Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit
TL;DR: Early mobilization is found to have positive effects on various outcomes in patients with or without mechanical ventilation, and the newer techniques can be used to facilitate early mobilization.
Abstract: Purpose. Patients admitted to the intensive care unit (ICU) are generally confined to bed leading to limited mobility that may have
detrimental effects on different body systems. Early mobilization prevents or reduces these effects and improves outcomes in
patients following critical illness. +e purpose of this review is to summarize different aspects of early mobilization in intensive
care. Methods. Electronic databases of PubMed, Google Scholar, ScienceDirect, and Scopus were searched using a combination of
keywords. Full-text articles meeting the inclusion criteria were selected. Results. Fifty-six studies on various aspects such as the
effectiveness of early mobilization in various intensive care units, newer techniques in early mobilization, outcome measures for
physical function in the intensive care unit, safety, and practice and barriers to early mobilization were included. Conclusion: Early
mobilization is found to have positive effects on various outcomes in patients with or without mechanical ventilation. +e newer
techniques can be used to facilitate early mobilization. Scoring systems—specific to the ICU—are available and should be used to
quantify patients’ status at different intervals of time. Early mobilization is not commonly practiced in many countries. Various
barriers to early mobilization have been identified, and different strategies can be used to overcome them.
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01 Aug 2001
TL;DR: The study of distributed systems which bring to life the vision of ubiquitous computing systems, also known as ambient intelligence, is concentrated on in this work.
Abstract: With digital equipment becoming increasingly networked, either on wired or wireless networks, for personal and professional use alike, distributed software systems have become a crucial element in information and communications technologies. The study of these systems forms the core of the ARLES' work, which is specifically concerned with defining new system software architectures, based on the use of emerging networking technologies. In this context, we concentrate on the study of distributed systems which bring to life the vision of ubiquitous computing systems, also known as ambient intelligence.
2,774 citations
81 citations
TL;DR: In this article, a review highlights the pathophysiology, evaluation, and contemporary management of cardiogenic shock related to myocardial infarction (HF-CS) is presented.
33 citations
TL;DR: In this article, a review of the rehabilitation treatments provided to patients undergoing ECMO support during the COVID-19 pandemic is presented, which mainly consists of in-bed mobilization, postural transfers (including sitting), and respiratory exercises.
Abstract: Background and purpose The coronavirus diseases 2019 (COVID-19) pandemic posed severe difficulties in managing critically ill patients in hospital care settings. Extracorporeal membrane oxygenation (ECMO) support has been proven to be lifesaving support during the SARS-CoV-2 outbreak. The purpose of this review was to describe the rehabilitative treatments provided to patients undergoing ECMO support during the COVID-19 pandemic. Methods We searched PubMed and Scopus for English-language studies published from the databases' inception until June 30, 2021. We excluded editorials, letters to the editor, and studies that did not describe rehabilitative procedures during ECMO support. We also excluded those articles not written in English. Results A total of 50 articles were identified. We ultimately included nine studies, seven of which were case reports. Only two studies had more than one patient; an observational design analyzing the clinical course of 19 patients and a case series of three patients. Extracorporeal support duration varied from 9 to 49 days, and the primary indication was acute respiratory distress syndrome COVID-19-related. Rehabilitative treatment mainly consisted of in-bed mobilization, postural transfers (including sitting), and respiratory exercises. After hospital discharge, patients were referred to rehabilitation facilities. Physiotherapeutic interventions provided during ECMO support and after its discontinuation were feasible and safe. Conclusion The physiotherapeutic treatment of patients undergoing ECMO support includes several components and must be provided in a multidisciplinary context. The optimal approach depends on the patient's status, including sedation, level of consciousness, ECMO configuration, types of cannulas, and cannulation site.
12 citations
TL;DR: In this article, the incidence and risk factors of patient-related safety events (PSE) in situations limited to intubated patients in which active mobilization, such as sitting on the edge of the bed/standing/walking, was carried out.
Abstract: The aim of this study is to clarify the incidence and risk factors of patient-related safety events (PSE) in situations limited to intubated patients in which active mobilization, such as sitting on the edge of the bed/standing/walking, was carried out. A multi-center retrospective observational study was conducted at nine hospitals between January 2017 and March 2018. The safety profiles and PSE of 87 patients were analyzed. PSE occurred in 10 out of 87 patients (11.5%) and 13 out of 198 sessions (6.6%). The types of PSE that occurred were hypotension (8, 62%), heart rate instability (3, 23%), and desaturation (2, 15%). Circulation-related events occurred in 85% of overall cases. No accidents, such as line/tube removal or falls, were observed. The highest incidence of PSE was observed during the mobilization level of standing (8 out of 39 sessions, 20.5%). The occurrence of PSE correlated with the highest activity level under logistic regression analysis. Close vigilance is required for intubated patients during active mobilization in the standing position with regard to circulatory dynamics.
8 citations
References
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01 Aug 2001
TL;DR: The study of distributed systems which bring to life the vision of ubiquitous computing systems, also known as ambient intelligence, is concentrated on in this work.
Abstract: With digital equipment becoming increasingly networked, either on wired or wireless networks, for personal and professional use alike, distributed software systems have become a crucial element in information and communications technologies. The study of these systems forms the core of the ARLES' work, which is specifically concerned with defining new system software architectures, based on the use of emerging networking technologies. In this context, we concentrate on the study of distributed systems which bring to life the vision of ubiquitous computing systems, also known as ambient intelligence.
2,774 citations
"Effectiveness, Safety, and Barriers..." refers background in this paper
...Such patients are at an increased risk of developing serious complications from their condition [1]....
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TL;DR: 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 duringintensive care unit treatment compared with patients who received usual care.
Abstract: Objective: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.Design and Setting:Prospective cohort
1,152 citations
TL;DR: Survivors of critical illness are frequently left with a legacy of long-term physical, neuropsychiatric, and quality of life impairments, which can help identify patients who are most at risk of these complications.
Abstract: Objectives:As critical care advances and intensive care unit mortality declines, the number of survivors of critical illness is increasing. These survivors frequently experience long-lasting complications of critical care. As a result, it is important to understand these complications and implement
678 citations
Ludwig Maximilian University of Munich1, Sir Charles Gairdner Hospital2, Paracelsus Private Medical University of Salzburg3, Harvard University4, Charité5, University of Brescia6, Beth Israel Deaconess Medical Center7, University of Massachusetts Amherst8, Spaulding Rehabilitation Hospital9, University of Duisburg-Essen10
TL;DR: Early, goal-directed mobilisation improved patient mobilisation throughout S ICU admission, shortened patient length of stay in the SICU, and improved patients' functional mobility at hospital discharge.
463 citations
TL;DR: Emerging research in this field provides preliminary evidence supporting the safety, feasibility, and potential benefits of early mobilization in critical care medicine.
Abstract: Early mobilization of patients in the hospital and the intensive care unit has a strong historical precedent. However, in more recent times, deep sedation and bed rest have been part of routine medical care for many mechanically ventilated patients. A growing body of literature demonstrates that survivors of severe critical illness commonly have significant and prolonged neuromuscular complications that impair their physical function and quality of life after hospital discharge. Bed rest, and its associated mechanisms, may play an important role in the pathogenesis of neuromuscular weakness in critically ill patients. A new approach for managing mechanically ventilated patients includes reducing deep sedation and increasing rehabilitation therapy and mobilization soon after admission to the intensive care unit. Emerging research in this field provides preliminary evidence supporting the safety, feasibility, and potential benefits of early mobilization in critical care medicine.
454 citations