scholarly journals Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Gopala Krishna Alaparthi ◽  
Aishwarya Gatty ◽  
Stephen Rajan Samuel ◽  
Sampath Kumar Amaravadi
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Full Text ◽  
Early Mobilization ◽  
Scoring Systems ◽  
Inclusion Criteria ◽  
Limited Mobility ◽  
Positive Effects

Purpose. Patients admitted to the intensive care unit (ICU) are generally confined to bed leading to limited mobility that may have detrimental effects on different body systems. Early mobilization prevents or reduces these effects and improves outcomes in patients following critical illness. The purpose of this review is to summarize different aspects of early mobilization in intensive care. Methods. Electronic databases of PubMed, Google Scholar, ScienceDirect, and Scopus were searched using a combination of keywords. Full-text articles meeting the inclusion criteria were selected. Results. Fifty-six studies on various aspects such as the effectiveness of early mobilization in various intensive care units, newer techniques in early mobilization, outcome measures for physical function in the intensive care unit, safety, and practice and barriers to early mobilization were included. Conclusion: Early mobilization is found to have positive effects on various outcomes in patients with or without mechanical ventilation. The newer techniques can be used to facilitate early mobilization. Scoring systems—specific to the ICU—are available and should be used to quantify patients’ status at different intervals of time. Early mobilization is not commonly practiced in many countries. Various barriers to early mobilization have been identified, and different strategies can be used to overcome them.

scholarly journals Family's Experience Dealing with Critical Patient Hospitalization in the Intensive Care Unit

2021 ◽  
Vol 10 (2) ◽  
pp. 52
Author(s):  
Maria Theresia Dhiu ◽  
Ninuk Dian Kurniawati ◽  
Andri Setya Wahyudi
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Full Text ◽  
Empirical Studies ◽  
Security And Privacy ◽  
Inclusion Criteria ◽  
The Family ◽  
Psychosocial Condition ◽  
Regulation Changes

Introduction: The Intensive Care Unit (ICU) is a treatment that can cause feelings of stress, anxiety, fear not only to the patient but also to the patient's family. The unfamiliar environment, intensive space regulation, changes in emotional status, and changes in daily activities are some of the factors that cause stress in the ICU patient's family. The purpose of this study is to reveal the experiences of families in facing hospitalization in intensive care units based on empirical studies in the last five years.Methods:Journal searches use indexed databases Scopus, Proquest, ScienceDirect and PubMed using keywords: hospitalitation, family, critical patient, icu. The Center for Review and Dissemination and The Joanna Briggs Institute was used to assess the quality of the study. The framework used is PICOS with inclusion criteria, namely journals in English and Indonesian, published years 2015 to 2020. Analyzes and tabulation of data on articles or journals, titles, abstracts, full text and methodology are assessed to determine the eligibility of articles or journals.Result:The family's experience in dealing with critical patient hospitalization in the ICU care room has an impact on the family who treats these patients both physically and psychologically. During patient hospitalization, the family plays a role in providing care, compassion, creating security and privacy, advocating for and ensuring that patients receive good care.Conclusion: The experience of hospitalization can disrupt the client's psychology and psychosocial condition, especially if the client is unable to adapt to his new environment at the hospital. published years 2015 to 2020. Analyzes and tabulation of data on articles or journals, titles, abstracts, full text and methodology are assessed to determine the eligibility of articles or journals

scholarly journals Neuromuscular Electrical Stimulation for Intensive Care Unit–Acquired Weakness: Protocol and Methodological Implications for a Randomized, Sham-Controlled, Phase II Trial

2012 ◽  
Vol 92 (12) ◽  
pp. 1564-1579 ◽  
Author(s):  
Michelle E. Kho ◽  
Alexander D. Truong ◽  
Roy G. Brower ◽  
Jeffrey B. Palmer ◽  
Eddy Fan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Electrical Stimulation ◽  
Critical Illness ◽  
Pilot Study ◽  
Muscle Strength ◽  
Phase Ii ◽  
Neuromuscular Electrical Stimulation ◽  
Bed Rest

