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      Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit

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          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. The 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. The 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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          Early intensive care unit mobility therapy in the treatment of acute respiratory failure.

          Peter Morris, Amanda Goad, Clifton C. Thompson … (2008)
          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. Prospective cohort study in a university medical intensive care unit that assessed whether a mobility protocol increased the proportion of intensive care unit patients receiving physical therapy vs. usual care. Medical intensive care unit patients with acute respiratory failure requiring mechanical ventilation on admission: Protocol, n = 165; Usual Care, n = 165. An intensive care unit Mobility Team (critical care nurse, nursing assistant, physical therapist) initiated the protocol within 48 hrs of mechanical ventilation. The primary outcome was the proportion of patients receiving physical therapy in patients surviving to hospital discharge. Baseline characteristics were similar between groups. Outcome data are reflective of survivors. More Protocol patients received at least one physical therapy session than did Usual Care (80% vs. 47%, p < or = .001). Protocol patients were out of bed earlier (5 vs. 11 days, p < or = .001), had therapy initiated more frequently in the intensive care unit (91% vs. 13%, p < or = .001), and had similar low complication rates compared with Usual Care. For Protocol patients, intensive care unit length of stay was 5.5 vs. 6.9 days for Usual Care (p = .025); hospital length of stay for Protocol patients was 11.2 vs. 14.5 days for Usual Care (p = .006) (intensive care unit/hospital length of stay adjusted for body mass index, Acute Physiology and Chronic Health Evaluation II, vasopressor). There were no untoward events during an intensive care unit Mobility session and no cost difference (survivors + nonsurvivors) between the two arms, including Mobility Team costs. 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 during intensive care unit treatment compared with patients who received usual care.
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            Long-term complications of critical care.

            Sanjay V Desai, Tyler Law, Dale M Needham (2011)
            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 evidence-based practices to minimize them. Database searches and review of relevant medical literature. Critical illness and intensive care unit care influence a wide range of long-term patient outcomes, with some impairments persisting for 5-15 yrs. Impaired pulmonary function, greater healthcare utilization, and increased mortality are observed in intensive care survivors. Neuromuscular weakness and impairments in both physical function and related aspects of quality of life are common and may be long-lasting. These complications may be reduced by multidisciplinary physical rehabilitation initiated early and continued throughout the intensive care unit care stay and by providing patient education for self-rehabilitation after hospital discharge. Common neuropsychiatric complications, including cognitive impairment and symptoms of depression and posttraumatic stress disorder, are frequently associated with intensive care unit sedation, delirium or delusional memories, and long-term impairments in quality of life. Survivors of critical illness are frequently left with a legacy of long-term physical, neuropsychiatric, and quality of life impairments. Understanding patient and intensive care risk factors can help identify patients who are most at risk of these complications. Furthermore, modifiable risk factors and beneficial interventions are increasingly being identified to help inform practical management recommendations to reduce the prevalence and impact of these long-term complications.
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              Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up

              Linda Denehy, Elizabeth H Skinner, Lara Edbrooke … (2013)
              Introduction The purpose of this trial was to investigate the effectiveness of an exercise rehabilitation program commencing during ICU admission and continuing into the outpatient setting compared with usual care on physical function and health-related quality of life in ICU survivors. Methods We conducted a single-center, assessor-blinded, randomized controlled trial. One hundred and fifty participants were stratified and randomized to receive usual care or intervention if they were in the ICU for 5 days or more and had no permanent neurological insult. The intervention group received intensive exercises in the ICU and the ward and as outpatients. Participants were assessed at recruitment, ICU admission, hospital discharge and at 3-, 6- and 12-month follow-up. Physical function was evaluated using the Six-Minute Walk Test (6MWT) (primary outcome), the Timed Up and Go Test and the Physical Function in ICU Test. Patient-reported outcomes were measured using the Short Form 36 Health Survey, version 2 (SF-36v2) and Assessment of Quality of Life (AQoL) Instrument. Data were analyzed using mixed models. Results The a priori enrollment goal was not reached. There were no between-group differences in demographic and hospital data, including acuity and length of acute hospital stay (LOS) (Acute Physiology and Chronic Health Evaluation II score: 21 vs 19; hospital LOS: 20 vs 24 days). No significant differences were found for the primary outcome of 6MWT or any other outcomes at 12 months after ICU discharge. However, exploratory analyses showed the rate of change over time and mean between-group differences in 6MWT from first assessment were greater in the intervention group. Conclusions Further research examining the trajectory of improvement with rehabilitation is warranted in this population. Trial registration The trial was registered with the Australian New Zealand Clinical Trials Registry ACTRN12605000776606.
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                Author and article information

                Contributors
                Aishwarya Gatty:
                ORCID: https://orcid.org/0000-0001-8426-2398
                Journal
                Journal ID (nlm-ta): Crit Care Res Pract
                Journal ID (iso-abbrev): Crit Care Res Pract
                Journal ID (publisher-id): CCRP
                Title: Critical Care Research and Practice
                Publisher: Hindawi
                ISSN (Print): 2090-1305
                ISSN (Electronic): 2090-1313
                Publication date Collection: 2020
                Publication date (Electronic): 26 November 2020
                Volume: 2020
                Electronic Location Identifier: 7840743
                Affiliations
                1Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
                2Department of Physiotherapy, Kastruba Medical College Mangalore, Manipal Academy of Higher Education, Mangaluru, Karnataka, India
                3Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, UAE
                Author notes

                Academic Editor: Timothy Plackett

                Author information
                https://orcid.org/0000-0001-7596-3459
                https://orcid.org/0000-0001-8426-2398
                https://orcid.org/0000-0002-5636-2620
                https://orcid.org/0000-0002-4744-0180
                Article
                DOI: 10.1155/2020/7840743
                PMC ID: 7714600
                PubMed ID: 33294221
                SO-VID: 38dd87ac-003d-41dd-9226-692d642fe5d2
                Copyright © Copyright © 2020 Gopala Krishna Alaparthi et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 July 2020
                Date accepted : 12 November 2020
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Emergency medicine & Trauma
                Data availability:
                ScienceOpen disciplines: Emergency medicine & Trauma

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