PHYSICAL THERAPY AND EARLY MOBILITY IN THE …

[Pages:99]PHYSICAL THERAPY AND EARLY MOBILITY IN THE INTENSIVE CARE UNIT

Sarah Neller, MSPT Katie Koester, MPT

WPTA Spring Conference April 13, 2018

Disclosures

We have no conflicts of interest to disclose.

All patients pictured in this presentation signed written consents.

Objectives

At the conclusion of this presentation participants will be able to:

Understand the rationale for early mobility and the research supporting it. Explain the potential negative outcomes associated with surviving critical

illness. Describe the barriers and potential solutions to early mobility in the ICU. Increase their understanding of common modes of ventilation and their

implications for therapy. Describe common lines and equipment encountered when treating in the ICU. Increase the comfort level of therapists who treat in the intensive care

environment.

What is early mobility?

A continuum of activities starting with range of motion and progressing all the way to walking Not just "vent walks"

Includes Positioning and assessing needs for splinting P/AA/AROM Upper and lower extremity strengthening Upright positioning and pulmonary hygiene Sitting at edge of bed, transfers, and walking Educating caregivers/family members

Literature Supporting Early Mobility

Numerous studies, including systematic reviews, support the safety, feasibility, and benefits of early mobility Very low rate of adverse events Limited RCTs Measurement of outcomes not uniform across studies

Literature Supporting Early Mobility

Early Intensive Care Unit Mobility Therapy in the Treatment of Acute Respiratory Failure- Morris 2008

Prospective study showing safety, decreased ICU and hospital length of stay (LOS)

Receiving Early Mobility During an Intensive Care Unit Admission Is a Predictor of Improved Outcomes in Acute Respiratory Failure- Morris 2011

Retrospective follow-up of survivors Independent of other factors, survivors who did not participate

in ICU early mobility were more likely to be re-admitted or die in 1st year following hospitalization

Literature Supporting Early Mobility

Early Physical and Occupational Therapy in Mechanically Ventilated, Critically Ill Patients: A Randomised Controlled Trial- Schweikert 2009

Started therapy median of 1.5 days after intubation Treatment group showed increased return to independent

function at hospital discharge- 59% vs. 35% Treatment group's medium delirium time was half as long-

2 days vs. 4 days Treatment group had median of 2.4 more ventilator-free

days

Literature Supporting Early Mobility

Early Mobilization and Recovery in Mechanically Ventilated Patients in the ICU: A Bi-national, Multi-centre, Prospective Cohort Study- Hodgson 2015

No mobility occurred in large percentage of therapy sessions High rate of ICU-acquired weakness (ICUAW) Improved strength at ICU discharge was associated with early

mobility, discharge to home, and survival at day 90

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