Early MobilizationIn 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

Discuss 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 Immobility

Increased length of hospital stay

Increased mortality

Increased muscle atrophy

Increased risk of aspiration

Increased rate of return to ICU

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

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

Patient Data

Perceived Barriers

Lack of understanding of mobility benefits

Patient status

Resources

Early Progressive Mobility Protocol – Step One

Early Progressive Mobility Protocol – Step Two

Resource Solutions

Interdisciplinary Involvement Physician GroupsRespiratory TherapyPhysical TherapyLift TeamPatient Care Technicians

Mobility Technician (MT)

Turn patients every two hours

Responsible for PROM exercise

Ambulate stable patients

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

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/