Impact of Early Mobility Protocols Led by Nursing and Physiotherapy Teams on ICU Length of Stay and Functional Recovery
DOI:
https://doi.org/10.22399/ijcesen.4853Keywords:
Early Mobility Protocols, Intensive Care Unit, ICU Length of Stay, Functional Recovery, ICU-Acquired Weakness, NursingAbstract
Early mobility protocols, spearheaded by the synergistic collaboration between nursing and physiotherapy teams, have emerged as a transformative standard of care within the intensive care unit (ICU), demonstrating a significant positive impact on both reducing ICU length of stay and enhancing functional recovery. These structured, interdisciplinary interventions directly counteract the rapid-onset pathophysiology of ICU-acquired weakness by initiating progressive physical activity as soon as medically feasible, thereby preserving muscle mass, mitigating catabolic processes, and preventing complications linked to prolonged immobility. The nursing role is pivotal for continuous assessment, safety monitoring, and integrating mobility into daily care, while physiotherapists provide specialized expertise in prescribing and advancing individualized, functional rehabilitation. Robust evidence confirms that this collaborative model safely decreases the duration of mechanical ventilation and incidence of delirium, leading to shorter ICU stays, lower healthcare costs, and, most importantly, substantially improved physical function and independence at hospital discharge and in long-term survivor outcomes. The successful implementation of such protocols represents a critical shift from a paradigm focused solely on survival to one dedicated to optimizing the quality of survival, underscoring the essential role of proactive rehabilitation in comprehensive critical care.
References
[1] Menges D, Seiler B, Tomonaga Y, Schwenkglenks M, Puhan MA, Yebyo HG. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Crit Care. 2021;25:16.
[2] Hickmann CE, Montecinos-Munoz NR, Castanares-Zapatero D, Arriagada-Garrido RS, Jeria-Blanco U, Gizzatullin T, et al. Acute effects of sitting out of bed and exercise on lung aeration and oxygenation in critically ill subjects. Respir Care. 2021;66:253–62.
[3] Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. 2014;18:658.
[4] de Miguel-Diez J, Jiménez-García R, Hernández-Barrera V, Puente-Maestu L, Girón-Matute WI, de Miguel-Yanes JM, et al. Trends in the use and outcomes of mechanical ventilation among patients hospitalized with acute exacerbations of COPD in Spain, 2001 to 2015. J Clin Med. 2019;8:1621.
[5] Harrold ME, Salisbury LG, Webb SA, Allison GT, Australia and Scotland ICU Physiotherapy Collaboration Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers. Crit Care. 2015;19:336.
[6] Saeys W, Vereeck L, Truijen S, Lafosse C, Wuyts FP, Heyning PV. Randomized controlled trial of truncal exercises early after stroke to improve balance and mobility. Neurorehabil Neural Repair. 2012;26:231–8.
[7] Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med. 2014;370:1626–35.
[8] Hodgson C, Needham D, Haines K, Bailey M, Ward A, Harrold M, et al. Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart Lung. 2014;43:19–24.
[9] Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310:1591–600.
[10] Demoule A, Chevret S, Carlucci A, Kouatchet A, Jaber S, Meziani F, et al. Changing use of noninvasive ventilation in critically ill patients: trends over 15 years in francophone countries. Intensive Care Med. 2016;42:82–92.
[11] Tipping CJ, Harrold M, Holland A, Romero L, Nisbet T, Hodgson CL. The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive Care Med. 2017;43:171–83.
[12] Waldauf P, Jiroutková K, Krajčová A, Puthucheary Z, Duška F. Effects of rehabilitation interventions on clinical outcomes in critically ill patients: systematic review and meta-analysis of randomized controlled trials. Crit Care Med. 2020;48:1055–65.
[13] Lottering M, Van Aswegen H. Physiotherapy practice in South African intensive care units. South Afr J Crit Care. 2016;32:11–6.
[14] Hodgson CL, Capell E, Tipping CJ. Early mobilization of patients in intensive care: organization, communication and safety factors that influence translation into clinical practice. Crit Care. 2018;22:77.
[15] Parry SM, Denehy L, Beach LJ, Berney S, Williamson HC, Granger CL. Functional outcomes in ICU: what should we be using?: an observational study. Crit Care. 2015;19:127.
[16] Ding N, Zhang Z, Zhang C, Yao L, Yang L, Jiang B, et al. What is the optimum time for initiation of early mobilization in mechanically ventilated patients?: a network meta-analysis. PLoS One. 2019;14:e0223151.
[17] Brummel NE, Girard TD, Ely EW, Pandharipande PP, Morandi A, Hughes CG, et al. Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial. Intensive Care Med. 2014;40:370–9.
[18] Lemyze M, Mallat J, Duhamel A, Pepy F, Gasan G, Barrailler S, et al. Effects of sitting position and applied positive end-expiratory pressure on respiratory mechanics of critically ill obese patients receiving mechanical ventilation. Crit Care Med. 2013;41:2592–9.
[19] Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–82.
[20] Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2014;42:1178–86.
[21] Billot M, Calvani R, Urtamo A, Sánchez-Sánchez JL, Ciccolari-Micaldi C, Chang M, et al. Preserving mobility in older adults with physical frailty and sarcopenia: opportunities, challenges, and recommendations for physical activity interventions. Clin Interv Aging. 2020;15:1675–90.
[22] Denehy L, Skinner EH, Edbrooke L, Haines K, Warrillow S, Hawthorne G, et al. Exercise rehabilitation for patients with critical illness: a randomized controlled trial with 12 months of follow-up. Crit Care. 2013;17:R156.
[23] Paton M, Lane R, Paul E, Cuthburtson GA, Hodgson CL. Mobilization during critical illness: a higher level of mobilization improves health status at 6 months, a secondary analysis of a prospective cohort study. Crit Care Med. 2021;49:e860–9.
[24] TEAM Study Investigators. Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H, et al. Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study. Crit Care. 2015;19:81.
[25] Kwah LK, Herbert RD, Harvey LA, Diong J, Clarke JL, Martin JH, et al. Passive mechanical properties of gastrocnemius muscles of people with ankle contracture after stroke. Arch Phys Med Rehabil. 2012;93:1185–90.
[26] Schnell D, Timsit JF, Darmon M, Vesin A, Goldgran-Toledano D, Dumenil AS, et al. Noninvasive mechanical ventilation in acute respiratory failure: trends in use and outcomes. Intensive Care Med. 2014;40:582–91.
[27] Killey B, Watt E. The effect of extra walking on the mobility, independence and exercise self-efficacy of elderly hospital in-patients: a pilot study. Contemp Nurse. 2006;22:120–33.
[28] Sibilla A, Nydahl P, Greco N, Mungo G, Ott N, Unger I, et al. Mobilization of mechanically ventilated patients in Switzerland. J Intensive Care Med. 2020;35:55–62.
[29] Stiller K, Phillips A. Safety aspects of mobilising acutely ill inpatients. Physiother Theory Pract. 2003;19:239–57.
[30] Lanzetta D, Cattaneo D, Pellegatta D, Cardini R. Trunk control in unstable sitting posture during functional activities in healthy subjects and patients with multiple sclerosis. Arch Phys Med Rehabil. 2004;85:279–83.
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