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Erschienen in: Current Anesthesiology Reports 2/2013

01.06.2013 | Critical Care Anesthesia (LL Liu, Section Editor)

Early Mobilization in the Intensive Care Unit

verfasst von: Andrew E. Schober, Kevin C. Thornton

Erschienen in: Current Anesthesiology Reports | Ausgabe 2/2013

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Abstract

Survivors of critical illness frequently suffer from disability associated with neuromuscular weakness. This can substantially impact their quality of life and ability to return home, and often results in the need for further rehabilitation. Early and aggressive physical and occupational therapy, beginning upon admission to the intensive care unit, can substantially reduce this functional disability and has been shown to impact numerous parameters including ICU and hospital length of stay, time needed to wean from mechanical ventilation, the incidence of delirium, and even rates of readmission and post-discharge mortality. While early mobilization has been shown to be both safe and feasible in a variety of ICU settings, it requires an interdisciplinary approach and changes to the ‘culture’ of the ICU. While the early results have been very encouraging, more research is needed to identify the optimal approach and the full extent of the benefits it may offer.
Literatur
1.
Zurück zum Zitat Dock W. The evil sequelae of complete bed rest. J Am Med Assoc. 1944;125(16):1083–4.CrossRef Dock W. The evil sequelae of complete bed rest. J Am Med Assoc. 1944;125(16):1083–4.CrossRef
2.
Zurück zum Zitat Schweickert WD, et al. Early physical and occupational therapy in mechanically-ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–82.PubMedCrossRef Schweickert WD, et al. Early physical and occupational therapy in mechanically-ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–82.PubMedCrossRef
3.
Zurück zum Zitat Garcia JP, et al. Ambulatory extracorporeal membrane oxygenation: a new approach for bridge-to-lung transplantation. J Thorac Cardiovasc Surg. 2010;139(6):e137–9.PubMedCrossRef Garcia JP, et al. Ambulatory extracorporeal membrane oxygenation: a new approach for bridge-to-lung transplantation. J Thorac Cardiovasc Surg. 2010;139(6):e137–9.PubMedCrossRef
4.
Zurück zum Zitat Morris PE, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36(8):2238–43.PubMedCrossRef Morris PE, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36(8):2238–43.PubMedCrossRef
5.
Zurück zum Zitat Allen C, Glasziou P, Mar CD. Bed rest: a potentially harmful treatment needing more careful evaluation. The Lancet. 1999;354(9186):1229–33.CrossRef Allen C, Glasziou P, Mar CD. Bed rest: a potentially harmful treatment needing more careful evaluation. The Lancet. 1999;354(9186):1229–33.CrossRef
6.
Zurück zum Zitat Chambers MA, Moylan JS, Reid MB. Physical inactivity and muscle weakness in the critically ill. Crit Care Med. 2009;37(Suppl 10):S337–46.PubMedCrossRef Chambers MA, Moylan JS, Reid MB. Physical inactivity and muscle weakness in the critically ill. Crit Care Med. 2009;37(Suppl 10):S337–46.PubMedCrossRef
7.
Zurück zum Zitat Puthucheary Z, Harridge S, Hart N. Skeletal muscle dysfunction in critical care: wasting, weakness, and rehabilitation strategies. Crit Care Med. 2010;38(Suppl 10):S676–82.PubMedCrossRef Puthucheary Z, Harridge S, Hart N. Skeletal muscle dysfunction in critical care: wasting, weakness, and rehabilitation strategies. Crit Care Med. 2010;38(Suppl 10):S676–82.PubMedCrossRef
8.
Zurück zum Zitat Levine S, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. 2008;358(13):1327–35.PubMedCrossRef Levine S, et al. Rapid disuse atrophy of diaphragm fibers in mechanically ventilated humans. N Engl J Med. 2008;358(13):1327–35.PubMedCrossRef
9.
Zurück zum Zitat de Jonghe B, et al. Intensive care unit-acquired weakness: risk factors and prevention. Crit Care Med. 2009;37(Suppl 10):S309–15.PubMedCrossRef de Jonghe B, et al. Intensive care unit-acquired weakness: risk factors and prevention. Crit Care Med. 2009;37(Suppl 10):S309–15.PubMedCrossRef
10.
Zurück zum Zitat Tennila A, et al. Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med. 2000;26(9):1360–3.PubMedCrossRef Tennila A, et al. Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis. Intensive Care Med. 2000;26(9):1360–3.PubMedCrossRef
11.
Zurück zum Zitat Herridge MS. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348(8):683–93.PubMedCrossRef Herridge MS. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med. 2003;348(8):683–93.PubMedCrossRef
12.
Zurück zum Zitat Herridge MS. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–304.PubMedCrossRef Herridge MS. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):1293–304.PubMedCrossRef
13.
Zurück zum Zitat Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. J Am Med Assoc. 2010;304(16):1787–94.CrossRef Iwashyna TJ, Ely EW, Smith DM, Langa KM. Long-term cognitive impairment and functional disability among survivors of severe sepsis. J Am Med Assoc. 2010;304(16):1787–94.CrossRef
14.
Zurück zum Zitat Finfer S, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.PubMedCrossRef Finfer S, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97.PubMedCrossRef
15.
Zurück zum Zitat Leditschke IA. What are the barriers to mobilizing intensive care patients. Cardiopulm Phys Ther J. 2012;23(1):26–9.PubMed Leditschke IA. What are the barriers to mobilizing intensive care patients. Cardiopulm Phys Ther J. 2012;23(1):26–9.PubMed
16.
Zurück zum Zitat •• Pohlman MC, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089–94. In this multi-center trial, the authors describe their experience and outcomes in implementing an early mobilization program in a population of patients with numerous barriers to mobilization. This study demonstrates that early mobilization is safe and feasible in mechanically-ventilated patients. •• Pohlman MC, et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med. 2010;38(11):2089–94. In this multi-center trial, the authors describe their experience and outcomes in implementing an early mobilization program in a population of patients with numerous barriers to mobilization. This study demonstrates that early mobilization is safe and feasible in mechanically-ventilated patients.
