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Semi upright position
Early mobilization
Frits van Beers Ventilation practitioner 1e European Conference Early mobilization Vienna
Semi upright position 2013
• Retrospective study • Supine (<10 º ) versus 45 º position • N = 60 • Multi ICU • Variables: SpO2 and ETCO2
Results
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Semi upright position improves ventilation and oxygenation in mechanical ventilated IC patients
Frits van Beers, Ventilation Practitioner, Intensive Care, St. Elisabeth hospital Tilburg, the Netherlands
Results • Significant increase of ventilation and oxygenation
• 1e step in early mobilzation • Effective for weaning procedures • Convenient position / psychological impact • Easy and effective application
Supine position and mechanical ventilation
Semi upright position
• ↓↓ Abdominal pressure • Recruitment dorsal lungparts • Improvement Va/Q ratio
• Daily: Awakening and breathing trial • Daily: Daily schedule & mobilization • Daily: VAP bundle & delirium • Daily: Consultation bedside IC team
Daily weanscreen in mechanically ventilated patients: J. van Rosmalen , A. van Hees, F. van Beers, , J.A.H. van Oers, Intensive Care Medicine, volume 36, supplement September 2010.
ABCDE bundle=Awakening and Breathing Coordination, Delirium monitoring, and Exercise/early mobility
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Study semi upright, EZ
1. Artificial ventilation in the semi-recumbent position improves oxygenation and gasexchange: Ben Speelberg, MD: Frits van Beers, Ventilation Practitioner, Chest, 124, 4, oktober 2003 supplement
2. Effect of body positioning in ventilated obese patients, F. v Beers, abstract 18th annual congres ESICM, Amsterdam
3. The effect of semi-recumbency in ventilated morbid obese patients, F. v Beers, abstract 19th annual congres ESICM, Barcelona
Early Mobilisation Network, Vienna, Austria, November 2013
Early mobility
Introduction
• Pieter Vaes, RN,CCRN, Woundcare specialist • Mark Verhagen,RN, CCRN, BA, Chairman
mobilize group • St.Elisabeth Hospital, Tilburg, The Netherlands
(Neuro )-Trauma center and Neuro-surgical center St.Elisabeth Hospital, Tilburg, The
Netherlands
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Program
• Introduction Patient Mobility • Special groups
Early Mobilisation Program on the ICU
2009: Patiënt Data Management System (PDMS) 2009: 12 hours/day physiotherapist available only for ICU 2012: Establish mobilize working group on ICU 2012: Build in a custom made Program; Patiënt Mobility Frame(PMF) 2012: Enlarge wheelchairs and Lift systems 2012: 3 x bed bike, developed with our physiotherapist and nurses
Determine Fase PMF
MET score: score one time Load Level: daily Coöperation Level: daily
cooperation and capability
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combined report Special groups
• Obese • Children • ABCDE bundle
Critical Care St. Elisabeth
CC EZ 2010 (n=1730) 2011 (n=1819)
BMI < 25 709 (42%) 711 (39%) BMI 25-30 667 (38%) 728 (40%) BMI 30-40 316 (18%) 333 (18%) BMI > 40 35 (2%) 46 (3%)
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2011 BMI 2010 - 2011
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The Netherlands
Overgewicht in Nederland
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1981 1985 1989 1993 1997 2001 2005 2009
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Overgewicht Nl per leeftijdscategorie (BMI > 25)
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CBS 1.9 million people BMI > 30
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Study St. Elisabeth Hospital 2013-2014
• Prospective analysis of the incidence and severity of post operative wound infections and the development of pressure ulcers in case of obesity.
• Olffen, Vos, Vaes & Gestel, 2013-2014
Thank you for your attention
Questions? [email protected] [email protected] [email protected]
