Early Patient Mobilization Key to Earlier Patient Recovery

The Problem

Physical deconditioning of ICU patients from illness, sedation and prolonged bed usage can occur within days of patient admission. The effect of deconditioning of the patient include weakness and neuromuscular abnormalities within 7 days of an ICU stay1, skeletal muscle strength may decline 1 to 1.5 percent per day of bed rest and up to 50% of the total muscle mass in two weeks2. Muscles that maintain posture, transferring position and ambulation tend to be the muscle groups that lose strength most quickly3. In addition, decrease in cardiovascular and respiratory reserves, neuropathies and myocardial dysfunction can also occur due to prolonged immobility3.

 

The Benefits

The benefits of mobility in traditional rehabilitation settings can also be seen in the ICU. The heart is 30% more efficient when not in a supine position as oxygen consumption is decreased. Venus statis, thrombophlebitis, deep vein thrombosis, and pulmonary emboli are all preventable by patient mobility. Kidney and urinary functioning are more effective in mobile patients. 1

 

Studies

Recent studies have discussed the benefits of early mobilization. Bailey et al proposes that activity earlier in the patient stay is a candidate therapy to prevent or treat neuromuscular complications of critical illness4. Perme et al suggest that improving mobility of patients has the potential to facilitate weaning from ventilation and improve outcomes of transplantation5. Stiller believes that mobility may decrease duration of mechanical ventilation and length of ICU and total hospital stay. Stiller also discusses the safety factors such as having to deal with patient attachments6.

 

Reduced Length of Stay

Peter Morris MD conducted a study to address the lack of data on early mobilization. The study found that patients receiving earlier mobility had their length of stay reduced by 3 days compared to the stay for patients who did not receive early mobility. This reduction included a reduced ICU stay by more than a day3. The study also found that patients receiving early mobilization were out of bed earlier, progressed more quickly to active physical therapy and experienced no adverse events during ICU therapy sessions7.

 

References

1. Pennington K. Beach, Catalyst Online. http://www. musc.edu/catalyst/archive/2008/co2-15beach.html. Accessed May 20, 2008.

2. Wagenmakers AJM. Muscle function in critically ill patients. Clin Nutr. 2001; 20(5):451-454

3. Morris PE. Moving our critically ill patients. Crit Care Clin. 2007; 23(1):1-20. doi:10.1016/j.ccc.2006.11.003.

4. Bailey P, Thomsen , Spuhler V, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007; 35(1):139-145

5. Perme C, Southard R, Joyce D, Noon G, Loebe M. Early mobilization of LVAD recipients who require prolonged mechanical ventilation. Tex Heart Inst J. 2006; 33(2):130-133

6. Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin. 2007; 23(1):35-53. doi:10.1016/j.ccc.2006.11.005

7. Physical therapy in intensive care reduces hospital stays. News-Medical.Net. http://www.news-medical. net/?id=32685/. Published November 20, 2007. Accessed May 20, 2008.