BackgroundAs the population ages and critical care advances, a growing number of survivors of critical illness will be at risk for intensive care unit (ICU)–acquired weakness. Bed rest, which is common in the ICU, causes adverse effects, including muscle weakness. Consequently, patients need ICU-based interventions focused on the muscular system. Although emerging evidence supports the benefits of early rehabilitation during mechanical ventilation, additional therapies may be beneficial. Neuromuscular electrical stimulation (NMES), which can provide some muscular activity even very early during critical illness, is a promising modality for patients in the ICU.ObjectiveThe objectives of this article are to discuss the implications of bed rest for patients with critical illness, summarize recent studies of early rehabilitation and NMES in the ICU, and describe a protocol for a randomized, phase II pilot study of NMES in patients receiving mechanical ventilation.DesignThe study was a randomized, sham-controlled, concealed, phase II pilot study with caregivers and outcome assessors blinded to the treatment allocation.SettingThe study setting will be a medical ICU.ParticipantsThe study participants will be patients who are receiving mechanical ventilation for 1 day or more, who are expected to stay in the ICU for an additional 2 days or more, and who meet no exclusion criteria.InterventionThe intervention will be NMES (versus a sham [control] intervention) applied to the quadriceps, tibialis anterior, and gastrocnemius muscles for 60 minutes per day.MeasurementsLower-extremity muscle strength at hospital discharge will be the primary outcome measure.LimitationsMuscle strength is a surrogate measure, not a patient-centered outcome. The assessments will not include laboratory, genetic, or histological measures aimed at a mechanistic understanding of NMES. The optimal duration or dose of NMES is unclear.ConclusionsIf NMES is beneficial, the results of the study will help advance research aimed at reducing the burden of muscular weakness and physical disability in survivors of critical illness.

Prognosis of Allogeneic Haematopoietic Stem Cell Recipients Admitted to the Intensive Care Unit: A Retrospective, Single-Centre Study

2015 ◽  
Vol 135 (2) ◽  
pp. 72-78 ◽  
Author(s):  
Sidsel Christy Lindgaard ◽  
Jonas Nielsen ◽  
Anders Lindmark ◽  
Henrik Sengeløv
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Stem Cell ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Scoring Systems ◽  
University Hospital ◽  
Haematopoietic Stem Cell ◽  
Icu Admission

Background: Allogeneic haematopoietic stem cell transplantation (HSCT) is a procedure with inherent complications and intensive care may be necessary. We evaluated the short- and long-term outcomes of the HSCT recipients requiring admission to the intensive care unit (ICU). Methods: We retrospectively examined the outcome of 54 adult haematological HSCT recipients admitted to the ICU at the University Hospital Rigshospitalet between January 2007 and March 2012. Results: The overall in-ICU, in-hospital, 6-month and 1-year mortality rates were 46.3, 75.9, 79.6 and 86.5%, respectively. Mechanical ventilation had a statistically significant effect on in-ICU (p = 0.02), 6-month (p = 0.049) and 1-year (p = 0.014) mortality. Renal replacement therapy also had a statistically significant effect on in-hospital (p = 0.038) and 6-month (p = 0.026) mortality. Short ICU admissions, i.e. <10 days, had a statistically significant positive effect on in-hospital, 6-month and 1-year mortality (all p < 0.001). The SAPS II, APACHE II and SOFA scoring systems grossly underestimated the actual in-hospital mortality observed for these patients. Conclusion: The poor prognosis of critically ill HSCT recipients admitted to the ICU was confirmed in our study. Mechanical ventilation, renal replacement therapy and an ICU admission of ≥10 days were each risk factors for mortality in the first year after ICU admission.

scholarly journals Intensive care unit–acquired weakness: unanswered questions and targets for future research

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 508 ◽  
Author(s):  
Simone Piva ◽  
Nazzareno Fagoni ◽  
Nicola Latronico
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Early Mobilization ◽  
Critical Illness Polyneuropathy ◽  
Artificial Nutrition ◽  
Limb Weakness ◽  
Muscle Involvement ◽  
Difficult Weaning ◽  
The Impact

