Early progressive mobilization in the intensive care unit without dedicated personnel

Background: Immobility in intensive care unit (ICU) patients is associated with relevant short-term and long-term adverse consequences such as delirium and ICU-acquired weakness. Early and progressive mobilization protocols have shown to be feasible, safe, and effective in improving outcomes. A dedi...

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Bibliographic Details
Published in:The Canadian journal of critical care nursing 2018-09, Vol.29 (3), p.26-31
Main Authors: Negro, Alessandra, Cabrini, Luca, Lembo, Rosalba, Monti, Giacomo, Dossi, Mauro, Perduca, Arianna, Colombo, Sergio, Marazzi, Monica, Villa, Giulia, Manara, Duilio, Landoni, Giovanni, Zangrillo, Alberto
Format: Article
Language:English
Subjects:
Anesthesiology
Care and treatment
Clinical outcomes
Critical care
Critically ill
Delirium
Exercise therapy
Intensive care
Intensive care nursing
Management
Medicine
Methods
Nurses
Patients
Physical therapists
Physical therapy
Quality of life
Rehabilitation
Teaching hospitals
Ventilators
Walking
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Summary:Background: Immobility in intensive care unit (ICU) patients is associated with relevant short-term and long-term adverse consequences such as delirium and ICU-acquired weakness. Early and progressive mobilization protocols have shown to be feasible, safe, and effective in improving outcomes. A dedicated mobilization team has been proposed as a necessity in the ICU, but in times of resource limitations it could be unavailable. Objectives: To assess the feasibility and safety of an early progressive mobilization protocol implemented without dedicated personnel, as part of the ABCDE bundle. Methods: This observational study took place in the general ICU of a teaching hospital in Italy. All of the staff, composed of nurses, aides and doctors, took part in a preliminary educational course. The protocol was nurse-led; mobilization was performed only with patients passing a safety checklist. Data collection lasted one year and included patients' demographics, duration and number of every advanced mobilization session, where "advanced" was defined as dangling, out-of-bed and walking, and any adverse event related to mobilization. Results: During the study period, 482 patients were admitted in the ICU and 94 (19.5%) were mobilized. Non-mobilized patients were more frequently surgical patients. We conducted 356 mobilization sessions. We found that there was a significant increase over time of patients being mobilized while receiving mechanical ventilation. Four minor adverse events occurred in the first three months, and no adverse events thereafter; all events were resolved immediately after stopping mobilization without any consequences. Conclusion: The implementation of an early and progressive mobilization protocol is both feasible and safe, even in the absence of dedicated personnel, but the number of mobilized patients was low.
ISSN:2368-8653