Early Mobilization in the ICU
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] Below is a gist of the system wise complications of prolonged immobility.
The respiratory system it causes retention of secretions, reduced respiratory excursion, pneumonia, 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]
Benefits of Early Mobilization[edit | edit source]
The proposed benefits are
- Increased circulation
- Prevention of venous stasis and deep vein thrombosis
- Feeling of alertness
- Better central and peripheral perfusion
- Ventilation
Physiological effects[edit | edit source]
The acute Physiological effects of early mobilization are summarized system wise below
| Pulmonary system | Increased Regional ventilation
Increased regional diffusion Increased Regional perfusion Increase tidal volume Increase efficiency of respiratory mechanics Reduce air flow resistance Increase flow rates Increase zone 2 (Area of ventilation perfusion matching) Increase or decrease Breathing frequency Increase floe rates Increase strength and quality of a cough Increase mucociliary transport and airway clearance Increase distribution and function of oulmonary immune factors |
|---|---|
There is an improved ventilation/perfusion matching, better lung complaince, mucociliary clearance, reduced work of breathing in upright positions.
Movement of the lower limbs mainly the ankle prevented statsis of blood and hence prevents Deep vein thrombosis as well as pulmonary embolus formation
Early Mobilization Intervention[edit | edit source]
The frequency of early mobilization can be conducted everyday of the week or five days a week. [4]Although active techniques are preferred more than passive and attribute more to the prevention of complications these are some of the listed techniques that come under the scope of early mobilization. The
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
- ↑ 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.
- ↑ 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.
- ↑ Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest 2013;144:825–47.
- ↑ 4.0 4.1 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).
- ↑ Hodgson CL, Berney S, Harrold M, Saxena M, Bellomo R. Clinical review: early patient mobilization in the ICU. Crit Care 2013;17:207.
- ↑ 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).
- ↑ Morris PE, Herridge MS. Early intensive care unit mobility: future directions. Critical care clinics. 2007 Jan 1;23(1):97-110.
- ↑ 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.
