Advertisement

Early Mobilization of Patients in Intensive Care: Organization, Communication and Safety Factors that Influence Translation into Clinical Practice

  • C. L. Hodgson
  • E. Capell
  • C. J. Tipping
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM)

Introduction

Early mobilization in the intensive care unit (ICU) is currently a hot topic, with more than 15 randomized controlled trials (RCTs) in the past ten years including several high impact publications [1]. However, the largest studies of early mobilization have enrolled 300 patients, and the results of phase II randomized trials, pilot studies and observational studies have been used to encourage practice change [2, 3, 4, 5]. There are currently several international practice guidelines available, and early mobilization has consistently been reported as safe and feasible in the ICU setting [6]. There is no doubt that this early intervention in ICU shows exciting potential. The reported benefits of early mobilization, include reduced ICU‐acquired weakness, improved functional recovery within hospital, improved walking distance at hospital discharge and reduced hospital length of stay [1]. However, medical research has repeatedly demonstrated that the results of pilot studies...

References

  1. 1.
    Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL (2017) The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med 43:171–183CrossRefGoogle Scholar
  2. 2.
    Morris PE, Berry MJ, Files DC et al (2016) Standardized rehabilitation and hospital length of stay among patients with acute respiratory failure: a randomized clinical trial. JAMA 315:2694–2702CrossRefGoogle Scholar
  3. 3.
    Moss M, Nordon-Craft A, Malone D et al (2016) A randomized trial of an intensive physical therapy program for patients with acute respiratory failure. Am J Respir Crit Care Med 193:1101–1110CrossRefGoogle Scholar
  4. 4.
    Schaller SJ, Anstey M, Blobner M et al (2016) Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet 388:1377–1388CrossRefGoogle Scholar
  5. 5.
    Schweickert WD, Pohlman MC, Pohlman AS et al (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373:1874–1882CrossRefGoogle Scholar
  6. 6.
    NICE Guidelines (2009) Rehabilitation after critical illness in adults. https://www.nice.org.uk/guidance/cg83. Accessed 11 January 2018Google Scholar
  7. 7.
    Bernhardt J, Langhorne P, Lindley RI et al (2015) Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 386:46–55CrossRefGoogle Scholar
  8. 8.
    Cooper DJ, Rosenfeld JV, Murray L et al (2011) Decompressive craniectomy in diffuse traumatic brain injury. N Engl J Med 364:1493–1502CrossRefGoogle Scholar
  9. 9.
    Wright SE, Thomas K, Watson G et al (2017) Intensive versus standard physical rehabilitation therapy in the critically ill (EPICC): a multicentre, parallel-group, randomised controlled trial. Thorax.  https://doi.org/10.1136/thoraxjnl-2016-209858 (Aug 5, Epub ahead of print)CrossRefPubMedGoogle Scholar
  10. 10.
    Harrold ME, Salisbury LG, Webb SA, Allison GT et al (2015) Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers. Crit Care 19:336CrossRefGoogle Scholar
  11. 11.
    Hodgson C, Bellomo R, Berney S et al (2015) Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care 19:81CrossRefGoogle Scholar
  12. 12.
    Gosselink R, Bott J, Johnson M et al (2008) Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med 34:1188–1199CrossRefGoogle Scholar
  13. 13.
    Nydahl P, Sricharoenchai T, Chandra S et al (2017) Safety of patient mobilization and rehabilitation in the intensive care unit. systematic review with meta-analysis. Ann Am Thorac Soc 14:766–777CrossRefGoogle Scholar
  14. 14.
    Stiller K, Phillips A (2003) Safety aspects of mobilising acutely ill inpatients. Physiother Theory Pract 19:239–257CrossRefGoogle Scholar
  15. 15.
    Hodgson CL, Stiller K, Needham DM et al (2014) Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 18:658CrossRefGoogle Scholar
  16. 16.
    Berney S, Harrold M, Webb S et al (2013) Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resus 15:260–265Google Scholar
  17. 17.
    Nydahl P, Ruhl AP, Bartoszek G et al (2014) Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med 42:1178–1186CrossRefGoogle Scholar
  18. 18.
    Costa DK, White MR, Ginier E et al (2017) Identifying barriers to delivering the awakening and breathing coordination, delirium, and early exercise/mobility bundle to minimize adverse outcomes for mechanically ventilated patients: a systematic review. Chest 152:304–311CrossRefGoogle Scholar
  19. 19.
    Hodgson CL, Bailey M, Bellomo R et al (2016) A binational multicenter pilot feasibility randomized controlled trial of early goal-directed mobilization in the ICU. Crit Care Med 44:1145–1152CrossRefGoogle Scholar
