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early Mobility in ICU
This document presents information on early mobilization for ICU patients. It defines mobilization as physical activity that improves hemodynamic parameters and counters the effects of bed rest. Early mobilization refers to activity within the first 2-5 days of critical illness. The benefits of early mobilization include reduced ICU and hospital stays, faster recovery of respiratory and muscle strength, and lower rates of delirium. The document outlines parameters and safety criteria for passive and active mobilization. Common barriers to early mobilization in the ICU include patient instability, limited staff and equipment, and deep sedation of patients.
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early Mobility in ICU
- 1. STUDENT TEACHING ON EARLY MOBILIZATION FOR ICU PATIENTS PRESENTEDBY: NIKITA DAS GUIDED BY: MAM SHERIN SUSAN
- 2. Mobilization in intensivecare…. Any activity that is done at the regular basis inside intensive care whether passively or actively in the view of improving hemodynamic parameter, reverse short term shock or bed rest complications. Linda Denhey, Kathe Stiller 2006
- 3. DEFINITION Mobilization has beendefined as “physical activity sufficient to elicit acute physiological effects that enhance ventilation, central and peripheral perfusion, circulation, muscle metabolism and alertness and are counter measures for venous stasis and deep vein thrombosis” . A current definition of early mobilization refers to the application of physical activity within the first 2 to 5 days of critical illness or injury ; however, it is important to note that some of the research published on “early” mobilization is beyond this window.
- 4. Effects of Prolongedhospital stays with mechanical ventilation Increased morbidity/mortality Increased cost of care Increased length of stay Respiratory muscle weakness and increased duration of ventilation Sleep deprivation Lack of social interaction Prolonged sedation Delirium
- 5. Goal and benefitsof mobilization To reduce incidence of critical illness myoneuropathy (72 hrs) Improves sleep wake cycle Improves and regulates hemodynamic parameters Improves patient confidence of coming out of ICU Improve respiratory function .
- 6. Cont.. Reduce adverse effectsof immobility . Increase levels of consciousness . Increase functional independence . Improve cardiovascular fitness . Increase psychological well-being . Reduce the risk for delirium .
- 7. Physiological changes inICU mobilisation Increases tissue demand of aerobic, increases stroke, tidal volumes, inspiratory capacities thereby regulates the hemodynamic parameters in critically ill Improves neural, skeletal muscles circulation, vital organs microgravity impact due to upright and activity
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- 11. Pooling of secretionsin dependent regions of lungs in supine position.
- 12. Thrombus formation ina vessel.
- 13. Musculoskeletal Changes Lossof endurance, strength, and muscle mass Decreased stability and balance. Impaired calcium metabolism and joint mobility Joint contracture Foot drop
- 14. Footdrop. Ankle isfixed in plantar flexion. Normally ankle is able to flex (dotted line), which eases walking.
- 15. Stasis of urinewith reflux to ureters.
- 16. Parameters to bemet before the initiation of mobilization therapy PASSIVE General: Cardiorespiratory stability Physiologically stable ACTIVE Neurological (alertness/agitation): Response to verbal stimuli Absence of agitation, confusion or impaired response to simple orders No increase in intracranial pressure No need for increased sedation Cardiovascular: heart rate Between 40 and 130 bpm No active myocardial ischemia Cardiovascular: blood pressure • Absence of orthostatic hypotension • Absence of catecholamine drips, ongoing vasopressors • SBP >90 mm Hg ,<200 mm Hg • MAP between 65 and 110 mm Hg Respiratory: blood gas PaO2/FIO2 ratio >200 mm Hg PaCO2 < 50 mm Hg pH > 7.30 Oxygen saturation :88%
- 17. Cont.. Respiratory: Respiratory rate <35 breaths/min ,5-40 breaths/min FIO2 <60% PEEP<10 cm H2O General: No ongoing renal replacement therapy No ongoing intravenous sedation No scheduled extubation No active GI blood loss No continuing procedures (eg,, hemodialysis)
- 18. Criteria for terminatingphysical activity and mobilization HEART RATE o > 20% decrease in resting HR o < 40 beats/minute; > 130 beats/minute New onset dysrhythmia New anti-arrhythmia medication New MI by ECG or cardiac enzymes PULSE OXIMETRY/SPO2: > 4% decrease < 88%- 90%
- 19. CONT.. Blood Pressure: SBP >180mmHg, > 20% decrease in SPB/DBP; orthostatic hypotension MAP < 65 mmHg; >110 mmHg, Presences of vasopressor medication, Mechanical Ventilation: FIO2 ≥ 60% PEEP ≥ 10 Patient-ventilator asynchrony MV mode change to assist-control Tenuous airway
- 20. CONT… Respiratory Rate: < 5breaths/minute, > 40 breaths/minute Alertness/Agitation and Patient symptoms: Patient sedation or coma – RASS ≤ −3 Patient agitation requiring addition or escalation of sedative medication- RASS >2 Patient refusal Cardiopulm Phys Ther J. 2012 Mar; 23(1): 5–13.
- 21. Early mobilization programs 2ndhourly position PROM Turning side to side Sitting on the side of the bed Active strengthening exercises Long sitting within bed High sitting Chair sitting Standing with or without support walking
- 26. Standing position during mechanical ventilationimproves the respiratory function, compliance and oxygen, and it stimulates autonomic activity, and reduces cardiac stress from compression.(Hoste 2005, Zhu Chang 2004b, Gosselink The upright position
- 27. For patients unable tostand, sitting in a chair helps prevent hypovolemia (Wenger 1982) Sitting in a reclined seating position
- 28. Barriers to earlymobilization o Patient too sick Hemodynamic instability Respiratory instability Pain Poor nutritional status Obesity New immobility or weakness Deep sedation Delirium , agitation Patient refusal
- 29. Continue… Palliative care Hemodynamic monitoringequipment ICU related devices Limited staff, time constraints Lack of early mobility program/protocol(no routine delivery of PT) Inadequate staff training
- 30. Cont.. Limited equipment Early discharge Lackof staff knowledge and expertise about risks/benefits of mobility Lack of patient / family knowledge Risk for mobility providers(stress, injuries)
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