Early Mobilization in the ICU: Difference between revisions

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== Why Early Mobilization ==
== Why Early Mobilization ==
Long term ICU care is always associated with complications in a high proportion of ICU survivors. Prolonged periods of immobility has often been associated with Physical deconditionng, fatigue, loss of function and decreased quality of life have also been observed.<ref>Castro-Avila AC, Serón P, Fan E, Gaete M, Mickan S. Effect of early rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis. PloS one. 2015;10(7).</ref> Pressre ulcer and deep vien thrombosis, <ref>Clark DE, Lowman JD, Griffin RL, Matthews HM, Reiff DA. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Physical therapy. 2013 Feb 1;93(2):186-96.</ref>
Long term ICU care is always associated with complications in a high proportion of ICU survivors. Prolonged periods of immobility has often been associated with Physical deconditionng, fatigue, loss of function and decreased quality of life have also been observed.<ref>Castro-Avila AC, Serón P, Fan E, Gaete M, Mickan S. Effect of early rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis. PloS one. 2015;10(7).</ref>


muscle weaknesses, which would in turn cause functional denervation of the muscle due to disuse. Nerve injury due to a reduction in microcirculation at the nerve including critical illness polyneuropathy.<ref>Morris PE, Herridge MS. Early intensive care unit mobility: future directions. Critical care clinics. 2007 Jan 1;23(1):97-110.</ref>
. Nerve injury due to a reduction in microcirculation at the nerve including critical illness polyneuropathy.<ref name=":0">Morris PE, Herridge MS. Early intensive care unit mobility: future directions. Critical care clinics. 2007 Jan 1;23(1):97-110.</ref>


The cardiovascular complications include Orthostatic hypertension, deep vein thrombosis, hypovolemia, embolisation. The Gastrointestinal complications include decreased motility, constipation, ilues. The musculoskeletal complications include muscle shortening and wasting, joint contractures, bone demineralisation and heterotrophic ossification. The endocrine system related complications include 
The respiratory system it causes retention of secretions, reduced respiratory excursion, oneumonia, atelectasis. The cardiovascular complications include Orthostatic hypertension, deep vein thrombosis, hypovolemia and embolisation. The Gastrointestinal complications include decreased motility, constipation, ilues. The musculoskeletal complications include muscle shortening, weakness and wasting which would in turn cause functional denervation, joint contractures, bone demineralisation and heterotrophic ossification.<ref name=":0" /> <ref name=":1">Amidei C. Mobilisation in critical care: a concept analysis. Intensive and critical care nursing. 2012 Apr 1;28(2):73-81.</ref>The neurological system is affected by polyneuropathies due to reduced micro circulation at the nerve. The endocrine system related complications include Hyperglycemia with insulin resistance and catabolism.  On the integumentary system it can cause pressure ulcers. And the psychology of the person is affected causing depression and delirium.<ref name=":1" /> 


The proposed benefits are
The proposed benefits are

Revision as of 15:51, 14 April 2020

Globally people recover from critical illnesses and get discharged from an ICU setup, however it has been noticed that patients develop weakness, probably credited to their prolonged period of immobilization.[1] Post intensive care syndrome was the term used which describes worsening of physical, mental and cognitive problems. [2] Early mobilization of the critically ill patients is a safe option with additional benefits of improving functional outcomes.[3]

The term "mobilization in the Intensive care Unit is refered to physical activity performed to the intensity that can bring about physiological changes.[4] Early mobilization is the application of physical activity as early as the 2nd to 5th day after the onset of critical illness or injury. [5]

Why Early Mobilization[edit | edit source]

Long term ICU care is always associated with complications in a high proportion of ICU survivors. Prolonged periods of immobility has often been associated with Physical deconditionng, fatigue, loss of function and decreased quality of life have also been observed.[6]

. Nerve injury due to a reduction in microcirculation at the nerve including critical illness polyneuropathy.[7]

The respiratory system it causes retention of secretions, reduced respiratory excursion, oneumonia, atelectasis. The cardiovascular complications include Orthostatic hypertension, deep vein thrombosis, hypovolemia and embolisation. The Gastrointestinal complications include decreased motility, constipation, ilues. The musculoskeletal complications include muscle shortening, weakness and wasting which would in turn cause functional denervation, joint contractures, bone demineralisation and heterotrophic ossification.[7] [8]The neurological system is affected by polyneuropathies due to reduced micro circulation at the nerve. The endocrine system related complications include Hyperglycemia with insulin resistance and catabolism. On the integumentary system it can cause pressure ulcers. And the psychology of the person is affected causing depression and delirium.[8] 

The proposed benefits are

increased circulation

Prevention of venous stasis and deep vein thrombosis

feeling of alertness

Better central and peripheral perfusion

Ventilation

Early Mobilization Techniques[edit | edit source]

Although active techniques are preferred more than passive and attribute more to the prevention of complications these are some of the listed techniques hat come under the scope of early mobilization

Passive and active range of motion

Active side to side turning

Exercising in the bed

Bed side sitting

Transfers from bed to the chair and vice versa

Ambulation

Hoist therapy

Tilt table

Resistance exercises

Electrical stimulation

  1. Harrold ME, Salisbury LG, Webb SA, Allison GT, Australia and Scotland ICU Physiotherapy Collaboration. Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers. Crit Care. 2015 Dec 1;19(1):336.
  2. Needham DM, Davidson J, Cohen H, Hopkins RO, Weinert C, Wunsch H, Zawistowski C, Bemis-Dougherty A, Berney SC, Bienvenu OJ, Brady SL. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Crit Care Med. 2012 Feb 1;40(2):502-9.
  3. Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest 2013;144:825–47.
  4. Castro-Avila AC, Serón P, Fan E, Gaete M, Mickan S. Effect of early rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis. PloS one. 2015;10(7).
  5. Hodgson CL, Berney S, Harrold M, Saxena M, Bellomo R. Clinical review: early patient mobilization in the ICU. Crit Care 2013;17:207.
  6. Castro-Avila AC, Serón P, Fan E, Gaete M, Mickan S. Effect of early rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis. PloS one. 2015;10(7).
  7. 7.0 7.1 Morris PE, Herridge MS. Early intensive care unit mobility: future directions. Critical care clinics. 2007 Jan 1;23(1):97-110.
  8. 8.0 8.1 Amidei C. Mobilisation in critical care: a concept analysis. Intensive and critical care nursing. 2012 Apr 1;28(2):73-81.