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Early Mobilization

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

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Early Mobilization

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  1. Early Mobilization In the Intensive Care Setting Lauren Wesson-Stout University of South Florida, College of Nursing

  2. Objectives • Define early mobilization within the intensive care setting • Identify benefits of early mobilization • Discuss current evidence-based research supporting the use of early mobilization in the ICU

  3. 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

  4. Risks of Immobility • Increased length of hospital stay • Increased mortality • Increased muscle atrophy • Increased risk of aspiration • Increased rate of return to ICU

  5. Benefits of Early Mobilization • Improved functional independence • Reduced ICU delirium • Reduced duration of mechanical ventilation • Reduced ICU (and hospital) length of stay • Improved walk distance • Improved muscle strength

  6. Goals of Mobility for TGH • Reduce bounceback • Patients should be out of bed before transfer to floor • Patient should maintain pre-hospital mobility • Prevent pressure ulcers

  7. Patient Data

  8. Perceived Barriers • Lack of understanding of mobility benefits • Patient status • Resources

  9. Early Progressive Mobility Protocol – Step One

  10. Early Progressive Mobility Protocol – Step Two

  11. Resource Solutions • Interdisciplinary Involvement • Physician Groups • Respiratory Therapy • Physical Therapy • Lift Team • Patient Care Technicians

  12. Mobility Technician (MT) • Turn patients every two hours • Responsible for PROM exercise • Ambulate stable patients

  13. Delegation • Level 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

  14. Evaluation

  15. 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

  16. 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

  17. 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/

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