17.
Zurück zum Zitat Bourdin G, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400–7.PubMed Bourdin G, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55(4):400–7.PubMed
18.
Zurück zum Zitat Bailey P, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139–45.PubMedCrossRef Bailey P, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007;35(1):139–45.PubMedCrossRef
19.
Zurück zum Zitat Olkowski BF, et al. Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther. 2012;93(2):208–15.PubMedCrossRef Olkowski BF, et al. Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther. 2012;93(2):208–15.PubMedCrossRef
20.
Zurück zum Zitat Clark DE, et al. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther. 2013;93(2):186–96.PubMedCrossRef Clark DE, et al. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther. 2013;93(2):186–96.PubMedCrossRef
21.
Zurück zum Zitat Garzon-Serrano J, et al. Early mobilization in critically ill patients: patients’ mobilization level depends on health care provider’s profession. PM R. 2011;3(4):307–13.PubMedCrossRef Garzon-Serrano J, et al. Early mobilization in critically ill patients: patients’ mobilization level depends on health care provider’s profession. PM R. 2011;3(4):307–13.PubMedCrossRef
22.
Zurück zum Zitat Zomorodi M, Topley D, McAnaw M. Developing a mobility protocol for early mobilization of patients in a surgical/trauma ICU. Crit Care Res Pract. 2012;2012:964547.PubMed Zomorodi M, Topley D, McAnaw M. Developing a mobility protocol for early mobilization of patients in a surgical/trauma ICU. Crit Care Res Pract. 2012;2012:964547.PubMed
23.
Zurück zum Zitat Turner DA, et al. Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach. Crit Care Med. 2011;39(12):2593–8.PubMed Turner DA, et al. Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach. Crit Care Med. 2011;39(12):2593–8.PubMed
24.
Zurück zum Zitat Burtin C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009;37(9):2499–505.PubMedCrossRef Burtin C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009;37(9):2499–505.PubMedCrossRef
25.
Zurück zum Zitat •• Needham DM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536–42. The authors describe their experience in the establishment and implementation of an early mobilization program using the model of a quality improvement project. Outlining the steps taken to develop their program, this will be helpful to anyone who is seeking to establish a similar program in an ICU. •• Needham DM, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91(4):536–42. The authors describe their experience in the establishment and implementation of an early mobilization program using the model of a quality improvement project. Outlining the steps taken to develop their program, this will be helpful to anyone who is seeking to establish a similar program in an ICU.
26.
Zurück zum Zitat • Morris PE. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci. 2011;341(5):373–77. The authors describe the results of a cohort study looking at outcomes in survivors of acute respiratory failure. Lack of early ICU mobility was associated with an increased likelihood of death and readmission within one year. While the study was not prospective, it establishes that there may be some effect of early mobilization beyond ICU and hospital discharge. • Morris PE. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci. 2011;341(5):373–77. The authors describe the results of a cohort study looking at outcomes in survivors of acute respiratory failure. Lack of early ICU mobility was associated with an increased likelihood of death and readmission within one year. While the study was not prospective, it establishes that there may be some effect of early mobilization beyond ICU and hospital discharge.
27.
Zurück zum Zitat Lipshutz AKM, et al. Early mobilization in the intensive care unit: evidence and implementation. ICU Dir. 2012;3(1):10–6.CrossRef Lipshutz AKM, et al. Early mobilization in the intensive care unit: evidence and implementation. ICU Dir. 2012;3(1):10–6.CrossRef
28.
Zurück zum Zitat Needham DM, Truong AD, Fan E. Technology to enhance physical rehabilitation of critically ill patients. Crit Care Med. 2009;37(10 Suppl):S436–41.PubMedCrossRef Needham DM, Truong AD, Fan E. Technology to enhance physical rehabilitation of critically ill patients. Crit Care Med. 2009;37(10 Suppl):S436–41.PubMedCrossRef
29.
Zurück zum Zitat Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. B Med J. 2008;337:a1714.CrossRef Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. B Med J. 2008;337:a1714.CrossRef
30.
Zurück zum Zitat • Hanekom S, et al. The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice. Clin Rehabil. 2011;25(9):771–87. Here, the authors describe the process of developing clinical management algorithms for mobilizing critically-ill adults based on their clinical status. This may be a valuable resource when establishing an early mobilization program. • Hanekom S, et al. The development of a clinical management algorithm for early physical activity and mobilization of critically ill patients: synthesis of evidence and expert opinion and its translation into practice. Clin Rehabil. 2011;25(9):771–87. Here, the authors describe the process of developing clinical management algorithms for mobilizing critically-ill adults based on their clinical status. This may be a valuable resource when establishing an early mobilization program.
31.
Zurück zum Zitat Kasotakis G, et al. The surgical intensive care unit optimal mobility score predicts mortality and length of stay. Crit Care Med. 2012;40(4):1122–8.PubMedCrossRef Kasotakis G, et al. The surgical intensive care unit optimal mobility score predicts mortality and length of stay. Crit Care Med. 2012;40(4):1122–8.PubMedCrossRef
Metadaten
Titel
Early Mobilization in the Intensive Care Unit
verfasst von
Andrew E. Schober
Kevin C. Thornton
Publikationsdatum
01.06.2013
Verlag
Current Science Inc.
Erschienen in
Current Anesthesiology Reports / Ausgabe 2/2013
Elektronische ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-013-0013-x

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