1. Critical Care and Early
Mobilization
Todd Brungardt
University of Cincinnati
2. The Effects of Immobility
O Immobility prolongs duration of
mechanical ventilation
O Increases hospital length of stay
O Increases mortality
O Immobility can persist for years after
hospital discharge
3. The effects of Immobility
O Immobility due to prolonged bed rest in
the ICU leads to ICU acquired-weakness
O Skeletal muscle strength can decline
O 1% to 1.5% per day from strict bed rest
O 4% to 5% for each week of strict bed rest
O Which leads to 10% reduction in postural
muscle strength after 1 week of bed-rest
4. Effects of Immobility
O Neuromuscular weakness is a common
disease process of critical illness occurring
in 20% to 25% of ICU patients
O Extends the duration of mechanical
ventilation
O Prolongs the length of the hospital stay
O Increases mortality
5. The effects of immobility
O Prolonged immobilization depresses
insulin-induced glucose transport in
skeletal muscle and leads to a catabolic
state in the affected areas:
MUSCLE WASTING
6. Interesting Facts
O Prolonged bed rest has been shown to
hasten a switch in the muscle fibers from
slow-contracting fatigue-resistance
myosin isoforms (type I) to fast-twitching
isoforms (type II)
O Leads to micro vascular dysfunction
O Decreased venous compliance
O Cause third spacing
7. Skin Breakdown from Immobility
O In older adults skin becomes weaker and
prone to breakdown
O Pressure ulcers are formed
8. Depression and Anxiety
O Patients who are critically ill often develop
depression and anxiety symptoms during
their stay in ICU.
O Delirium is the most prevalent mental
disorder among older patients in the ICU
associated with…
O Poor prognosis
O Increased length of hospital stay
9. Benefits of Early Mobility
O Safe
O Feasible
O Improves patients ICU outcomes
O Discharge patients home earlier
O Decreases neuromuscular weakness
O Decreases bed sores
O Decreases anxiety and depression
10. Benefits of Early Mobility
O Provides psychological support for
the…
O Patient
O Family members
O Improves the patient holistic
pathway
11. Definition of Early Mobilization
O A pattern of increasing activity beginning
with active/passive range of motion
through ambulation:
O Begins upon stabilization of hemodynamic
and respiratory physiology
O Should begin within 24 to 48 hours after
ICU admission
12. Safety and Benefits of Early Mobilization
O Physical exercise can activate pathways
and increase protection against oxidative
stress
O Moderate exercise triggers the production
of anti-inflammatory cytokines
O Decreases the pro-inflammatory ones
13. What will it Take to
Implement this Type of Care
O Critical care nurses
O Motivated patients
O Physicians
O Physical Therapy
O Occupational Therapy
O Respiratory Therapy
14. What will it Take to Implement this
Type of Care
O Include mobilization in the plan of care
O Implement mobilization through a broad
range of activities
O Passive and active range of motion
O Moving out of bed to a chair
O Ambulation
O Use of active resistive exercise
O Electrical muscle simulation
15. What will it Take to Implement this
Type of Care
O Use mobilization as a goal-directed
therapy
O Promotion of comfort
O Improved responsiveness
O Increased cardiovascular fitness
O Expedite recovery
O Enhance functional abilities
O Improve psychological well-being
16. What will it take to Implement
this Type of care
O Mobilization will require energy
O Low energy exercises
O High energy exercises
O Mobilization will require an
interdisciplinary process
O Nurses
O Physical Therapist
O Assistants
17. Risks with Early Mobilization
O Accidental removal of tubes and
lines
O Hemodynamically instability
O Oxygen desaturation
O Accidental extubation
O Patient discomfort
O Limited staff and time
O Lack of motivation from the patient
18. Barriers to Early Mobilization
O Changing the culture of the critical
care unit
O Changing the philosophy of the unit
and patient
O Changing the strategies in practice
19. Ideas How to Overcome the
Barriers
O Develop a model of care where
mobilization is a priority
O Teamwork in promoting mobilization
is valued
O Mobilization outcomes are
consistently measured
20. The Synergy Model (System Thinking)
O The Clinical Nurse Specialist will be able
to develop strategies based on the needs
and strengths of the patient
O Global outlook
O Holistic outlook
O The Clinical Nurse Specialist will be able
to see the whole picture instead of the
pieces.
23. Reference
Amidei, C. (2012). Mobilization in critical care: a concept analysis.
Intensive and Critical Care Nursing, 28(2), 73-81.
Engel, H., Gropper, M., Lipshutz, A. & Thornton, K. (2012). Early
mobilization in the Intensive Care unit: evidence and
implementation. ICU Director, 3(1), 10-16.
Ganzini, L. & Misra, S. (2003). Delirium, depression, and anxiety.
Critical Care Clinics, 19(4), 48-49.
Grap, M. J. & McFetridge, B. (2012), Critical care rehabilitation and
early mobilization. Intensive and Critical Care Nursing, 22(2),
55-57.
Hardin, S. R. & Kaplow, R. (2005). Synergy for clinical excellence: The
Synergy Model for Patient Care. Sudbury, MA: Jones and
Bartlett.
Lowson, S. (2012). Early mobilization in critically Ill patients. ICU
Director, 3(1), 17-20.
