Relationship between potential barriers to early mobilization in adult patients during intensive care stay using the Perme ICU Mobility score

Introduction: The functional benefits of Early Mobilization (EM) capable of minimizing limitations and deformities in the face of immobility are clear, but there are many barriers to conduct EM as a routine practice in the Intensive Care Unit (ICU), including the use of vasoactive drugs (VAD), since it is directly related to weakness acquired in the ICU, in addition to the resistance of the multidisciplinary team to mobilize the patient using VAD. Objective: The objective of this literature review is to raise a scientific basis in the management of critically ill patients using DVAs for EM in the ICU. Methods: It is an integrative review of the literature, with research in the databases: PEDro, Pubmed, Lilacs, with articles published between 2011 and 2018, in Portuguese and English, using the terms: vasoactive drugs, early mobility, exercise in UCI, vasopressor and its equivalents in Portuguese. Results: Nine studies were included that analyzed the EM intervention in patients using VAD, with or without ventilatory support. There was no homogeneous treatment among the researched works, varying between exercises in bed and outside, with passive and / or active action. However, regardless of the conduct, there was an improvement in the cardiovascular response without relevant changes regarding the use of VAD. Conclusion: EM is not contraindicated for patients in the ICU with the use of VAD, and it was shown to be effective and safe without promoting relevant hemodynamic and cardiorespiratory changes, which would determine its absolute contraindication.Keywords: vasodilator agents, early ambulation, intensive care units, physical therapy specialty.

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Exercise in intensive care units, safety and hemodynamic monitoring

Revista Brasileira de Fisiologia do Exercício ◽

10.33233/rbfe.v19i1.3981 ◽

2020 ◽

Vol 19 (1) ◽

pp. 3

Author(s):

Giulliano Gardenghi

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Hemodynamic Monitoring ◽

Artificial Respiration ◽

Exercise Physiology ◽

Ventilatory Support ◽

Early Mobilization ◽

Cycle Ergometer ◽

Search Terms

Introduction: Patients in the intensive care unit (ICU) have several deleterious effects of immobilization, including weakness acquired in the ICU. Exercise appears as an alternative for early mobilization in these patients. Objective: This work aims to highlight the hemodynamic repercussions and the applicability of exercise in the ICU. Methods: An integrative literature review was carried out, with articles published between 2010 and 2018, in the Lilacs, PubMed and Scielo databases, using the following search terms: exercise, cycle ergometer, intensive care units, early mobilization, mechanical ventilation, artificial respiration. Results: 13 articles were included, addressing hemodynamic monitoring and the role of exercise as early mobilization, with or without ventilatory support. The exercise sessions were feasible and safe within the ICU environment. Conclusion: Physical exercise can be performed safely in an ICU environment, if respecting a series of criteria such as those presented here. It is important that the assistant professional seeks to prescribe interventions based on Exercise Physiology that can positively intervene in the functional prognosis in critically ill patients.Keywords: exercise, intensive care units, patient safety.

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Nutrition deficit during intensive care stay: incidence, predisposing factors and outcomes

Minerva Anestesiologica ◽

10.23736/s0375-9393.20.14068-9 ◽

2020 ◽

Vol 86 (5) ◽

Author(s):

Juho P. Nurkkala ◽

Timo I. Kaakinen ◽

Merja A. Vakkala ◽

Tero I. Ala-Kokko ◽

Janne H. Liisanantti

Keyword(s):

Intensive Care ◽

Predisposing Factors ◽

Intensive Care Stay

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ICU Follow-up After Prolonged Intensive Care Stay

Case Medical Research ◽

10.31525/ct1-nct04186468 ◽

2019 ◽

Author(s):

Keyword(s):

Intensive Care ◽

Intensive Care Stay

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Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards

10.1002/14651858.cd005529 ◽

2005 ◽

Cited By ~ 4

Author(s):

J McGaughey ◽

F Alderdice ◽

R Fowler ◽

A Kapila ◽

M Moutray

Keyword(s):

Intensive Care ◽

General Hospital ◽

Critically Ill ◽

Early Warning ◽

Early Warning Systems ◽

Adult Patients ◽

Warning Systems ◽

Intensive Care Admission ◽

Hospital Wards

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Early mobilization in intensive care for patients with brain injury: e-Survey of current practices in France

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2020.07.004 ◽

2021 ◽

Author(s):

François Feuvrier ◽

Claire Jourdan ◽

Olivier Barber ◽

Margrit Ascher ◽

Karolina Griffiths ◽

...

