WCPT Africa Region Conference System, 9th WCPT Africa Region Congress

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The Critically Ill Intensive Care Patient: Getting Going Early
NATASCHA PLANI

Last modified: 2012-02-06

Abstract


Purpose/Aim of the study and paper

Critically ill patients in intensive care units (ICU) are often immobilised for prolonged periods secondary to sedation or mechanical ventilation. Survivors frequently present with neuromuscular complications such as ICU-acquired weakness, which impairs physical function and quality of life long after hospital discharge. This delays return to self-sufficiency, and has profound consequences for patients and caregivers. ICU-acquired weakness is associated with increased length of stay (LOS), cost, morbidity and mortality.

Methodology

A search was conducted on Pubmed NCBI and PEDro databases, using the search term “early mobilisation critically ill”. Articles from 2003 to 2011 were considered.

Results

Research suggests improvement in morbidity and economic benefit with early mobilisation starting while patients may still be mechanically ventilated but is hemodynamically stable. It is associated with decreased ventilator days, ICU and hospital LOS, reduced weaning time from mechanical ventilation and less use of sedatives, as well as improved muscle strength and better independence scores, and a possible mortality benefit.

Discussion and conclusion

Up to 25% of ICU patients could be safely mobilised within 72 hours, however the practice of early mobilisation is not widely implemented. Mobilisation should include bed mobility, edge of bed activity, transfers to a chair and ambulation as well as endurance and strength training. Adverse events associated with mobilisation even in mechanically ventilated patients are minimal.

Studies show that greater percentages of patients who are mobilised early are able to ambulate, and return to independent functional status at hospital discharge.

Research shows that patients’ level of mobilisation is significantly higher with physiotherapists than nurses. Therefore, physiotherapists should be driving daily assessment and implementation of early mobilisation in critically ill patients. Future work should focus on development of protocols for early mobilisation and measures to accurately calculate energy requirements for activities.

Ethical clearance for your study? Not applicable


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