Early Mobility in the Intensive Care Unit: Standard Equipment vs a Mobility Platform

2014 ◽  
Vol 23 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Melanie Roberts ◽  
Laura Adele Johnson ◽  
Trent L. Lalonde
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Data Collection ◽  
Intensive Care Units ◽  
Research Study ◽  
Medical Decision ◽  
General Belief ◽  
Standard Equipment ◽  
Early Mobility ◽  
Intensive Care Patients

Background Despite the general belief that mobility and exercise play an important role in the recovery of functional status, mobility is difficult to implement in patients in intensive care units. Objectives To compare a mobility platform with standard equipment, assessing efficiency (decreased time and staff required to prepare patient), effectiveness (increased activity time), and safety (no falls, unplanned tube removals, or emergency situations) for intensive care patients. Methods This observational study was approved by the institutional review board, and informed consent was obtained from the patient or the medical decision maker. Intensive care patients were assigned to a room in the usual manner, with platforms in odd-numbered rooms and standard equipment in even-numbered rooms. Standardized data collection tools were designed to collect data for 24 hours for each patient. The nurses caring for the patients completed the data collection tools in real time during the activity. The stages of activity and the physiological states that would preclude mobility were very specifically defined for the research study. Results Data were collected for a total of 71 patients and 238 activities. Important (although not significant) descriptive statistics regarding early mobility in the intensive care unit were discovered. The unintended result of the research study was a change in the culture and practice regarding early mobility in the intensive care unit. Conclusions Early mobility can be implemented in intensive care units. Standard equipment can be used to mobilize such patients safely; however, for patients who ambulate, a platform may increase efficiency and effectiveness.

scholarly journals Bundled Consent in US Intensive Care Units

2020 ◽  
Vol 29 (3) ◽  
pp. e44-e51
Author(s):  
Maria L. Espinosa ◽  
Aaron M. Tannenbaum ◽  
Megha Kilaru ◽  
Jennifer Stevens ◽  
Mark Siegler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
The United States ◽  
Self Report ◽  
Medical Decision ◽  
Consent Rate ◽  
Surgical Intensive Care ◽  
American Hospital ◽  
American Hospital Association

Background Bundled consent, the practice of obtaining anticipatory consent for a predefined set of intensive care unit procedures, increases the rate of informed consent conversations and incorporation of patients’ wishes into medical decision-making without sacrificing patients’ or surrogates’ understanding. However, the adoption rate for this practice in academic and nonacademic centers in the United States is unknown. Objective To determine the national prevalence of use of bundled consent in adult intensive care units and opinions related to bundled consent. Methods A random sample of US hospitals with medical/surgical intensive care units was selected from the AHA [American Hospital Association] Guide. One intensive care unit provider (bedside nurse, nurse manager, or physician) from each hospital was asked to self-reportuse of per-procedure consent versus bundled consent, consent rate for intensive care unit procedures, and opinions about bundled consent. Results Of the 238 hospitals contacted, respondents from 100 (42%) completed the survey; 94% of respondents were nurses. The prevalence of bundled consent use was 15% (95% CI, 9%–24%). Respondents using per-procedure consent were more likely than those using bundled consent to self-report performing invasive procedures without consent. Users of bundled consent unanimously recommended the practice, and 49% of respondents using per-procedure consent reported interest in implementing bundled consent. Results Bundled consent use is uncommon in academic and nonacademic intensive care units, most likely because of conflicting evidence about the effect on patients and surrogate decision makers. Future work is needed to determine if patients, family members, and providers prefer bundled consent over per-procedure consent.

scholarly journals Implementation of an Interdisciplinary AACN Early Mobility Protocol

2020 ◽  
Vol 40 (4) ◽  
pp. e7-e17 ◽  
Author(s):  
Marilyn Schallom ◽  
Heidi Tymkew ◽  
Kara Vyers ◽  
Donna Prentice ◽  
Carrie Sona ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Intensive Care Units ◽  
American Association ◽  
Phase 1 ◽  
Phase 2 ◽  
Early Mobility ◽  
Protocol Implementation

