AACN advanced critical care
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Review
Physiological rationale and current evidence for therapeutic positioning of critically ill patients.
Prolonged bed rest is common in critically ill patients, and therapeutic positioning is important to prevent further complications and to improve patient outcomes. Nurses use therapeutic positioning to prevent complications of immobility. ⋯ Applicable evidence-based practice guidelines are summarized. Special considerations for therapeutic positioning of critically ill obese and elderly patients are also discussed.
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Prolonged immobilization plays a significant role in neuromuscular abnormalities and complicates the clinical course of a majority of critically ill patients. Immobilization in critically ill patients is associated with significant morbidity and impaired physical function. Overuse of sedation, sleep deprivation, immobility, and the development of delirium are all intensive care unit (ICU) factors that may negatively impact patient outcomes. ⋯ However, with a dedicated and trained team and culture change, early ICU mobility can be a feasible and safe process. Early mobility has potential as a therapy to prevent or treat the neuromuscular complications of critical illness. ICU culture can be transformed in a way that leads to improved and more reliable treatments and care, including early activity and mobility.
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Bed rest is a common intervention for critically ill adults. Associated with both benefits and adverse effects, bed rest is undergoing increasing scrutiny as a therapeutic option in the intensive care unit. ⋯ This review uses body systems to cluster classic and current results of bed rest studies, beginning with cardiovascular and including pulmonary, renal, skin, nervous, immune, gastrointestinal/ metabolic, and skeletal systems. It concludes with effects on muscles, a system profoundly affected by immobility and bed rest.
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Neuromuscular complications of critical illness are common and can be severe and persistent in some patients. Neuromyopathy from critical illness and disuse atrophy from prolonged immobility contribute to muscle weakness acquired while in the intensive care unit. Although various risk factors (eg, severity of illness, corticosteroids, neuromuscular blocking agents) have been implicated in critical illness neuromyopathy (CINM), the evidence supporting these associations is inconsistent. ⋯ Early mobility in the intensive care unit may minimize disuse atrophy and possibly CINM, through exercise training and its anti-inflammatory effects. Although emerging data have demonstrated the safety, feasibility, and benefit of early mobility in critically ill patients, randomized controlled trials are needed to thoroughly evaluate its potential benefits on patients' muscle strength, physical function, and quality of life. Future studies are needed to elucidate the multiple mechanisms by which immobility, CINM, and other aspects of critical illness lead to muscle loss and neuromuscular dysfunction.