  20. 20.
    Parry SM, Knight LD, Connolly B et al (2017) Factors influencing physical activity and rehabilitation in survivors of critical illness: a systematic review of quantitative and qualitative studies. Intensive Care Med 43:531–542CrossRefGoogle Scholar
  21. 21.
    Barber EA, Everard T, Holland AE, Tipping C, Bradley SJ, Hodgson CL (2015) Barriers and facilitators to early mobilisation in intensive care: a qualitative study. Aust Crit Care 28:177–182CrossRefGoogle Scholar
  22. 22.
    Leditschke IA, Green M, Irvine J, Bissett B, Mitchell IA (2012) What are the barriers to mobilizing intensive care patients? Cardiopulm Phys Ther J 23:26–29PubMedPubMedCentralGoogle Scholar
  23. 23.
    Holdsworth C, Haines KJ, Francis JJ, Marshall A, O’Connor D, Skinner EH (2015) Mobilization of ventilated patients in the intensive care unit: an elicitation study using the theory of planned behavior. J Crit Care 30:1243–1250CrossRefGoogle Scholar
  24. 24.
    Iwashyna TJ, Ely EW, Smith DM, Langa KM (2010) Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA 304:1787–1794CrossRefGoogle Scholar
  25. 25.
    Needham DM, Davidson J, Cohen H et al (2012) Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med 40:502–509CrossRefGoogle Scholar
  26. 26.
    Blackwood B, Marshall J, Rose L (2015) Progress on core outcome sets for critical care research. Curr Opin Crit Care 21:439–444CrossRefGoogle Scholar
  27. 27.
    Angus DC, Carlet J (2003) Surviving intensive care: a report from the 2002 Brussels Roundtable. Intensive Care Med 29:368–377CrossRefGoogle Scholar
  28. 28.
    Turnbull AE, Rabiee A, Davis WE et al (2016) Outcome measurement in ICU survivorship research from 1970 to 2013: a scoping review of 425 publications. Crit Care Med 44:1267–1277CrossRefGoogle Scholar
  29. 29.
    Hodgson C, Cuthbertson BH (2016) Improving outcomes after critical illness: harder than we thought! Intensive Care Med 42:1772–1774CrossRefGoogle Scholar
  30. 30.
    Hodgson CL, Iwashyna TJ, Schweickert WD (2016) All that work and no gain – what should we do to restore physical function in our survivors? Am J Respir Crit Care Med 15:1071–1072CrossRefGoogle Scholar
  31. 31.
    Hodgson CL, Fan E (2016) Better measures, better trials, better outcomes in survivors of critical illness? Crit Care Med 44:1254–1255CrossRefGoogle Scholar
  32. 32.
    Needham DM, Sepulveda KA, Dinglas VD et al (2017) Core outcome measures for clinical research in acute respiratory failure survivors: an international modified delphi consensus study. Am J Respir Crit Care Med 196:1122–1130CrossRefGoogle Scholar
  33. 33.
    Bernhardt J, Churilov L, Ellery F et al (2016) Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT). Neurology 86:2138–2145CrossRefGoogle Scholar
  34. 34.
    Brummel NE, Girard TD, Ely EW et al (2014) Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the activity and cognitive therapy in ICU (ACT-ICU) trial. Intensive Care Med 40:370–379CrossRefGoogle Scholar
  35. 35.
    Dantas CM, Silva PF, Siqueira FH et al (2012) Influence of early mobilization on respiratory and peripheral muscle strength in critically ill patients. Rev Bras Ter Intensiva 24:173–178CrossRefGoogle Scholar
  36. 36.
    Denehy L, Skinner EH, Edbrooke L et al (2013) Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up. Crit Care 17:R156CrossRefGoogle Scholar
  37. 37.
    Dong ZH, Yu BX, Sun YB, Fang W, Li L (2014) Effects of early rehabilitation therapy on patients with mechanical ventilation. World J Emerg Med 5:48–52CrossRefGoogle Scholar
  38. 38.
    Kayambu G, Boots R, Paratz J (2015) Early physical rehabilitation in intensive care patients with sepsis syndromes: a pilot randomised controlled trial. Intensive Care Med 41:865–874CrossRefGoogle Scholar
  39. 39.
    Yosef-Brauner O, Adi N, Shahar BT, Yehezkel E, Carmeli E (2015) Effect of physical therapy on muscle strength, respiratory muscles and functional parameters in patients with intensive care unit-acquired weakness. Clin Respir J 9:1–6CrossRefGoogle Scholar
  40. 40.
    Dong Z, Yu B, Zhang Q et al (2016) Early rehabilitation therapy is beneficial for patients with prolonged mechanical ventilation after coronary artery bypass surgery. Int Heart J 57:241–246CrossRefGoogle Scholar
  41. 41.
    Morris PE, Goad A, Thompson C et al (2008) Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 36:2238–2243CrossRefGoogle Scholar
  42. 42.
    Wolfe KS, Wendlandt BN, Patel SB et al (2013) Long-term survival and health care utilization of mechanically ventilated patients in a randomized controlled trial of early mobilization. Am J Respir Crit Care Med 187:A5235 (abst)Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  2. 2.Department of PhysiotherapyThe Alfred HospitalMelbourneAustralia

Personalised recommendations