Background Increasing mobility in the intensive care unit is an important part of the ABCDEF bundle. Objective To examine the impact of an interdisciplinary mobility protocol in 7 specialty intensive care units that previously implemented other bundle components. Methods A staggered quality improvement project using the American Association of Critical-Care Nurses mobility protocol was conducted. In phase 1, data were collected on patients with intensive care unit stays of 24 hours or more for 2 months before and 2 months after protocol implementation. In phase 2, data were collected on a random sample of 20% of patients with an intensive care unit stay of 3 days or more for 2 months before and 12 months after protocol implementation. Results The study population consisted of 1266 patients before and 1420 patients after implementation in phase 1 and 258 patients before and 1681 patients after implementation in phase 2. In phase 1, the mean (SD) mobility level increased in all intensive care units, from 1.45 (1.03) before to 1.64 (1.03) after implementation (P < .001). Mean (SD) ICU Mobility Scale scores increased on initial evaluation from 4.4 (2.8) to 5.0 (2.8) (P = .01) and at intensive care unit discharge from 6.4 (2.5) to 6.8 (2.3) (P = .04). Complications occurred in 0.2% of patients mobilized. In phase 2, 84% of patients had out-of-bed activity after implementation. The time to achieve mobility levels 2 to 4 decreased (P = .05). Intensive care unit length of stay decreased significantly in both phases. Conclusions Implementing the American Association of Critical-Care early mobility protocol in intensive care units with ABCDEF components in place can increase mobility levels, decrease length of stay, and decrease delirium with minimal complications.

Haemoglobin Level in Scottish Intensive Care Patients — A National One Day Survey

2002 ◽  
Vol 47 (3) ◽  
pp. 54-56
Author(s):  
M.A. Garrioch ◽  
G. C. Fletcher ◽  
A.P Holmes
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Heart Disease ◽  
Haemoglobin Level ◽  
Intensive Care Units ◽  
Single Unit ◽  
Questionnaire Data ◽  
Transfusion Trigger ◽  
Intensive Care Patients ◽  
Typical Day

Objectives were to determine haemoglobin (Hb) levels present in patients and blood ordering habits of clinicians within Scottish Intensive Care Units (ICUs) on one typical day. A questionnaire survey (February 29 2000) was sent to all adult Scottish ICUs. All patients present in the responding adult ICUs in Scotland on the above date were included. Measurements and main results: Nineteen (73%) of the 26 Scottish Adult Intensive Care Units (ICUs) responded to the questionnaire. Data were received from 78 patients, 8 (10%) received blood. Mean initial Hb was 102 g/l (range 63–138). Modal transfusion trigger haemoglobin was 80 g/l in 38% of subjects at first trigger, 100 g/l in 24% of cases. No intensive care unit allowed haemoglobin to fall below 70 g/l and no patients were transfused when measured Hb was greater than 100 g/l. The presence of ischaemic heart disease was the second most important trigger to transfuse after haemoglobin level. Modal transfusion was 2 units (n=7). Only one patient received a single unit transfusion. Conclusions: Scottish ICUs maintain Hb between 70 and 100 g/l but clinicians are currently not consistent when ordering blood. More investigation is required to determine the optimal haemoglobin in our ICU population.

Early Mobility and Walking Program for Patients in Intensive Care Units: Creating a Standard of Care

2009 ◽  
Vol 18 (3) ◽  
pp. 212-221 ◽  
Author(s):  
Christiane Perme ◽  
Rohini Chandrashekar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Units ◽  
New Technologies ◽  
Cost Of Care ◽  
Term Survival ◽  
Early Mobility ◽  
Walking Program ◽  
Therapeutic Exercises

New technologies in critical care and mechanical ventilation have led to long-term survival of critically ill patients. An early mobility and walking program was developed to provide guidelines for early mobility that would assist clinicians working in intensive care units, especially clinicians working with patients who are receiving mechanical ventilation. Prolonged stays in the intensive care unit and mechanical ventilation are associated with functional decline and increased morbidity, mortality, cost of care, and length of hospital stay. Implementation of an early mobility and walking program could have a beneficial effect on all of these factors. The program encompasses progressive mobilization and walking, with the progression based on a patient’s functional capability and ability to tolerate the prescribed activity. The program is divided into 4 phases. Each phase includes guidelines on positioning, therapeutic exercises, transfers, walking reeducation, and duration and frequency of mobility sessions. Additionally, the criteria for progressing to the next phase are provided. Use of this program demands a collaborative effort among members of the multidisciplinary team in order to coordinate care for and provide safe mobilization of patients in the intensive care unit.

