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Early mobilization of patients in ICU leads to quicker recovery

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  1. 1. Critical Care and Early Mobilization Todd Brungardt University of Cincinnati
  2. 2. The Effects of ImmobilityO Immobility prolongs duration of mechanical ventilationO Increases hospital length of stayO Increases mortalityO Immobility can persist for years after hospital discharge
  3. 3. The effects of ImmobilityO 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. 4. Effects of ImmobilityO 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. 5. The effects of immobilityO Prolonged immobilization depresses insulin-induced glucose transport in skeletal muscle and leads to a catabolic state in the affected areas: MUSCLE WASTING
  6. 6. Interesting FactsO 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. 7. Skin Breakdown from Immobility O In older adults skin becomes weaker and prone to breakdown O Pressure ulcers are formed
  8. 8. Depression and AnxietyO 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. 9. Benefits of Early MobilityO SafeO FeasibleO Improves patients ICU outcomesO Discharge patients home earlierO Decreases neuromuscular weaknessO Decreases bed soresO Decreases anxiety and depression
  10. 10. Benefits of Early MobilityO Provides psychological support for the… O Patient O Family members O Improves the patient holistic pathway
  11. 11. Definition of Early MobilizationO 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. 12. Safety and Benefits of Early MobilizationO Physical exercise can activate pathways and increase protection against oxidative stressO Moderate exercise triggers the production of anti-inflammatory cytokinesO Decreases the pro-inflammatory ones
  13. 13. What will it Take toImplement this Type of CareO Critical care nursesO Motivated patientsO PhysiciansO Physical TherapyO Occupational TherapyO Respiratory Therapy
  14. 14. What will it Take to Implement this Type of CareO Include mobilization in the plan of careO 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. 15. What will it Take to Implement this Type of CareO 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. 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. 17. Risks with Early MobilizationO Accidental removal of tubes and linesO Hemodynamically instabilityO Oxygen desaturationO Accidental extubationO Patient discomfortO Limited staff and timeO Lack of motivation from the patient
  18. 18. Barriers to Early MobilizationO Changing the culture of the critical care unitO Changing the philosophy of the unit and patientO Changing the strategies in practice
  19. 19. Ideas How to Overcome the BarriersO Develop a model of care where mobilization is a priorityO Teamwork in promoting mobilization is valuedO Mobilization outcomes are consistently measured
  20. 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.
  21. 21. In the Right Direction
  22. 22. Any Questions?
  23. 23. ReferenceAmidei, 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 andBartlett.Lowson, S. (2012). Early mobilization in critically Ill patients. ICU Director, 3(1), 17-20.