Keyword(s):

Intensive Care ◽

Brain Injury ◽

Early Mobilization ◽

Current Practices

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Caring for critically ill adults in paediatric intensive care units in England during the COVID-19 pandemic: planning, implementation and lessons for the future

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-320962 ◽

2021 ◽

pp. archdischild-2020-320962

Author(s):

Ruchi Sinha ◽

Angela Aramburo ◽

Akash Deep ◽

Emma-Jane Bould ◽

Hannah L Buckley ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Clinical Care ◽

Adult Patients ◽

Paediatric Intensive Care ◽

Critically Ill Adults ◽

Care Capacity ◽

Ill Adults ◽

Paediatric Intensive Care Units

ObjectiveTo describe the experience of paediatric intensive care units (PICUs) in England that repurposed their units, equipment and staff to care for critically ill adults during the first wave of the COVID-19 pandemic.DesignDescriptive study.SettingSeven PICUs in England.Main outcome measures(1) Modelling using historical Paediatric Intensive Care Audit Network data; (2) space, staff, equipment, clinical care, communication and governance considerations during repurposing of PICUs; (3) characteristics, interventions and outcomes of adults cared for in repurposed PICUs.ResultsSeven English PICUs, accounting for 137 beds, repurposed their space, staff and equipment to admit critically ill adults. Neighbouring PICUs increased their bed capacity to maintain overall bed numbers for children, which was informed by historical data modelling (median 280–307 PICU beds were required in England from March to June). A total of 145 adult patients (median age 50–62 years) were cared for in repurposed PICUs (1553 bed-days). The vast majority of patients had COVID-19 (109/145, 75%); the majority required invasive ventilation (91/109, 85%). Nearly, a third of patients (42/145, 29%) underwent a tracheostomy. Renal replacement therapy was provided in 20/145 (14%) patients. Twenty adults died in PICU (14%).ConclusionIn a rapid and unprecedented effort during the first wave of the COVID-19 pandemic, seven PICUs in England were repurposed to care for adult patients. The success of this effort was underpinned by extensive local preparation, close collaboration with adult intensivists and careful national planning to safeguard paediatric critical care capacity.

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Topical Lidocaine Patch for Postthoracotomy and Poststernotomy Pain in Cardiothoracic Intensive Care Unit Adult Patients

Critical Care Nurse ◽

10.4037/ccn2019849 ◽

2019 ◽

Vol 39 (5) ◽

pp. 51-57 ◽

Cited By ~ 1

Author(s):

Michael Liu ◽

Mabel Wai ◽

James Nunez

Keyword(s):

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Standard Care ◽

Academic Medical Center ◽

Adult Patients ◽

Control Group ◽

Lidocaine Group ◽

Lengths Of Stay ◽

Topical Lidocaine

Background Transdermal lidocaine patches have few systemic toxicities and may be useful analgesics in cardiac surgery patients. However, few studies have evaluated their efficacy in the perioperative setting. Objective To compare the efficacy of topical lidocaine 5% patch plus standard care (opioid and nonopioid analgesics) with standard care alone for postthoracotomy or poststernotomy pain in adult patients in a cardiothoracic intensive care unit. Methods A single-center, retrospective cohort evaluation was conducted from January 2015 through December 2015 in the adult cardiothoracic intensive care unit at a tertiary academic medical center. Cardiac surgery patients with new sternotomies or thoracotomies were included. Patients in the lidocaine group received 1 to 3 topical lidocaine 5% patches near sternotomy and/or thoracotomy sites daily. Patches remained in place for 12 hours daily. Patients in the control group received standard care alone. Results The primary outcome was numeric pain rating for sternotomy/thoracotomy sites. Secondary outcomes were cardiothoracic intensive care unit and hospital lengths of stay and total doses of analgesics received. Forty-seven patients were included in the lidocaine group; 44 were included in the control group. Mean visual analogue scores for pain did not differ between groups (lidocaine, 2; control, 1.9; P = .58). Lengths of stay were similar for both groups (cardiothoracic intensive care unit: lidocaine, 3.06 days; control, 3.11 days; P = .86; hospital: lidocaine, 8.26 days; control, 7.61 days; P = .47). Conclusions Adjunctive lidocaine 5% patches did not reduce acute pain in postthoracotomy and post-sternotomy patients in the cardiothoracic intensive care unit.

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