early mobilization
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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 - PowerPoint PPT PresentationTRANSCRIPT
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Early MobilizationIn the Intensive Care Setting
Lauren Wesson-StoutUniversity of South Florida, College of Nursing
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ObjectivesDefine early mobilization within the intensive care
settingIdentify benefits of early mobilizationDiscuss current evidence-based research
supporting the use of early mobilization in the ICU
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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
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Risks of ImmobilityIncreased length of hospital stayIncreased mortalityIncreased muscle atrophyIncreased risk of aspirationIncreased rate of return to ICU
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Benefits of Early MobilizationImproved functional independenceReduced ICU deliriumReduced duration of mechanical ventilationReduced ICU (and hospital) length of stayImproved walk distanceImproved muscle strength
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Goals of Mobility for TGHReduce bouncebackPatients should be out of bed before transfer to
floorPatient should maintain pre-hospital mobilityPrevent pressure ulcers
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Patient Data
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Perceived BarriersLack of understanding of mobility benefitsPatient statusResources
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Early Progressive Mobility Protocol – Step One
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Early Progressive Mobility Protocol – Step Two
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Resource SolutionsInterdisciplinary Involvement
Physician GroupsRespiratory TherapyPhysical TherapyLift TeamPatient Care Technicians
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Mobility Technician (MT)Turn patients every two hoursResponsible for PROM exerciseAmbulate stable patients
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DelegationLevel 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
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Evaluation
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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
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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
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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/