Exercise as early mobilization in patients using vasoactive drugs

2020 ◽  
Vol 19 (4) ◽  
pp. 301
Author(s):  
Amanda Mariano Morais ◽  
Daiane Naiara Da Penha ◽  
Danila Gonçalves Costa ◽  
Vanessa Beatriz Aparecida Fontes Schweling ◽  
Jaqueline Aparecida Almeida Spadari ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cardiovascular Response ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Scientific Basis ◽  
Routine Practice ◽  
Vasoactive Drugs ◽  
Early Ambulation ◽  
Early Mobility ◽  
The Face

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.

Exercise in intensive care units, safety and hemodynamic monitoring

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.

Early Ambulation in Patients With External Ventricular Drains

2016 ◽  
Vol 33 (6) ◽  
pp. 370-374 ◽  
Author(s):  
Syed Omar Shah ◽  
Jacqueline Kraft ◽  
Nethra Ankam ◽  
Paula Bu ◽  
Kristen Stout ◽  
...  
Keyword(s):  
Observational Study ◽  
Patient Population ◽  
Physical Therapists ◽  
Early Mobilization ◽  
Mean Flow ◽  
Entire Study ◽  
Early Ambulation ◽  
Early Mobility ◽  
Hospital Stays ◽  
Hospital Acquired

Introduction: Prolonged immobility in patients in the intensive care unit (ICU) can lead to muscle wasting and weakness, longer hospital stays, increased number of days in restraints, and hospital-acquired infections. Increasing evidence demonstrates the safety and feasibility of early mobilization in the ICU. However, there is a lack of evidence in the safety and feasibility of mobilizing patients with external ventricular drains (EVDs). The purpose of this study was to determine the safety and feasibility of early mobility in this patient population. Methods: We conducted a prospective, observational study. All patients in the study were managed with standard protocols and procedures practiced in our ICU including early mobility. Patients with an EVD who received early mobilization were awake and following commands, had a Lindegaard ratio <3.0 or middle cerebral artery (MCA) mean flow velocity <120 cm/s, a Mean Arterial Pressure (MAP) > 80 mm Hg, and an intracranial pressure consistently <20 mm Hg. Data were collected by physical therapists at the time of encounter. Results: Ninety patients with a total of 185 patient encounters were recorded over a 12-month period. The average time between EVD placement and physical therapy (PT) session was 8.3 ± 5.5 days. In 149 (81%) encounters, patients were at least standing or better. Patients were walking with assistance or better in 99 (54%) encounters. There were 4 (2.2%) adverse events recorded during the entire study. Conclusion: This observational study suggests that PT is feasible in patients with EVDs and can be safely tolerated. Further research is warranted in a larger patient population conducted prospectively to assess the potential benefit of early mobility in this patient population.

scholarly journals AVALIAÇÃO DE UM PROTOCOLO DE MOBILIZAÇÃO PRECOCE EM UMA UNIDADE DE TERAPIA INTENSIVA

2019 ◽  
Vol 3 ◽  
pp. 92
Author(s):  
Cassia Cinara Costa ◽  
Briane Da Silva Leite ◽  
Claudia Kist Fortino ◽  
Vinicius Gonçalves Bastos
Keyword(s):  
Intensive Care ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Pulmonary Complications ◽  
Control Group ◽  
Strength Gain ◽  
Early Ambulation ◽  
Peripheral Muscle ◽  
Terapia Intensiva

RESUMOAvaliar se o protocolo de mobilização precoce contribui para a redução do tempo de internação na Unidade de Terapia Intensiva (UTI) em pacientes submetidos a ventilação mecânica invasiva (VMI), analisar o tempo de assistência à VMI e os efeitos da mobilização precoce na força da musculatura periférica, através de um estudo de coorte concorrente com amostra consecutiva, realizado em 14 pacientes que estiveram internados em uma UTI de um hospital do Vale dos Sinos/RS. Os pacientes foram divididos em Grupo Controle, que realizou a fisioterapia do setor, e Grupo Intervenção, que recebeu o protocolo de mobilização precoce proposto por Morris et al. (2008). Os pacientes do Grupo Intervenção permaneceram um tempo menor no VMI e de internação na UTI, além de terem um ganho de força muscular periférica quando comparado ao Grupo Controle. O protocolo de mobilização precoce pode reduzir a incidência de complicações pulmonares, acelerar a recuperação, diminuir o tempo da VMI e o tempo de internação da UTI.Palavras-chave: Deambulação precoce. Fisioterapia. Reabilitação. Unidades de Terapia Intensiva.ABSTRACTTo evaluate whether the early mobilization protocol contributes to the reduction of the length of hospital stay in the Intensive Care Unit (ICU) in patients undergoing mechanical ventilation (NIV), to analyze the time of NIV care and the effects of early mobilization on the strength of the peripheral musculature. Through a concurrent cohort study with a consecutive sample, performed in 14 patients who were hospitalized in an ICU of a Vale dos Sinos / RS hospital. The patients were divided into a Control Group that performed the physiotherapy of the sector, and Intervention Group that received the protocol of early mobilization proposed by Morris et al. (2008). The Intervention Group patients remained shorter in the NIV and in the ICU, in addition to having a peripheral muscle strength gain when compared to the Control Group. The early mobilization protocol can reduce the incidence of pulmonary complications, accelerate recovery, decrease NIV time and ICU length of stay.Keywords: Early Ambulation. Intensive Care Units. Physical Therapy Specialty. Rehabilitation.

