Early Mobility in the ICU

There is significant clinical evidence to  support that early patient mobility as part of an ICU (Intensive Care Unit) rehabilitation program can help to counter the effects of ICU acquired weakness, which in turn can improve the patient recovery process and long-term functional outcomes.1,2,3

 
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Immobility can contribute in the development of weakness which is associated with functional impairment in an ICU survivors’ post discharge physical ability, quality of life, and eventual return to work.4,5,6,7,8,9

Within less than 24 hours, many body systems are affected by adverse changes associated with immobility. Body systems affected include the respiratory and cardiovascular system, the renal and gastrointestinal functions, as well as the skin and musculoskeletal system.

Critically ill patients may lose significant muscle mass; Herridgeet al (2003)10 found an 18% reduction in body weight of ARDS patients at time of ICU discharge. In addition, physical inactivity contributes to the development of atelectasis, insulin resistance, and joint contractures.11

Early mobilisation including physical and occupational therapy in the earliest days of critical illness has shown to be safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care.12,13

Structured early mobilisation14 of ICU patients is performed with the aim to:
- Improve respiratory function
- Reduce adverse effects of immobility
- Increase levels of consciousness
- Increase functional independence
- Improve cardiovascular fitness
- Increase psychological well-being
- Reduce the risk for delirium15
 
Mobilising mechanically ventilated patients in ICU by sitting and standing out of bed has been demonstrated as feasible and safe.16 There have been multiple studies demonstrating successful outcomes combined with low rates of serious adverse events.17,18,19 The recommendations of the European Respiratory Society and European Society of Intensive Care Medicine (ESICM) states that a multidisciplinary focus on early mobilisation is necessary as part of daily clinical routines in the ICU. Strict exclusion criteria should be avoided and the patient should be assessed holistically. Early mobilisation should be performed with a dedicated team approach and an individualised patient protocol.20

Arjo Rental provides both flexibility and choice, allowing access to a bespoke solution which includes the latest equipment to support in and out of bed mobilisation / repositioning whilst channelling limited financial resources to where they are most needed.

Click below to see how an ICU solution from Arjo can assist with enhanced recovery.
Learn more about our ICU Early Mobilisation solutions

 

 

References
1.McWilliams (2017) https://healthmanagement.org/uploads/article_attachment/mcwilliams-implementationrehab-2017-v17-i4.pdf [Accessed December 2018]

2.Engel HJ, Needham DM, Morris PE, Gropper MA (2013) ICU early mobilisation: from recommendation to implementation at three medical centers. Critical Care Med 2013 Sept; 41 (9 Suppl1) S 69 – 80.)

3.McWilliams DJ, PantelidesKP (2008) Does Physiotherapy led early mobilisation affect length of stay on ICU. ACPRC Journal. 40; 5-11

4.Herridgeet al 2003 One-Year Outcomes in Survivors of the Acute Respiratory Distress Syndrome https://www.nejm.org/doi/full/10.1056/NEJMoa022450 [Accessed December 2018]

5.Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. CritCare Med. 2008;36(8):2238–2243,

6.Alder J, Malone D (2012) Early Mobilization in the Intensive Care Unit: A Systematic Review Journal List CardiopulmPhysTherJ v.23(1); 2012 Mar; 23(1): 5–13

7.McWilliams D, WeblinJ, Atkins G et al. (2014) Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: A quality improvement project. Journal of critical care. 30(1):13-8

8.McWilliams et al - McWilliams, D., Weblin, J, Atkins G, BionJ, Williams J,  Elliott C, Whitehouse T, Snelson, C (2015) Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: A quality improvement project https://ac.els-cdn.com/S0883944114004018/1-s2.0-S0883944114004018-main.pdf?_tid=bbfbe6bb-84e8-45fb-bc7d-637ead0adc7f&acdnat=1543992106_1a51321ab63f5ff36cc8286da33a762d [Accessed December 2018]

9.National Institute for Health and Care Excellence (2017) Implementing early and structured rehabilitation for patients admitted to critical care https://www.nice.org.uk/sharedlearning/implementating-early-and-structured-rehabilitation-for-patients-admitted-to-critical-care [Accessed December 2018]

10.Herridgeet al 2003 One-Year Outcomes in Survivors of the Acute Respiratory Distress Syndrome https://www.nejm.org/doi/full/10.1056/NEJMoa022450 [Accessed December 2018]

11.HerridgeM,TanseyC,MatteAetal (2011).Functional disability 5 years after acute respiratory distress syndrome. NEJM;  364(14):1293-­‐1304.

  1. Brahmbhatt, N.,Murugan, R.,Milbrandt, E., (2010)  Early Mobilization Improves Functional Outcomes in Critically Ill Patientshttp://www.biomedcentral.com/content/pdf/cc9262.pdf [Accessed December 2018]

13.McWilliams D, Atkins G, HodsonJ et al. (2016) The Sara Combilizer® as an early mobilization aid for critically ill patients: A prospective before and after study. AustCritCare, 30(4): 189-195

14.McWilliams (2017) https://healthmanagement.org/uploads/article_attachment/mcwilliams-implementationrehab-2017-v17-i4.pdf [Accessed December 2018]

15.Devlin JW, SkrobikY, GélinasC, Needham DM, SlooterAJC, PandharipandePP, Watson PL, WeinhouseGL, NunnallyME, RochwergB, BalasMC, van den BoogaardM, BosmaKJ, Brummel NE, ChanquesG, DenehyL, DrouotX, Fraser GL, Harris JE, JoffeAM, Kho ME, Kress JP, LanphereJA, McKinley S, Neufeld KJ, PisaniMA, PayenJF, Pun BT, Puntillo KA, Riker RR, Robinson BRH, ShehabiY, SzumitaPM, WinkelmanC, CentofantiJE, Price C, NikayinS, MisakCJ, Flood PD, KiedrowskiK, AlhazzaniW. (2018) Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU CritCare Med. 2018 Sep;46(9):e825-e873. doi: 10.1097/CCM.0000000000003299.

16.McWilliamsD, Atkins G, HodsonJ et al. (2016) The Sara Combilizer® as an early mobilization aid for critically ill patients: A prospective before and after study. AustCritCare, 30(4): 189-195

17.EngelHJ, Needham DM, Morris PE, Gropper MA (2013) ICU early mobilisation: from recommendation to implementation at three medical centers. Critical Care Med 2013 Sept; 41 (9 Suppl1) S 69 – 80.)

18.McWilliams D, WeblinJ, Atkins G et al. (2014) Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: A quality improvement project. Journal of critical care. 30(1):13-8

19.McWilliams et al - McWilliams, D., Weblin, J, Atkins G, BionJ, Williams J,  Elliott C, Whitehouse T, Snelson, C (2015) Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: A quality improvement project https://ac.els-cdn.com/S0883944114004018/1-s2.0-S0883944114004018-main.pdf?_tid=bbfbe6bb-84e8-45fb-bc7d-637ead0adc7f&acdnat=1543992106_1a51321ab63f5ff36cc8286da33a762d [Accessed December 2018]

20.McWilliams (2017) https://healthmanagement.org/uploads/article_attachment/mcwilliams-implementationrehab-2017-v17-i4.pdf [Accessed December 2018]