Surgical Intensive Care Unit Mobility is Increased after Institution of a Computerized Mobility Order Set and Intensive Care Unit Mobility Protocol: A Prospective Cohort Analysis
Restricted accessResearch articleFirst published online August, 2010
Surgical Intensive Care Unit Mobility is Increased after Institution of a Computerized Mobility Order Set and Intensive Care Unit Mobility Protocol: A Prospective Cohort Analysis
In some populations, intensive care unit (ICU) mobility has been shown to be safe and beneficial. We gathered data on 50 nonintubated surgical patients in a 10-bed surgical ICU (SICU) who met physiologic inclusion criteria beginning in May 2008 (A group). In January 2009, we began mandatory entry of computerized mobility orders as part of a standardized ICU order set. We also created a mobility protocol for nurses in this ICU. We then collected data on 50 patients in this postintervention cohort (B group). Both groups had similar baseline characteristics. A group patients had some form of mobility orders entered in 29 patients (58%) versus 47 patients (82%) in the B group, P < 0.05. In the A group, 11 patients (22%) were mobilized; in the B group, 40 patients (80%) were mobilized, P < 0.05. In our SICU patient population, mandatory entry of computerized mobility orders as part of a standard SICU order set and establishment of an ICU mobility nursing protocol was associated with an increase in number of mobility orders entered as well as an increase in SICU patient activity. Further studies should focus on measurement of the effect of mobility interventions on patient outcomes.
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References
1.
HerridgeM.S., CheungA.M., TanseyC.M.One-year outcomes in survivors of the acute respiratory distress syndrome.N Engl J Med2003; 348: 683–93.
2.
PolkeyM.I., MoxhamJ.Clinical aspects of respiratory muscle dysfunction in the critically ill.Chest2001; 119: 926–39.
3.
De JongheB., SharsharT., LefaucheurJ.P.Paresis acquired in the intensive care unit: a prospective multicenter study.JAMA2002; 288: 2859–67.
4.
EikermannM., KochG., GerwigM.Muscle force and fatigue in patients with sepsis and multiorgan failure.Intensive Care Med2006; 32: 251–9.
5.
DeemS., LeeC.M., CurtisJ.R.Acquired neuromuscular disorders in the intensive care unit.Am J Respir Crit Care Med2003; 168: 735–9.
6.
ThomasD.C., KreizmanI.J., MelchiorreP., RagnarssonK.T.Rehabilitation of the patient with chronic critical illness.Crit Care Clin2002; 18: 695–715.
7.
StevensR.D., DowdyD.W., MichaelsR.K.Neuromuscular dysfunction acquired in critical illness: a systematic review.Intensive Care Med2007; 33: 1876–91.
8.
DockW.The evil sequelae of complete bed rest.JAMA1944; 125: 1083–5.
9.
AllenC., GlasziouP., Del MarC.Bed rest: a potentially harmful treatment needing more careful evaluation.Lancet1999; 354: 1229–33.
10.
RiesA.L., MakeB.J., LeeS.M.The effects of pulmonary rehabilitation in the national emphysema treatment trial.Chest2005; 128: 3799–809.
11.
BrownC.J., FriedkinR.J., InouyeS.K.Prevalence and outcomes of low mobility in hospitalized older patients.J Am Geriatr Soc2004; 52: 1263–70.
12.
BlairS.N., KohlH.W.III, BarlowC.E.Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men.JAMA1995; 273: 1093–8.
13.
MuninM.C., RudyT.E., GlynnN.W.Early inpatient rehabilitation after elective hip and knee arthroplasty.JAMA1998; 279: 847–52.
14.
MundyL.M., LeetT.L., DarstK.Early mobilization of patients hospitalized with community-acquired pneumonia.Chest2003; 124: 883–9.
15.
LavieC.J., MilaniR.V., CassidyM.M., GillilandY.E.Effects of cardiac rehabilitation and exercise training programs in women with depression.Am J Cardiol1999; 83(10): 1480–3, A1487.
16.
MilaniR.V., LavieC.J.Behavioral differences and effects of cardiac rehabilitation in diabetic patients following cardiac events.Am J Med1996; 100: 517–23.
17.
MilaniR.V., LavieC.J.Prevalence and effects of cardiac rehabilitation on depression in the elderly with coronary heart disease.Am J Cardiol1998; 81: 1233–6.
18.
MilaniR.V., LavieC.J.Prevalence and profile of metabolic syndrome in patients following acute coronary events and effects of therapeutic lifestyle change with cardiac rehabilitation.Am J Cardiol2003; 92: 50–4.
19.
MilaniR.V., LavieC.J., CassidyM.M.Effects of cardiac rehabilitation and exercise training programs on depression in patients after major coronary events.Am Heart J1996; 132: 726–32.
20.
MilaniR.V., LavieC.J., MehraM.R.Reduction in C-reactive protein through cardiac rehabilitation and exercise training.J Am Coll Cardiol2004; 43: 1056–61.
21.
SiebensH., AronowH., EdwardsD., GhasemiZ.A randomized controlled trial of exercise to improve outcomes of acute hospitalization in older adults.J Am Geriatr Soc2000; 48: 1545–52.
22.
BelardinelliR., GeorgiouD., CianciG., PurcaroA.Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome.Circulation1999; 99: 1173–82.
23.
MorrisP.E.Moving our critically ill patients: mobility barriers and benefits.Crit Care Clin2007; 23: 1–20.
24.
BaileyP., ThomsenG.E., SpuhlerV.J.Early activity is feasible and safe in respiratory failure patients.Crit Care Med2007; 35: 139–45.
25.
MorrisP.E., GoadA., ThompsonC.Early intensive care unit mobility therapy in the treatment of acute respiratory failure.Crit Care Med2008; 36: 2238–43.
26.
SchweickertW.D., PohlmanM.C., PohlmanA.S.Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial.Lancet2009; 373: 1874–82.
27.
BloomfieldS.A.Changes in musculoskeletal structure and function with prolonged bed rest.Med Sci Sports Exerc1997; 29: 197–206.
28.
EngbergI.B., LindellM., Nyren-NolbergerU.Prevalence of skin and genital mucous membrane irritations in patients confined to bed.Int J Nurs Stud1995; 32: 315–24.
29.
HaubrichV.R.Marginal atelectasis of the lower lobes (author's transl).Rofo.1976; 125: 1–5 (in German).
30.
LoebM., McGeerA., McArthurM.Risk factors for pneumonia and other lower respiratory tract infections in elderly residents of long-term care facilities.Arch Intern Med1999; 159: 2058–64.
31.
ConvertinoV.A.Cardiovascular consequences of bed rest: effect on maximal oxygen uptake.Med Sci Sports Exerc1997; 29: 191–6.
32.
ConvertinoV., HungJ., GoldwaterD., DeBuskR.F.Cardiovascular responses to exercise in middle-aged men after 10 days of bedrest.Circulation1982; 65: 134–40.
33.
SaltinB., BlomqvistG., MitchellJ.H.Response to exercise after bed rest and after training.Circulation1968; 38(Suppl): VII1–78.
34.
HamburgN.M., McMackinC.J., HuangA.L.Physical inactivity rapidly induces insulin resistance and microvascular dysfunction in healthy volunteers.Arterioscler Thromb Vasc Biol2007; 27: 2650–6.