Artificial intelligence--- Future of Anesthesiology!!

2019 ◽  
pp. 247-249
Author(s):  
Tariq H. Khan
Keyword(s):  
Artificial Intelligence ◽  
Machine Learning ◽  
Intensive Care ◽  
Routine Practice ◽  
Surgical Practice ◽  
Anesthesia Practice ◽  
The Face ◽  
To Come ◽  
The Many ◽  
Applications Of Ai

The term artificial intelligence (AI) was introduced in 1950. There have been many attempts to develop machines capable of performing cognitive and skill based tasks of anesthesiologist based on the principles of AI. These attempts have not been successful because of the complexities of anesthesia practice. Recent innovations in AI, especially machine learning, will continue to grow in importance in the years to come and will greatly revolutionize the face of anesthesia along with surgical practice, perioperative medicine practiced in clinics, and imaging interpretation. Anesthesiologists should continue to embrace this technology, stay up to date with the advances in AI, and also make genuine efforts to smoothly assimilate it in their routine practice now so that they can be the revolutionaries of their own future. We hope to see an ever-widening spectrum of the uses of AI in all fields of medical practice, and anesthesiology is not an exception. Its time our friends start visualizing the many applications of AI in their practice. Citation: Khan FH, Fazal M. Artificial intelligence--- Future of Anesthesiology!! Anaesth pain & intensive care 2019;23(3):247-249

scholarly journals Factors Affecting Adherence to Early Mobilization in an Intensive Care Unit: An Analysis of Data Collected Prospectively Over a Three-Year Period by Clinical Information System

2021 ◽  
Author(s):  
Paula Perelló ◽  
Josep Gómez ◽  
Judith Mariné ◽  
Maria Teresa Cabas ◽  
Alba Arasa ◽  
...  
Keyword(s):  
Information System ◽  
Intensive Care ◽  
Adverse Events ◽  
Clinical Information System ◽  
Ventilatory Support ◽  
Early Mobilization ◽  
Clinical Information ◽  
Artificial Airway ◽  
Icu Stay ◽  
Clinical Stability

Abstract Background: Early mobilization benefits critically ill patients. Scant information is available about adherence to early mobilization protocols in intensive care units (ICU). With the aim of optimizing the application of our early mobilization protocol in mechanically ventilated patients in routine daily practice, this study analyzed adherence to the protocol, impediments to adherence, and adverse eventsin our ICU. Methods: This observational study analyzed data collected prospectively at a 24-bed polyvalent ICU over a three-year period (2017–2019). Data from adult patients on mechanical ventilation > 48 hours who met the inclusion criteria for the early mobilization protocol were included. We analyzed demographics, adherence to the protocol, total number of mobilizations, impediments to early mobilization, artificial airway/ventilatory support at each mobilization level, and adverse events during mobilization. All data was automatically obtained from the clinical information system by extract, transform, and load processes using Python 3.0. The unit of analysis was ICU stay-day. Results: We analyzed 3269 stay-days from 388 patients with median age of 63 (51–72) years, median APACHE II 23 (18–29) and median ICU stay of 10.1 (6.2–16.5) days. Adherence to the protocol was 56.6% (1850 stay-days), but patients were mobilized in only 32.2% (1472) of all stay-days. The most common reasons for not mobilizing patients were failure to meeting the criteria for clinical stability in 241 (42%) stay-days and unavailability of physiotherapists in 190 (33%) stay-days. Adverse events occurred in only 6 (0.4%) stay-days mobilizations. Conclusions: Although adherence to the protocol was high, patients were mobilized in only one-third of all stay-days. This study points to ways we can improve early mobilization in our ICU, including assessing the suitability of the criteria for clinical stability and increasing the presence of physiotherapists.

