Transcript Mobility In the Audie Murphy MICU

Benjamin Michels MD
Marcos Restrepo MD



Discuss the complications of immobility in
critically ill patients
Review the evidence supporting early mobility
in the MICU
Discuss a proposed mobility protocol to apply
to our MICU patients




Traditionally, MICU care typically included deep
sedation and bed rest.
Evidence has now emerged that this can actually be
detrimental to our patients.
Avoiding bed rest and actively mobilizing patients
improves outcomes
We would like to start mobilizing patients in our
MICU

Muscular weakness is common
◦ 46% of all pts with sepsis, multiorgan dysfunction
or prolonged mechanical ventilation

It is associated with worse outcomes
◦
◦
◦
◦
Longer duration of mechanical ventilation
Longer ICU and hospital stay
Reduced functional capacity at hospital discharge
Reduced quality of life after returning home







Muscle atrophy
Weight loss
Reduced bone density
Pressure Ulcers
Delerium
Reduction in Lung and Heart function
Increased risk of pneumonia


Multiple studies showing early mobility of ICU
patients, even including ambulation, to be
safe
Stiller K: The safety of mobilisation and its effect on haemodynamic
and respiratory status of intensive care patients. Physiother Theory
Pract 2004, 20:175-185.
◦ 31 patients, 61 interventions. 3 episodes of transient hypoxemia reported.

Bailey P: Early activity is feasible and safe in respiratory failure
patients. Crit Care Med 2007, 35: 139-145.
◦ 103 pts, 1449 interventions. 14 adverse events including transient reductions in
blood pressure and oxygenation, 1 feeding tube removal, 5 falls to the knees without
injury (ambulating patients)

Reduction in duration of mechanical
ventilation

Reduced ICU LOS

Reduced Hospital LOS

Increased ability to walk at hospital discharge

Morris PE: Early intensive care unit mobility therapy
in the treatment of acute respiratory failure. Crit
Care Med 2008, 36:2238-2243.
◦ No difference in overall hospital costs compared to control
patients. This was even with additional dedicated mobility staff
to perform these interventions

Experienced centers with early mobility (Johns
Hopkins, UCSF) reporting reductions in hospital
costs. Mainly related to reductions in hospital LOS.



Prolonged bed rest and muscular weakness
are harmful to our MICU patients
Mobilization of our patients is safe and
improves clinical outcomes
Aggressive early mobility appears to be cost
effective and may actually reduce costs by
getting patients out of the hospital and out of
the ICU more quickly.



We would like early mobility and physical
therapy to become a routine part of the care
of our MICU patients
A Mobility protocol has been designed to
achieve this
We would like your feedback prior to
implementation

Overview
◦ Our target population is mechanically ventilated
patients in our MICU with stable or improving
respiratory status
◦ The physicians will determine when it and if it is
safe to begin mobility exercises
◦ Exercises will include




Passive and active ROM
Putting the patients bed in a chair position
Sitting the patient on the edge of the bed
Transferring the patient to a chair




Physical therapy consultations will be ordered as soon as the
patient is able to participate in active ROM
Interventions will be carried out primarily by nursing staff and
nurses aides with the assistance of PT / RT / Housestaff as
needed for support with patient transfers
Interventions should be carried out daily
Interventions will be stopped if there is any change in the
patients clinical status





Bailey, Polly. Early activity is feasible and safe in respiratory
failure patients. Crit Care Med 2007. Vol 35, No. 1.
Kress, John. Clinical trials of early mobilization of critically ill
patients. Crit Care Med 2009, Vol 37. No. 10 (Suppl.)
Needham, Dale. Mobilizing Patients in the Intensive Care
Unit. Improving Neuromuscular Weakness and Physical
Function. JAMA, October 8, 2008, Vol 300 No 14
Schweickert, William. Early physical and occupational therapy
in mechanically ventilated, critically ill patients: a randomised
controlled trial. Lancet 2009; 373: 1874-82
Truong, Alex. Bench to Bedside review: Mobilizing patients in
the intensive care unit – from pathophysiology to clinical
trials. Critical Care 2009, 13:216