Immobility
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Immobility

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Early mobilization of patients in ICU leads to quicker recovery

Early mobilization of patients in ICU leads to quicker recovery

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Immobility Immobility Presentation Transcript

  • Critical Care and Early Mobilization Todd Brungardt University of Cincinnati
  • 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
  • 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
  • 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
  • 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
  • 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
  • Skin Breakdown from Immobility O In older adults skin becomes weaker and prone to breakdown O Pressure ulcers are formed
  • 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
  • Benefits of Early MobilityO SafeO FeasibleO Improves patients ICU outcomesO Discharge patients home earlierO Decreases neuromuscular weaknessO Decreases bed soresO Decreases anxiety and depression
  • Benefits of Early MobilityO Provides psychological support for the… O Patient O Family members O Improves the patient holistic pathway
  • 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
  • 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
  • What will it Take toImplement this Type of CareO Critical care nursesO Motivated patientsO PhysiciansO Physical TherapyO Occupational TherapyO Respiratory Therapy
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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.
  • In the Right Direction
  • Any Questions?
  • 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.