The Importance of Early Mobilisation for The Intensive Care Patient

Yıl 2023, Cilt: 6 Sayı: 3, 510 - 524, 30.12.2023

Ebubekir Kaplan , Aylin Aktaş Özakgül , Özkan Sir

https://doi.org/10.54803/sauhsd.1381519

Öz

Early mobilisation is considered a safe and effective treatment strategy to improve the rehabilitation of patients admitted to the intensive care unit and provides proven benefits for critically ill patients. Early mobilisation of patients plays an important role in preventing physical and psychosocial problems that may develop. Nurses can easily integrate early mobilisation into the intensive care unit while carrying out their usual activities for patients. When nurses are able to provide early mobilisation, significant improvements in the recovery of patients will be achieved and as a result, patients will be helped to regain their previous physical abilities. Several clinical studies have shown that early mobilisation can improve muscle and hand grip strength and reduce the incidence of intensive care unit-related weakness and delirium, thereby improving the ability to live independently and shortening the length of stay in the intensive care unit and hospital stay. Furthermore, the lack of mobilisation protocols and associated safety concerns are a barrier to the implementation of early mobilisation in critically ill patients. Therefore, determination of appropriate methods for the implementation of early mobilisation is an important necessity in order to increase its potential in these patients. It is recommended that all intensive care unit staff should be trained in the use of early mobilisation protocol. In this review, the definition and importance of early mobilisation and the role of the nurse in early mobilisation are discussed.

Anahtar Kelimeler

Intensive care unit, nursing, intensive care nurse, early mobilisation

Yoğun Bakım Hastası İçin Erken Mobilizasyonun Önemi

Öz

Erken mobilizasyon, yoğun bakım ünitesine kabul edilen hastaların rehabilitasyonunu iyileştirmek için güvenli ve etkili bir tedavi stratejisi olarak kabul edilir ve kritik hastalar için kanıtlanmış faydalar sağlamaktadır. Erken dönemde hastaların mobilizasyonu gelişebilecek fiziksel ve psikososyal sorunların önlenmesinde önemli rol oynamaktadır. Hemşireler hastalar için olağan faaliyetlerini yürütürken erken mobilizasyon uygulamasını yoğun bakım ünitesine kolaylıkla entegre edebilirler. Hemşireler erken mobilizasyon uygulamasını sağlayabildiklerinde hastaların iyileşmesinde önemli gelişmeler sağlanmış olacak ve sonuç olarak hastaların önceki fiziksel yeteneklerini kazanmalarına yardımcı olunacaktır. Çeşitli klinik araştırmalar, erken mobilizasyonun kas ve el kavrama gücünü artırabildiğini ve yoğun bakım ünitesiyle ilişkili güçsüzlük ve deliryum insidansını azaltabildiğini, böylece bağımsız yaşam yeteneğini geliştirebildiğini ve yoğun bakım ünitesinde kalış ve hastanede kalış sürelerini kısaltabildiğini göstermiştir. Ayrıca, mobilizasyon protokollerinin eksikliği ve buna bağlı güvenlik kaygıları, kritik hastalarda erken mobilizasyonun uygulanmasının önünde bir engeldir. Bu nedenle, erken mobilizasyonun uygulanmasına yönelik uygun yöntemlerin belirlenmesi, bu hastalardaki potansiyelinin artırılması açısından önemli bir zorunluluktur. Tüm yoğun bakım çalışanına erken mobilizasyon protokolünün kullanımına ilişkin eğitim verilmesi önerilmektedir. Bu derlemede, erken mobilizasyonun tanımı, önemi ve erken mobilizasyonda hemşirenin rolüne yer verilmiştir.

