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Early Mobilization. In the Intensive Care Setting Lauren Wesson-Stout University of South Florida, College of Nursing. Objectives. Define early mobilization within the intensive care setting Identify benefits of early mobilization - PowerPoint PPT Presentation
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Early MobilizationIn the Intensive Care Setting
Lauren Wesson-StoutUniversity of South Florida, College of Nursing
ObjectivesDefine early mobilization within the intensive care
settingIdentify benefits of early mobilizationDiscuss current evidence-based research
supporting the use of early mobilization in the ICU
What is early mobilization?Getting patients moving!Includes sitting, moving to a chair, ambulating,
and AROM and PROM exercises based on patient status
Evaluate patients individually to determine if they are stable for mobilization
Risks of ImmobilityIncreased length of hospital stayIncreased mortalityIncreased muscle atrophyIncreased risk of aspirationIncreased rate of return to ICU
Benefits of Early MobilizationImproved functional independenceReduced ICU deliriumReduced duration of mechanical ventilationReduced ICU (and hospital) length of stayImproved walk distanceImproved muscle strength
Goals of Mobility for TGHReduce bouncebackPatients should be out of bed before transfer to
floorPatient should maintain pre-hospital mobilityPrevent pressure ulcers
Patient Data
Perceived BarriersLack of understanding of mobility benefitsPatient statusResources
Early Progressive Mobility Protocol – Step One
Early Progressive Mobility Protocol – Step Two
Resource SolutionsInterdisciplinary Involvement
Physician GroupsRespiratory TherapyPhysical TherapyLift TeamPatient Care Technicians
Mobility Technician (MT)Turn patients every two hoursResponsible for PROM exerciseAmbulate stable patients
DelegationLevel 1
Passive ROM – MT Turn every 2 hours – Lift Team/MT
Level 2 Active resistance exercise – PT Sitting position for 20 minutes – Lift Team/MT
Level 3 Active transfer to chair – PT/MT/RT
Level 4 Stand at bedside – PT/MT/RT Ambulating in hallway – PT/MT/RT
Evaluation
References and Research Bourdin, G., Barbier, J., Burlem, J., Durante, G., Passant, S., Vincent, B.,
Badet, M., & Guerin, C. (2010). The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respiratory Care, 55(4), 400-407. Retrieved from http://rc.rcjournal.com/content/55/4/400.short
Clark, D., Lowman, J., Griffin, R., Matthews, H., & Reiff, D. (2013). Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. American Physical Therapy Association, 93(2), 186-196. doi: 10.2522/ ptj.20110417
Engel, H., Needham, D., Morris, P., & Gropper, M. (2013). Icu early mobilization: from recommendation to implementation at three medical centers. Critical Care Medicine, 41. doi: 10.1097/CCM.0b013e3182a240d5
Hopkins, R. (2010). Early activity in the icu: beyond safety and feasibility. Respiratory Care, 55(4), 481-484. Retrieved from http://rc.rcjournal.com/content/55/4/481.short
Leditschke, I., Green, M., Irvine, J., Bissett, B., & Mitchell, I. (2012). What are the barriers to mobilizing intensive care patients?. Cardiopulmonary Physical Therapy Journal, 23(1), 26-29. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286497/
Mah, J., Staff, I., Fichandler, D., & Butler, K. (2012). Resource-efficient mobilization programs in the intensive care unit: who stands to win?. The American Journal of Surgery, 206(4), 488-493. doi: 10.1016/j.amjsurg.2013.03.001
Meyer, M., Stanislaus, A., Lee, J., Waak, K., Ryan, C., Saxena, R., Ball, S., & Eikermann, M. (2013). Surgical intensive care unit optimal mobilisation score (soms) trial: a protocol for an international, multicentre, randomised controlled trial focused on goal-directed early mobilisation of surgical icu patients. BMJ Open, 3(8). doi: 10.1136/bmjopen-2013-003262
Morris, P., Goad, A., Thompson, C., Taylor, K., Harry, B., Passmore, L., Ross, A., & Haponik, E. (2008). Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Critical Care Medicine, 36(8), 2238-43. doi: 10.1097/CCM.0b013e318180b90e
Pires-Neto, R., Kawaguchi, Y., Hirota, A., Fu, C., Tanaka, C., Caruso, P., Park, M., & Carvalho, C. (2013). Very early passive cycling exercise in mechanically ventilated critically ill patients: physiological and safety aspects - a case series. PLoS One, 8(9). doi: 10.1371/journal.pone.0074182
Schweickert, W., & Kress, J. (2011). Implementing early mobilization interventions in mechanically ventilated patients in the icu. Chest, 140(6), 1612-17. doi: 10.1378/chest.10-2829
Schweickert, W., Pohlman, M., Pholman, A., Nigos, C., Pawlik, A., Esbrook, C., Spears, L., & Kress, J. (2009). Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. The Lancet, 373(9678), 1874-82. doi: 10.1016/S0140-6736(09)60658-9
Zomorodi, M., Topley, D., & McAnaw, M. (2012). Developing a mobility protocol for early mobilization of patients in a surgical/trauma icu. Critical Care Research and Practice. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539434/