Early mobilization of patients in ICU leads to quicker recovery

1. Critical Care and Early
Mobilization
Todd Brungardt
University of Cincinnati

2. The Effects of Immobility
O Immobility prolongs duration of
mechanical ventilation
O Increases hospital length of stay
O Increases mortality
O Immobility can persist for years after
hospital discharge

3. The effects of Immobility
O Immobility due to prolonged bed rest in
the ICU leads to ICU acquired-weakness
O Skeletal muscle strength can decline
O 1% to 1.5% per day from strict bed rest
O 4% to 5% for each week of strict bed rest
O Which leads to 10% reduction in postural
muscle strength after 1 week of bed-rest

4. Effects of Immobility
O Neuromuscular weakness is a common
disease process of critical illness occurring
in 20% to 25% of ICU patients
O Extends the duration of mechanical
ventilation
O Prolongs the length of the hospital stay
O Increases mortality

5. The effects of immobility
O Prolonged immobilization depresses
insulin-induced glucose transport in
skeletal muscle and leads to a catabolic
state in the affected areas:
MUSCLE WASTING

6. Interesting Facts
O Prolonged bed rest has been shown to
hasten a switch in the muscle fibers from
slow-contracting fatigue-resistance
myosin isoforms (type I) to fast-twitching
isoforms (type II)
O Leads to micro vascular dysfunction
O Decreased venous compliance
O Cause third spacing

7. Skin Breakdown from Immobility
O In older adults skin becomes weaker and
prone to breakdown
O Pressure ulcers are formed

8. Depression and Anxiety
O Patients who are critically ill often develop
depression and anxiety symptoms during
their stay in ICU.
O Delirium is the most prevalent mental
disorder among older patients in the ICU
associated with…
O Poor prognosis
O Increased length of hospital stay

9. Benefits of Early Mobility
O Safe
O Feasible
O Improves patients ICU outcomes
O Discharge patients home earlier
O Decreases neuromuscular weakness
O Decreases bed sores
O Decreases anxiety and depression

10. Benefits of Early Mobility
O Provides psychological support for
the…
O Patient
O Family members
O Improves the patient holistic
pathway

11. Definition of Early Mobilization
O A pattern of increasing activity beginning
with active/passive range of motion
through ambulation:
O Begins upon stabilization of hemodynamic
and respiratory physiology
O Should begin within 24 to 48 hours after
ICU admission

12. Safety and Benefits of Early Mobilization
O Physical exercise can activate pathways
and increase protection against oxidative
stress
O Moderate exercise triggers the production
of anti-inflammatory cytokines
O Decreases the pro-inflammatory ones

13. What will it Take to
Implement this Type of Care
O Critical care nurses
O Motivated patients
O Physicians
O Physical Therapy
O Occupational Therapy
O Respiratory Therapy

14. What will it Take to Implement this
Type of Care
O Include mobilization in the plan of care
O Implement mobilization through a broad
range of activities
O Passive and active range of motion
O Moving out of bed to a chair
O Ambulation
O Use of active resistive exercise
O Electrical muscle simulation

15. What will it Take to Implement this
Type of Care
O Use mobilization as a goal-directed
therapy
O Promotion of comfort
O Improved responsiveness
O Increased cardiovascular fitness
O Expedite recovery
O Enhance functional abilities
O Improve psychological well-being

16. What will it take to Implement
this Type of care
O Mobilization will require energy
O Low energy exercises
O High energy exercises
O Mobilization will require an
interdisciplinary process
O Nurses
O Physical Therapist
O Assistants

17. Risks with Early Mobilization
O Accidental removal of tubes and
lines
O Hemodynamically instability
O Oxygen desaturation
O Accidental extubation
O Patient discomfort
O Limited staff and time
O Lack of motivation from the patient

18. Barriers to Early Mobilization
O Changing the culture of the critical
care unit
O Changing the philosophy of the unit
and patient
O Changing the strategies in practice

19. Ideas How to Overcome the
Barriers
O Develop a model of care where
mobilization is a priority
O Teamwork in promoting mobilization
is valued
O Mobilization outcomes are
consistently measured

20. The Synergy Model (System Thinking)
O The Clinical Nurse Specialist will be able
to develop strategies based on the needs
and strengths of the patient
O Global outlook
O Holistic outlook
O The Clinical Nurse Specialist will be able
to see the whole picture instead of the
pieces.

21. In the Right Direction

22. Any Questions?

23. Reference
Amidei, C. (2012). Mobilization in critical care: a concept analysis.
Intensive and Critical Care Nursing, 28(2), 73-81.
Engel, H., Gropper, M., Lipshutz, A. & Thornton, K. (2012). Early
mobilization in the Intensive Care unit: evidence and
implementation. ICU Director, 3(1), 10-16.
Ganzini, L. & Misra, S. (2003). Delirium, depression, and anxiety.
Critical Care Clinics, 19(4), 48-49.
Grap, M. J. & McFetridge, B. (2012), Critical care rehabilitation and
early mobilization. Intensive and Critical Care Nursing, 22(2),
55-57.
Hardin, S. R. & Kaplow, R. (2005). Synergy for clinical excellence: The
Synergy Model for Patient Care. Sudbury, MA: Jones and
Bartlett.
Lowson, S. (2012). Early mobilization in critically Ill patients. ICU
Director, 3(1), 17-20.