Anahtar Kelimeler

Yoğun bakım ünitesi, hemşirelik, yoğun bakım hemşiresi, erken mobilizasyon

Kaynakça

• Watanabe S, Hirasawa J, Naito Y, Mizutani M, Uemura A, Nishimura S, et al. Association between the early mobilization of mechanically ventilated patients and independence in activities of daily living at hospital discharge. Scientific Reports [Internet]. 2023;13(1):1–9. https://doi.org/10.1038/s41598-023-314591
• Rawal G, Yadav S, Kumar R. Post-intensive care syndrome: An overview. Journal of Translational Internal Medicine. 2017;5(2):90–2.
• Fuke R, Hifumi T, Kondo Y, Hatakeyama J, Takei T, Yamakawa K, et al. Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: A systematic review and meta-analysis. BMJ Open. 2018;8(5):1–10.
• Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Vol. 46, Critical Care Medicine. 2018. 825–873 p.
• Alaparthi GK, Gatty A, Samuel SR, Amaravadi SK. Effectiveness, safety, and barriers to early mobilization in the intensive care unit. Critical Care Research and Practice. 2020;2020.
• Farhan H, Moreno-Duarte I, Latronico N, Zafonte R, Eikermann M. Acquired muscle weakness in the surgical intensive care unit: Nosology, epidemiology, diagnosis, and prevention. Anesthesiology. 2016;124(1):207–34.
• Wang W, Xu C, Ma X, Zhang X, Xie P. Intensive Care Unit-Acquired Weakness: A Review of Recent Progress With a Look Toward the Future. Frontiers in Medicine. 2020;7(November):1–9.
• Menges D, Seiler B, Tomonaga Y, Schwenkglenks M, Puhan MA, Yebyo HG. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Critical Care [Internet]. 2021;25(1):1–24. https://doi.org/10.1186/s13054-020-03446-9
• Vanhorebeek I, Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Medicine [Internet]. 2020;46(4):637–53.
• Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, et al. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS ONE. 2019;14(10):1–16. , Zang K, Chen B, Wang M, Chen D, Hui L, Guo S, et al. The effect of early mobilization in critically ill patients: A meta-analysis. Nursing in Critical Care. 2020;25(6):360–7.
• Koukourikos K, Kourkouta L, Iliadis C, Krepia V, Tsaloglidou A. Early Mobilization of Intensive Care Unit ((ICU) Patients. International Journal of Caring Sciences [Internet]. 2020;13(3):2269–77. Available from: www.internationaljournalofcaringsciences.org
• Yang R, Zheng Q, Zuo D, Zhang C, Gan X. Safety assessment criteria for early active mobilization in mechanically ventilated ICU subjects. Respiratory Care. 2021;66(2):307–15.
• Group =TEAM Study Investigators and the ANZICS Clinical Trials, Hodgson CL, Bailey M, Bellomo R, Brickell K, Broadley T, et al. Early Active Mobilization during Mechanical Ventilation in the ICU. The New England journal of medicine [Internet]. 2022;387(19):1747–58. Available from: http://europepmc.org/abstract/MED/36286256
• Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Medicine. 2017;43(2):171–83.
• Green M, Marzano V, Leditschke IA, Mitchell I, Bissett B. Mobilization of intensive care patients: A multidisciplinary practical guide for clinicians. Journal of Multidisciplinary Healthcare. 2016;9:247–56.
• Silva TD da, Oliveira PM de, Dionizio JB, Santana AP de, Bahadori S, Dias ED, et al. Comparison Between Conventional Intervention and Non-immersive Virtual Reality in the Rehabilitation of Individuals in an Inpatient Unit for the Treatment of COVID-19: A Study Protocol for a Randomized Controlled Crossover Trial. Frontiers in Psychology. 2021;12(February):1–11.
• Kuru T, Olcar HA. Effects of early mobilization and weight bearing on postoperative walking ability and pain in geriatric patients operated due to hip fracture: A retrospective analysis. Turkish Journal of Medical Sciences. 2020;50(1):117–25.