Intensive care unit–acquired weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients. We discuss critical aspects of ICU-AW that have not been completely defined or that are still under discussion. Critical illness polyneuropathy, myopathy, and muscle atrophy contribute in various proportions to ICU-AW. Diagnosis of ICU-AW is clinical and is based on Medical Research Council sum score and handgrip dynamometry for limb weakness and recognition of a patient’s ventilator dependency or difficult weaning from artificial ventilation for diaphragmatic weakness (DW). ICU-AW can be caused by a critical illness polyneuropathy, a critical illness myopathy, or muscle disuse atrophy, alone or in combination. Its diagnosis requires both clinical assessment of muscle strength and complete electrophysiological evaluation of peripheral nerves and muscles. The peroneal nerve test (PENT) is a quick simplified electrophysiological test with high sensitivity and good specificity that can be used instead of complete electrophysiological evaluation as a screening test in non-cooperative patients. DW, assessed by bilateral phrenic nerve magnetic stimulation or diaphragm ultrasound, can be an isolated event without concurrent limb muscle involvement. Therefore, it remains uncertain whether DW and limb weakness are different manifestations of the same syndrome or are two distinct entities. Delirium is often associated with ICU-AW but a clear correlation between these two entities requires further studies. Artificial nutrition may have an impact on ICU-AW, but no study has assessed the impact of nutrition on ICU-AW as the primary outcome. Early mobilization improves activity limitation at hospital discharge if it is started early in the ICU, but beneficial long-term effects are not established. Determinants of ICU-AW can be many and can interact with each other. Therefore, future studies assessing early mobilization should consider a holistic patient approach with consideration of all components that may lead to muscle weakness.

scholarly journals Mononeuritis multiplex: an unexpectedly frequent feature of severe COVID-19

2020 ◽  
Author(s):  
Edward Needham ◽  
Virginia Newcombe ◽  
Andrew Michell ◽  
Rachel Thornton ◽  
Andrew Grainger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Prolonged Mechanical Ventilation ◽  
Significant Proportion ◽  
Neurological Deficits ◽  
Mononeuritis Multiplex ◽  
Critical Illness Neuromyopathy

AbstractThe prolonged mechanical ventilation that is often required by patients with severe COVID-19 is expected to result in significant intensive care unit-acquired weakness (ICUAW) in many of the survivors. However, in our post-COVID-19 follow-up clinic we have found that, as well as the anticipated global weakness related to loss of muscle mass, a significant proportion of these patients also have disabling focal neurological deficits relating to multiple axonal mononeuropathies. Amongst the 69 patients with severe COVID-19 that have been discharged from the intensive care units in our hospital, we have seen 11 individuals (16%) with such a mononeuritis multiplex. In many instances, the multi-focal nature of the weakness in these patients was initially unrecognised as symptoms were wrongly assumed to relate simply to “critical illness neuromyopathy”. While mononeuropathy is well recognised as an occasional complication of intensive care, our experience suggests that such deficits are surprisingly frequent and often disabling in patients recovering from severe COVID-19.

scholarly journals Acquired neuromuscular weakness In Intensive Care Unit: Review article

2019 ◽  
Vol 6 (12) ◽  
pp. 4664-4671
Author(s):  
Mohamed Hamdy Elghotmy ◽  
Hamdy Elewa ◽  
Mohamed Rabea
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Muscle Strength ◽  
Burn Injury ◽  
De Novo ◽  
Axonal Neuropathy ◽  
Early Mobilization ◽  
Future Research ◽  
Number Of Patients

A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as “intensive care unit acquired weakness” (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy. ICUAW is typically symmetrical and affects predominantly proximal limb muscles and respiratory muscles, whereas facial and ocular muscles are often spared. ICUAW is diagnosed in awake and cooperative patients by bedside manual testing of muscle strength and the severity is scored by the Medical Research Council sum score. In cases of atypical clinical presentation or evolution, additional electrophysiological testing may be required for differential diagnosis. The cornerstones of prevention are aggressive treatment of sepsis, early mobilization, preventing hyperglycemia with insulin, and avoiding the use parenteral nutrition during the first week of critical illness. Future research should focus on new preventive and/or therapeutic strategies for this detrimental complication of critical illness and on clarifying how ICUAW contributes to poor longer-term prognosis.

scholarly journals Assessment and identification of predictors of performance of early rehabilitation of patients in the general intensive care unit.