scholarly journals A multidisciplinary early mobility model for cardiac patients in coronary intensive care unit

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
S Matharsa ◽  
D Selvamani ◽  
R Thakur ◽  
P Mathew ◽  
M Thomas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Quality Improvement ◽  
Early Mobilization ◽  
Quality Improvement Project ◽  
Second Phase ◽  
Improvement Project ◽  
Early Mobility ◽  
Number Of Patients ◽  
Ventilated Patients

Abstract Funding Acknowledgements This is an unfunded project Background Early mobilization is considered as a complex task in an intensive care unit (ICU) and patients are often on prolonged bed rest leading to physical deconditioning. Intensive care early mobility programs have been recognized to be safe and have shown positive outcomes. However, implementing early mobility program as a standard of care remains a challenge. Coronary Intensive Care Unit (CICU) provides complex care for cardiac critically ill patients. In February 2018, the CICU multidisciplinary team (MDT) started a quality improvement project to implement early mobility program in the unit. Purpose This project aimed to investigate the feasibility of implementing an Early Mobility Protocol in CICU to increase the number of patients mobilized to more than 95%. Secondary objective was to explore the impact of the protocol on the mobility level of the patients at the time of discharge or transfer from the CICU. Methods A multidisciplinary mobility task force including Physicians, nurses, physiotherapists and respiratory therapists was formed to analyze the barriers in implementing an early mobility program. A staff survey was conducted to identify the need for a standard early mobility protocol. Root cause analysis and Pareto analysis was done. An evidence based early mobility protocol was developed and implemented. All non-mechanical ventilated patients were included in the first phase and all mechanical ventilated patients were included in the second phase of the project. A standard ICU Mobility scale (IMS) was used for scoring the mobility level of the patients. This quality improvement project is based on "Institute for Healthcare Improvement" model. Periodical staff education and training programs about early mobilization were conducted to improve staff confidence. Change ideas were implemented using multiple Plan Do Study Act cycles. Results The total number of patients included from 1st March 2018 till 31st December 2019 was 2356. This included both the genders. In March 2018, only 68% of non-mechanical ventilated patients were mobilized, that reached to 88% by November 2018. This gradually increased to 100% in May 2019 and is currently sustained at 100%. In November 2019, only 50% of mechanical ventilated patients were mobilized which gradually increased to 66.66% and 75% in middle and end of December 2019. The mean IMS score at discharge or transfer from CICU was "8". From patient-family experience survey, 93.75% of patients perceived that the program was helpful in regaining mobility and 96.25% of patients felt that the program helped in regaining their autonomy. Conclusion The result shows that it is safe and feasible to implement an early mobility program in a Coronary Intensive Care Unit. A standardized mobility protocol can lead to efficient mobilization practice facilitating early transfers from ICUs without any complications. This could further enhance the collaboration of the MDT members leading to culture change in ICUs.

scholarly journals Beginning Restorative Activities Very Early: Implementation of an Early Mobility Initiative in a Pediatric Onco-Critical Care Unit

2021 ◽  
Vol 11 ◽  
Author(s):  
Saad Ghafoor ◽  
Kimberly Fan ◽  
Sarah Williams ◽  
Amanda Brown ◽  
Sarah Bowman ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Critical Care Unit ◽  
Early Mobilization ◽  
Rehabilitation Services ◽  
Quality Improvement Initiative ◽  
High Risk Population ◽  
Functional Impairments ◽  
Early Mobility ◽  
Unplanned Extubations

IntroductionChildren with underlying oncologic and hematologic diseases who require critical care services have unique risk factors for developing functional impairments from pediatric post-intensive care syndrome (PICS-p). Early mobilization and rehabilitation programs offer a promising approach for mitigating the effects of PICS-p in oncology patients but have not yet been studied in this high-risk population.MethodsWe describe the development and feasibility of implementing an early mobility quality improvement initiative in a dedicated pediatric onco-critical care unit. Our primary outcomes include the percentage of patients with consults for rehabilitation services within 72 h of admission, the percentage of patients who are mobilized within 72 h of admission, and the percentage of patients with a positive delirium screen after 48 h of admission.ResultsBetween January 2019 and June 2020, we significantly increased the proportion of patients with consults ordered for rehabilitation services within 72 h of admission from 25 to 56% (p&lt;0.001), increased the percentage of patients who were mobilized within 72 h of admission to the intensive care unit from 21 to 30% (p=0.02), and observed a decrease in patients with positive delirium screens from 43 to 37% (p=0.46). The early mobility initiative was not associated with an increase in unplanned extubations, unintentional removal of central venous catheters, or injury to patient or staff.ConclusionsOur experience supports the safety and feasibility of early mobility initiatives in pediatric onco-critical care. Additional evaluation is needed to determine the effects of early mobilization on patient outcomes.

