Effectiveness of early mobilization in a trauma ICU
Bed rest, sedation and mechanical ventilation in patients during critical illness in an intensive care unit (ICU) have detrimental effects.
Prolonged immobility is associated with joint mobility restrictions, muscle weakness, critical illness neuromyopathies, pressure ulcers, deep vein thrombosis (DVT), pneumonia's, and psychological disturbances.
The aim of this study was to assess the safety and effects of an early mobilization protocol for a trauma and burns ICU.
An early mobility program was developed that progressed ICU patient mobility based on medical stability, cognitive abilities, and motor status. Contra-indications were established and nursing staff was educated.
Results showed a significant decrease in ventilator-acquired pneumonia, airway complications and venous thromboembolism. There was no difference in lenght of stay and no adverse events (accidental extubation, decanulation of catheters, etc) or increased complications were reported. Early mobilization for trauma and burns patients is safe and definitely effective.
Previous evidence shows that early mobilization is beneficial in medical and surgical ICU's. However, the injuries and management of trauma and burns patients differs significantly: unstable fractures, chest trauma, inhalation injuries and open wounds require specific medical interventions that might interfere with mobilitization possibilities.
The team at UAB Hospital in Birmingham (USA) adapted and implemented an extensive early mobility programma, consisting of positioning, PROM (nurses), active assisted exercsises, sitting up edge of bed, active transfers, standing and walking (physiotherapist). Communication to progress programme and prevent complications was essential and secured by flow sheets, daily rounds, and daily multidisciplinary team meetings.
Early mobilization of patients admitted to a TBICU was safe and effective. Neither acute adverse events nor increased complications associated with early mobility were reported. Patients in the TBICU significantly reduced airway, pulmonary, and vascular complications. No reduction was found for hospital LOS, ICU LOS nor ventilator support
Staff satisfction and feasability were good; these kind of interdisciplinary protocols are possible due to a deliberate effort to involve all stakeholders in the planning process and a shift from multi-disciplinary to interdisciplinary patient care. Nurses, medical staff, physician assistants, respiratory therapists and physical therapists were all involved in implementing this beneficial programme.
How does your team organise mobilization of patients in ICU, and what are your successes and barriers?
> From: Clark et al., Phys Ther 93 (2) (2015) 186-96(Epub ahead of print). All rights reserved to © 2013 American Physical Therapy Association. Click here for the Pubmed summary.