Critical care nursing quarterly
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Historically, intensive care cardiac surgery patients remained on bed rest for several days postoperatively to prevent complications and promote rest and healing. Over time, the cardiac surgery discipline has acknowledged the benefits of early mobility, including reduced risk of venous thromboembolism and pulmonary emboli, improved pulmonary toilet, prevention of pneumonia, decreased length of stay, reduced deconditioning, and need for rehabilitation, among others advantages. These benefits have changed clinical practice, with emphasis on early extubation, progressive mobility, and reduced lengths of stay. ⋯ Postoperative day 1 entails transferring from the bed to the chair 2 to 3 times and, if feasible, ambulation in the room and hallway. Patients with pulmonary artery catheters, arterial lines, chest tubes, and mechanical circulatory support devices are included in early progressive mobility to prevent postoperative complications. This article will discuss early progressive mobility in cardiovascular intensive care unit patients, with a focus on specific considerations for patients post-cardiac surgery and those with mechanical circulatory support devices.
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The postoperative period following abdominal surgery presents many challenges to patients and clinicians as recovery progresses and discharge from the intensive care unit approaches. Physiologic changes including the release of inflammatory mediators, increased fatigue and reduction in body mass, and a decline in pulmonary function occurring after abdominal surgery are often potentiated by bed rest and immobility. ⋯ By understanding the specific needs of the abdominal surgery population, the clinician can safely and effectively implement a mobility plan. The purpose of this article was to briefly review the inflammatory effects associated with bed rest, critical illness, and surgery; review the literature related to mobility in the abdominal surgery patient; describe the effects of immobility on postoperative outcomes; discuss the safety concerns and barriers to mobilization; discuss strategies to overcome barriers; and provide suggestions for application in practice.
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The safety and efficacy of mobility programs for the ventilated patient and the ability to improve outcomes related to immobility of the critically ill are well documented in the literature. Early mobility programs have been proven safe and effective in study. ⋯ Early mobility targets ventilated patients upon admission to ensure that interventions are performed that promote physical therapy at first possible moment. In order to accomplish this innovation, evidence-based practice was used to guide culture change in an intensive care unit and build partnerships among disciplines that worked to achieve the same goals independently.
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Mobilizing critically ill patients in the intensive care unit requires careful planning and attention to detail. The risks involved in mobilizing these patients include dislodging equipment, injury to the patient, injury to the caregivers, and physiologic decompensation of the patient. ⋯ There are simple pieces of equipment, already available in the intensive care unit, which can be used to accomplish the mobility goals safely in all patient populations. This article explores how standard hospital equipment can be used to improve patient activity and performance and minimize risk.
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Professional experience and wisdom have taught us that immobility is a risk factor for various adverse outcomes, such as deep vein thrombosis, joint contractures, pulmonary dysfunction, and bone demineralization to name a few. Balancing bed rest and mobility may improve both short- and long-term outcomes for our patients. Moreover, early, routine mobilization of critically ill patients is safe and reduces hospital length of stay, shortens the duration of mechanical ventilation, improves muscle strength, and functional independence. ⋯ Our protocol is simple and can easily be adapted for all patient populations by simply modifying some of the inclusion and exclusion criteria. The activities are grounded in the evidence and well thought out to prevent complications and promote mobilization. The purpose of this article was to present the science behind the development of a multidisciplinary protocol for early mobilization of critically ill patients that can be adapted to any intensive care unit patient with minor modifications.