scholarly journals Effectiveness of an Early Mobilization Protocol in a Trauma and Burns Intensive Care Unit: A Retrospective Cohort Study

2013 ◽  
Vol 93 (2) ◽  
pp. 186-196 ◽  
Author(s):  
Diane E. Clark ◽  
John D. Lowman ◽  
Russell L. Griffin ◽  
Helen M. Matthews ◽  
Donald A. Reiff
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Early Mobilization ◽  
Complication Rates ◽  
Early Mobility ◽  
Lengths Of Stay ◽  
Medical Icus

Background Bed rest and immobility in patients on mechanical ventilation or in an intensive care unit (ICU) have detrimental effects. Studies in medical ICUs show that early mobilization is safe, does not increase costs, and can be associated with decreased ICU and hospital lengths of stay (LOS). Objective The purpose of this study was to assess the effects of an early mobilization protocol on complication rates, ventilator days, and ICU and hospital LOS for patients admitted to a trauma and burn ICU (TBICU). Design This was a retrospective cohort study of an interdisciplinary quality-improvement program. Methods Pre– and post–early mobility program patient data from the trauma registry for 2,176 patients admitted to the TBICU between May 2008 and April 2010 were compared. Results No adverse events were reported related to the early mobility program. After adjusting for age and injury severity, there was a decrease in airway, pulmonary, and vascular complications (including pneumonia and deep vein thrombosis) post–early mobility program. Ventilator days and TBICU and hospital lengths of stay were not significantly decreased. Limitations Using a historical control group, there was no way to account for other changes in patient care that may have occurred between the 2 periods that could have affected patient outcomes. The dose of physical activity both before and after the early mobility program were not specifically assessed. Conclusions Early mobilization of patients in a TBICU was safe and effective. Medical, nursing, and physical therapy staff, as well as hospital administrators, have embraced the new culture of early mobilization in the ICU.

Variation in antibiotic use across intensive care units (ICU): A population-based cohort study in Ontario, Canada

2020 ◽  
Vol 41 (9) ◽  
pp. 1035-1041
Author(s):  
Erika Y. Lee ◽  
Michael E. Detsky ◽  
Jin Ma ◽  
Chaim M. Bell ◽  
Andrew M. Morris
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Ventilatory Support ◽  
Severity Of Illness ◽  
Antibiotic Use ◽  
Patient Factors ◽  
Days Of Therapy ◽  
Level 3 ◽  
Level 2

AbstractObjectives:Antibiotics are commonly used in intensive care units (ICUs), yet differences in antibiotic use across ICUs are unknown. Herein, we studied antibiotic use across ICUs and examined factors that contributed to variation.Methods:We conducted a retrospective cohort study using data from Ontario’s Critical Care Information System (CCIS), which included 201 adult ICUs and 2,013,397 patient days from January 2012 to June 2016. Antibiotic use was measured in days of therapy (DOT) per 1,000 patient days. ICU factors included ability to provide ventilator support (level 3) or not (level 2), ICU type (medical-surgical or other), and academic status. Patient factors included severity of illness using multiple-organ dysfunction score (MODS), ventilatory support, and central venous catheter (CVC) use. We analyzed the effect of these factors on variation in antibiotic use.Results:Overall, 269,351 patients (56%) received antibiotics during their ICU stay. The mean antibiotic use was 624 (range 3–1460) DOT per 1,000 patient days. Antibiotic use was significantly higher in medical-surgical ICUs compared to other ICUs (697 vs 410 DOT per 1,000 patient days; P < .0001) and in level 3 ICUs compared to level 2 ICUs (751 vs 513 DOT per 1,000 patient days; P < .0001). Higher antibiotic use was associated with higher severity of illness and intensity of treatment. ICU and patient factors explained 47% of the variation in antibiotic use across ICUs.Conclusions:Antibiotic use varies widely across ICUs, which is partially associated with ICUs and patient characteristics. These differences highlight the importance of antimicrobial stewardship to ensure appropriate use of antibiotics in ICU patients.

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

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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