• Arias-Fernández P, Romero-Martin M, Gómez-Salgado J, Fernández-García D. Rehabilitation and early mobilization in the critical patient: systematic review. Journal of Physical Therapy Science. 2018;30(9):1193–201.
• Dagnachew TK, Woldegerima Berhe Y, Yalew Mustofa S, Birlie Chekol W. Clinicians’ knowledge and attitude towards early mobilization in intensive care units in Ethiopian tertiary hospitals: A multi-centre study. SAGE Open Medicine. 2023;11.
• Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care. 2014;18(6):1–9.
• Aprisunadi, Nursalam N, Mustikasari M, Ifadah E, Hapsari ED. Effect of Early Mobilization on Hip and Lower Extremity Postoperative: A Literature Review. SAGE Open Nursing. 2023;9.
• Baer M, Neuhaus V, Pape HC, Ciritsis B. Influence of mobilization and weight bearing on in-hospital outcome in geriatric patients with hip fractures. Sicot-J. 2019;5(1).
• Haslam-Larmer L, Donnelly C, Auais M, Woo K, DePaul V. Early mobility after fragility hip fracture: a mixed methods embedded case study. BMC Geriatrics. 2021;21(1):1–14.
• Mahmudova R, Candan Dönmez Y. Investigation of the Factors Affecting the Standing Conditions of Patients After Surgery. Turkiye Klinikleri Journal of Nursing Sciences. 2019;11(1):1–6.
• Sricharoenchai T, Parker AM, Zanni JM, Nelliot A, Dinglas VD, Needham DM. Safety of physical therapy interventions in critically ill patients: A single-center prospective evaluation of 1110 intensive care unit admissions. Journal of Critical Care [Internet]. 2014;29(3):395–400. Available from: http://dx.doi.org/10.1016/j.jcrc.2013.12.012
• Cameron S, Ball I, Cepinskas G, Choong K, Doherty TJ, Ellis CG, et al. Early mobilization in the critical care unit: A review of adult and pediatric literature. Journal of Critical Care [Internet]. 2015;30(4):664–72.
• Vollenweider R, Manettas AI, Häni N, de Bruin ED, Knols RH. Passive motion of the lower extremities in sedated and ventilated patients in the ICU – a systematic review of early effects and replicability of Interventions. PLoS ONE. 2022;17(5 May):1–21.
• Amidei C, Sole M Lou. Physiological Responses to Passive Exercise in Adults Receiving Mechanical Ventilation. American Journal of Critical Care . 2013 Jul 1;22(4):337–48.
• Clarissa C, Salisbury L, Rodgers S, Kean S. Early mobilisation in mechanically ventilated patients: A systematic integrative review of definitions and activities. Journal of Intensive Care. 2019;7(1):1–19.
• Söderberg A, Karlsson V, Fagevik Olsén M, Thelandersson A, Johansson A. Patient as active partner–clue to successful early mobilization in intensive care. Physiotherapy Theory and Practice [Internet]. 2023;00(00):1–11.
• Makic MBF, Rauen C, Watson R, Poteet AW. Examining the Evidence to Guide Practice: Challenging Practice Habits. Critical Care Nurse [Internet]. 2014 Apr 1;34(2):28–45.
• Engel HJ, Needham DM, Morris PE, Gropper MA. ICU early mobilization: From recommendation to implementation at three medical centers. Critical Care Medicine. 2013;41(9 SUPPL.1):69–80.
• Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: A systematic review. Archives of Physical Medicine and Rehabilitation [Internet]. 2013;94(3):551–61.
• Parker AM, Sricharoenchai T, Needham DM. Early Rehabilitation in the Intensive Care Unit: Preventing Impairment of Physical and Mental Health. Current Physical Medicine and Rehabilitation Reports. 2013;1(4):307–14.
• Dirkes SM, Kozlowski C. Early Mobility in the Intensive Care Unit: Evidence, Barriers, and Future Directions. Critical Care Nurse [Internet]. 2019 Jun 1;39(3):33–42.
• Liew SM, Mordiffi SZ, Ong YJA, Lopez V. Nurses’ perceptions of early mobilisation in the adult Intensive Care Unit: A qualitative study. Intensive and Critical Care Nursing. 2021;66:103039. Available from: https://doi.org/10.1016/j.iccn.2021.103039
