early mobilization therapy requires changes in ICU culture, including decreased sedation and bedrest. Various technologies exist to increase compliance with early mobilization programs. Drugs targeting muscle pathways to decrease atrophy and muscle-wasting are in development. Additional research on early mobilization in the ICU is needed.

Receiving Early Mobility During an Intensive Care Unit Admission Is a Predictor of Improved Outcomes in Acute Respiratory Failure

IntroductionHospitals are under pressure to provide care that not only shortens hospital length of stay but also reduces subsequent hospital admissions. Hospital readmissions have received increased attention in outcome reporting. The authors identified survivors of acute respiratory failure who then required subsequent hospitalization. A cohort of acute respiratory failure survivors, who participated in an early intensive care unit (ICU) mobility program, was assessed to determine if variables from the index hospitalization predict hospital readmission or death, within 12 months of hospital discharge. MethodsHospital database and responses to letters mailed to 280 acute respiratory failure survivors. Univariate predictor variables shown to be associated with hospital readmission or death (P < 0.1) were included in a multiple logistic regression. A stepwise selection procedure was used to identify significant variables (P < 0.05). ResultsOf the 280 survivors, 132 (47%) had at least 1 readmission or died within the first year, 126 (45%) were not readmitted and 22 (8%) were lost to follow-up. Tracheostomy [odds ratio (OR), 4.02 (95%CI, 1.72-9.40)], female gender [OR, 1.94 (95%CI, 1.13-3.32)], a higher Charlson Comorbidity Index assessed upon index hospitalization discharge [OR, 1.15 (95%CI, 1.01-1.31)] and lack of early ICU mobility therapy [OR, 1.77 (95%CI, 1.04-3.01)] predicted readmission or death in the first year postindex hospitalization. ConclusionsTracheostomy, female gender, higher Charlson Comorbidity Index and lack of early ICU mobility were associated with readmissions or death during the first year. Although the mechanisms of increased hospital readmission are unclear, these findings may provide further support for early ICU mobility for patients with acute respiratory failure.

Strategies for Promoting Early Activity in Critically Ill Mechanically Ventilated Patients

Prolonged immobilization plays a significant role in neuromuscular abnormalities and complicates the clinical course of a majority of critically ill patients. Immobilization in critically ill patients is associated with significant morbidity and impaired physical function. Overuse of sedation, sleep deprivation, immobility, and the development of delirium are all intensive care unit (ICU) factors that may negatively impact patient outcomes. Ambulation of critically ill patients is difficult with risk for adverse events. However, with a dedicated and trained team and culture change, early ICU mobility can be a feasible and safe process. Early mobility has potential as a therapy to prevent or treat the neuromuscular complications of critical illness. ICU culture can be transformed in a way that leads to improved and more reliable treatments and care, including early activity and mobility.

Strategies for Promoting Early Activity in Critically Ill Mechanically Ventilated Patients

Prolonged immobilization plays a significant role in neuromuscular abnormalities and complicates the clinical course of a majority of critically ill patients. Immobilization in critically ill patients is associated with significant morbidity and impaired physical function. Overuse of sedation, sleep deprivation, immobility, and the development of delirium are all intensive care unit (ICU) factors that may negatively impact patient outcomes. Ambulation of critically ill patients is difficult with risk for adverse events. However, with a dedicated and trained team and culture change, early ICU mobility can be a feasible and safe process. Early mobility has potential as a therapy to prevent or treat the neuromuscular complications of critical illness. ICU culture can be transformed in a way that leads to improved and more reliable treatments and care, including early activity and mobility.

Early intensive care unit mobility therapy in the treatment of acute respiratory failure*

Immobilization and subsequent weakness are consequences of critical illness. Despite the theoretical advantages of physical therapy to address this problem, it has not been shown that physical therapy initiated in the intensive care unit offers benefit. Prospective cohort study in a university medical intensive care unit that assessed whether a mobility protocol increased the proportion of intensive care unit patients receiving physical therapy vs. usual care. Medical intensive care unit patients with acute respiratory failure requiring mechanical ventilation on admission: Protocol, n = 165; Usual Care, n = 165. An intensive care unit Mobility Team (critical care nurse, nursing assistant, physical therapist) initiated the protocol within 48 hrs of mechanical ventilation. The primary outcome was the proportion of patients receiving physical therapy in patients surviving to hospital discharge. Baseline characteristics were similar between groups. Outcome data are reflective of survivors. More Protocol patients received at least one physical therapy session than did Usual Care (80% vs. 47%, p < or = .001). Protocol patients were out of bed earlier (5 vs. 11 days, p < or = .001), had therapy initiated more frequently in the intensive care unit (91% vs. 13%, p < or = .001), and had similar low complication rates compared with Usual Care. For Protocol patients, intensive care unit length of stay was 5.5 vs. 6.9 days for Usual Care (p = .025); hospital length of stay for Protocol patients was 11.2 vs. 14.5 days for Usual Care (p = .006) (intensive care unit/hospital length of stay adjusted for body mass index, Acute Physiology and Chronic Health Evaluation II, vasopressor). There were no untoward events during an intensive care unit Mobility session and no cost difference (survivors + nonsurvivors) between the two arms, including Mobility Team costs. A Mobility Team using a mobility protocol initiated earlier physical therapy that was feasible, safe, did not increase costs, and was associated with decreased intensive care unit and hospital length of stay in survivors who received physical therapy during intensive care unit treatment compared with patients who received usual care.