Parameters of bed occupancy of intensive care units in Hungary

2011 ◽  
Vol 152 (24) ◽  
pp. 946-950 ◽  
Author(s):  
Miklós Gresz
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Health Insurance ◽  
Intensive Care Units ◽  
Emergency Care ◽  
Present Author ◽  
Bed Occupancy ◽  
National Network ◽  
Bed Capacity

According to the Semmelweis Plan for Saving Health Care, ”the capacity of the national network of intensive care units in Hungary is one but not the only bottleneck of emergency care at present”. Author shows on the basis of data reported to the health insurance that not on a single calendar day more than 75% of beds in intensive care units were occupied. There were about 15 to 20 thousand sick days which could be considered unnecessary because patients occupying these beds were discharged to their homes directly from the intensive care unit. The data indicate that on the whole bed capacity is not low, only in some institutions insufficient. Thus, in order to improve emergency care in Hungary, the rearrangement of existing beds, rather than an increase of bed capacity is needed. Orv. Hetil., 2011, 152, 946–950.

scholarly journals The feasibility and reliability of actigraphy to monitor sleep in intensive care patients: an observational study

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
L. J. Delaney ◽  
E. Litton ◽  
K. L. Melehan ◽  
H.-C. C. Huang ◽  
V. Lopez ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Total Sleep Time ◽  
Sleep Time ◽  
Moderate Level ◽  
Sleep Monitoring ◽  
Clinical Trial Registration ◽  
Wake Time ◽  
Intensive Care Patients

Abstract Background Sleep amongst intensive care patients is reduced and highly fragmented which may adversely impact on recovery. The current challenge for Intensive Care clinicians is identifying feasible and accurate assessments of sleep that can be widely implemented. The objective of this study was to investigate the feasibility and reliability of a minimally invasive sleep monitoring technique compared to the gold standard, polysomnography, for sleep monitoring. Methods Prospective observational study employing a within subject design in adult patients admitted to an Intensive Care Unit. Sleep monitoring was undertaken amongst minimally sedated patients via concurrent polysomnography and actigraphy monitoring over a 24-h duration to assess agreement between the two methods; total sleep time and wake time. Results We recruited 80 patients who were mechanically ventilated (24%) and non-ventilated (76%) within the intensive care unit. Sleep was found to be highly fragmented, composed of numerous sleep bouts and characterized by abnormal sleep architecture. Actigraphy was found to have a moderate level of overall agreement in identifying sleep and wake states with polysomnography (69.4%; K = 0.386, p < 0.05) in an epoch by epoch analysis, with a moderate level of sensitivity (65.5%) and specificity (76.1%). Monitoring accuracy via actigraphy was improved amongst non-ventilated patients (specificity 83.7%; sensitivity 56.7%). Actigraphy was found to have a moderate correlation with polysomnography reported total sleep time (r = 0.359, p < 0.05) and wakefulness (r = 0.371, p < 0.05). Bland–Altman plots indicated that sleep was underestimated by actigraphy, with wakeful states overestimated. Conclusions Actigraphy was easy and safe to use, provided moderate level of agreement with polysomnography in distinguishing between sleep and wakeful states, and may be a reasonable alternative to measure sleep in intensive care patients. Clinical Trial Registration number ACTRN12615000945527 (Registered 9/9/2015).

scholarly journals Continuous EEG Monitoring in the Intensive Care Unit

1998 ◽  
Vol 25 (S1) ◽  
pp. S12-S15 ◽  
Author(s):  
John Kay
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Eeg Monitoring ◽  
General Icus ◽  
Continuous Eeg ◽  
Nonconvulsive Seizures ◽  
Continuous Eeg Monitoring ◽  
Clinical Problems

AbstractBackground:Electroencephalography (EEG) is playing an increasingly important role in the management of comatose patients in the intensive care unit.Methods:The techniques of EEG monitoring are reviewed. Initially, standard, discontinuous recordings were performed in intensive care units (ICUs). Later, continuous displays of “raw EEG” (CEEG) were used. More recently, the addition of quantitative techniques allowed for more effective reading.Results and Conclusions:Applications of continuous EEG to clinical problems are discussed. The most useful role of CEEG appears to be the detection and management of nonconvulsive seizures. There is a need for controlled studies to assess the role for CEEG in neuro-ICUs and general ICUs.

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