• Ho L, Tsang JHC, Cheung E, Chan WY, Lee KW, Lui SR, et al. Improving mobility in the intensive care unit with a protocolized, early mobilization program: observations of a single center before-and-after the implementation of a multidisciplinary program. Acute and Critical Care. 2022;37(3):286–94.
• Monsees J, Moore Z, Patton D, Watson C, Nugent L, Avsar P, et al. A systematic review of the effect of early mobilisation on length of stay for adults in the intensive care unit. Nursing in Critical Care. 2023;28(4):499–509.
• Stolldorf DP, Dietrich MS, Chidume T, Mcintosh M, Maxwell C. Pilot Study. 2019;37(6):318–23.
• Noone CE, Franck LS, Staveski SL, Rehm RS. Barriers and facilitators to early mobilisation programmes in the paediatric intensive care unit: A scoping literature review. Nursing in Critical Care. 2023;28(4):526–44.
• Davidson JE, Winkelman C, Gélinas C, Dermenchyan A. Pain, Agitation, and Delirium Guidelines: Nurses’ Involvement in Development and Implementation. Critical Care Nurse [Internet]. 2015 Jun 1;35(3):17–31.
• Fraser D, Spiva L, Forman W, Hallen C. Implementation of an Early Mobility Program in an ICU. AJN, American Journal of Nursing [Internet]. 2015 Dec;115(12):49–58. Available from: https://journals.lww.com/00000446-201512000-00027
• Dammeyer JA, Baldwin N, Packard D, Harrington S, Christofferson B, Christopher J, et al. Mobilizing outcomes: Implementation of a nurse-led multidisciplinary mobility program. Critical Care Nursing Quarterly. 2013;36(1):109–19.
• Fernández-Castillo RJ, González-Caro MD, Fernández-García E, Porcel-Gálvez AM, Garnacho-Montero J. Intensive care nurses’ experiences during the COVID-19 pandemic: A qualitative study. Nursing in Critical Care. 2021;26(5):397–406.
• Schallom M, Tymkew H, Vyers K, Prentice D, Sona C, Norris T, et al. Implementation of an Interdisciplinary AACN Early Mobility Protocol. Critical Care Nurse [Internet]. 2020 Aug 1;40(4):e7–17.
• Krupp A, Steege L, King B. A systematic review evaluating the role of nurses and processes for delivering early mobility interventions in the intensive care unit. Intensive and Critical Care Nursing. 2018;47:30–8.
• Phelan S, Lin F, Mitchell M, Chaboyer W. Implementing early mobilisation in the intensive care unit: An integrative review. International Journal of Nursing Studies [Internet]. 2018;77(March 2017):91–105.
• Jolley SE, Regan-Baggs J, Dickson RP, Hough CL. Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: A cross-sectional survey study. BMC Anesthesiology. 2014;14(1):1–9.
• Anekwe DE, Milner SC, Bussières A, de Marchie M, Spahija J. Intensive care unit clinicians identify many barriers to, and facilitators of, early mobilisation: a qualitative study using the Theoretical Domains Framework. Journal of Physiotherapy [Internet]. 2020;66(2):120–7. Available from: https://doi.org/10.1016/j.jphys.2020.03.001
• Dubb R, Nydahl P, Hermes C, Schwabbauer N, Toonstra A, Parker AM, et al. Barriers and strategies for early mobilization of patients in intensive care units. Annals of the American Thoracic Society. 2016;13(5):724–30.
• Babazadeh M, Jahani S, Poursangbor T, Cheraghian B. Perceived barriers to early mobilization of intensive care unit patients by nurses in hospitals affiliated to Jundishapur University of Medical Sciences of Ahvaz in 2019. Journal of Medicine and Life. 2021;14(1):100–4.
• Goodson CM, Friedman LA, Mantheiy E, Heckle K, Lavezza A, Toonstra A, et al. Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU. Journal of Intensive Care Medicine. 2020;35(10):1026–31.
• Dafoe S, Chapman MJ, Edwards S, Stiller K. Overcoming barriers to the mobilisation of patients in an intensive care unit. Anaesthesia and Intensive Care. 2015;43(6):719–27.
• Fontela PC, Forgiarini LA, Friedman G. Clinical attitudes and perceived barriers to early mobilization of critically ill patients in adult intensive care units. Revista Brasileira de Terapia Intensiva. 2018;30(2):187–94.