2020 ◽  
pp. 33-40
Author(s):  
Sergey A. Andreychenko ◽  
M. V Bychinin ◽  
T. V Klypa
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Laboratory Data ◽  
Functional Independence ◽  
Multiple Organ ◽  
Early Rehabilitation ◽  
Rehabilitation Potential ◽  
Negative Effect

Introduction. Currently, there are no universal criteria for assessing the volume of predicted functional recovery of patients during rehabilitation in intensive care units. Objective. To identify independent predictors of efficiency of rehabilitation of patients after a critical illness. Materials and methods. The study was conducted on the basis of a general ICU in 2017-2019. Patients with a short course of rehabilitation ( 7 days), deep impairment of consciousness ( 7 points on the Glasgow coma scale), decompensated multiple organ failure were excluded from the study. Clinical and laboratory data of 82 patients were retrospectively analyzed, including baseline severity of the condition, degree of functional independence and mobility, assessment of neurological deficit, incidence of depression and delirium, duration of mechanical ventilation and terms of hospitalization. We used a calculated indicator to analyze the effectiveness of rehabilitation - the rehabilitation potential index (RPI). Patients were assigned to the group of effective rehabilitation (ER) or ineffective rehabilitation (IR) depending on the level of RPI. Results. The duration of mechanical ventilation, the frequency of impaired consciousness and the duration of hospitalization were higher in the IR group than in the ER group. Consciousness impairment was found to be an independent predictor of low efficacy of the rehabilitation (odds ratio 4.53; confidence interval 95 % 1.63-12.6; p 0.05). Conclusions. RPI can be used as a tool for assessing the effectiveness of rehabilitation of patients after a critical illness. The duration of mechanical ventilation has a negative effect on the functional outcome at discharge from the intensive care unit. The initial level of consciousness can be a benchmark for predicting the effectiveness of rehabilitation. Further prospective studies are needed to identify predictors of the effectiveness of early rehabilitation.

scholarly journals Evaluation of the incidence, characteristics, and outcomes of pediatric chronic critical illness

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0248883
Author(s):  
Hilmi Demirkiran ◽  
Mehmet Kilic ◽  
Yakup Tomak ◽  
Tahir Dalkiran ◽  
Sadik Yurttutan ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Prolonged Mechanical Ventilation ◽  
Tertiary Care ◽  
University Hospitals ◽  
Icu Stay ◽  
Chronic Critical Illness ◽  
Length Of Icu Stay

Our aim was to determine characteristics of children with chronic critical illness (CCI) admitted to the pediatric intensive care unit (PICU) of a tertiary care children’s hospital in Turkey. The current study was a multicenter retrospective cohort study that was done from 2014 to 2017. It involved three university hospitals PICUs in which multiple criteria were set to identify pediatric CCIs. Pediatric patients staying in the ICU for at least 14 days and having at least one additional criterion, including prolonged mechanical ventilation, tracheostomy, sepsis, severe wound (burn) or trauma, encephalopathy, traumatic brain injury, status epilepticus, being postoperative, and neuromuscular disease, was accepted as CCI. In order to identify the newborn as a chronic critical patient, a stay in the intensive care unit for at least 30 days in addition to prematurity was required. Eight hundred eighty seven (11.14%) of the patients who were admitted to the PICU met the definition of CCI and 775 of them (87.3%) were discharged to their home. Of CCI patients, 289 (32.6%) were premature and 678 (76.4%) had prolonged mechanical ventilation. The total cost values for 2017 were statistically higher than the other years. As the length of ICU stay increased, the costs also increased. Interestingly, high incidence rates were observed for PCCI in our hospitals and these patients occupied 38.01% of the intensive care bed capacity. In conclusion, we observed that prematurity and prolonged mechanical ventilation increase the length of ICU stay, which also increased the costs. More work is needed to better understand PCCI.

Sleep Disorders and Recovery from Critical Illness

2014 ◽  
Author(s):  
Scott Hoff ◽  
Nancy A Collop
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Critical Illness ◽  
Light Exposure ◽  
Biological Effects ◽  
Sleep Disruption ◽  
Complex Process ◽  
Intensive Care Unit Delirium ◽  
Pharmacologic Agents

Many factors contribute to sleep disruption in critically ill patients. Sleep is a complex process, with broad effects on diverse physiologic systems. Environmental factors, such as light exposure, noise from diverse sources, and sleep interruptions related to patient care, have all received considerable investigational attention. Critical illness can affect elements involved in sleep initiation and maintenance. The various modes of mechanical ventilation may have different effects on sleep fragmentation and on the propensity to cause central apnoeas, thereby potentially prolonging the time on the ventilator. Pharmacologic agents, especially sedatives, can directly affect sleep architecture and may contribute to the incidence of intensive care unit delirium. Additional research is needed on the biological effects of critical illness on sleep, how sleep disruption affects systemic physiology and outcomes, and how these interactions can be modulated for therapeutic purposes.

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