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for Medical Professionals — ABCDEFs of Prevention and Safety

Early Mobility and Exercise

Early mobility is an integral part of the ABCDEF Bundle and has been the only intervention resulting in a decrease in days of delirium. Studies have shown that early mobility has been shown to be safe and feasible in critically ill patients. Early mobility decreases days of delirium, days on mechanical ventilation, and ICU and hospital length of stay. Functional outcomes are also improved with early mobility. Early mobility can be performed by any part of the interdisciplinary team including nurses, physical therapists, occupational therapists, or physicians. Physical Impairment Following the ICUrIt consists of activities from passive range of motion to ambulation. The level of activity for each patient can be determined by the patient’s RASS score. The following is the early mobility protocol that was developed at our facility and used in the ACT-ICU study.

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Articles

A combined early cognitive and physical rehabilitation program for people who are critically ill: the activity and cognitive therapy in the intensive care unit (ACT-ICU) trial.

Brummel NE, Jackson JC, Girard TD, Pandharipande PP, Schiro E, Work B, Pun BT, Boehm L, Gill TM, Ely EW

  • The purpose of this trial was to determine the feasibility of early and sustained cognitive rehabilitation paired with physical rehabilitation in patients who are critically ill from medical and surgical intensive care units.
  • Patients randomized to groups receiving usual care, physical rehabilitation, or cognitive rehabilitation plus physical rehabilitation. Patients in treatment groups received twice-daily cognitive rehabilitation sessions and daily physical rehabilitation sessions. Patients with cognitive or physical impairment at discharge underwent a 12-week, in-home cognitive rehabilitation program.
Read on PubMed.gov

Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial

Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP.

  • Randomized controlled trial at two university hospitals.
  • 104 patients randomized to early exercise and mobilization (physical and occupational therapy) during periods of daily interruption of sedation or to daily interruption of sedation with therapy as ordered by the primary care team.
  • Early mobility was safe and well tolerated, and resulted in better functional outcomes at hospital discharge, a shorter duration of delirium, and more ventilator-free days compared with standard care.
Read on PubMed.gov

Changing the work environment in intensive care units to achieve patient-focused care: the time has come.

McCauley K, Irwin RS.

The American Association of Critical-Care Nurses (AACN) Standards for Establishing and Sustaining Healthy Work Environments and the American College of Chest Physicians (ACCP) Patient-Focused Care Project Initiative

  • How to reinvent ICU Culture
  • Making activity a key component of care
  • Agreeing on need for practice change
  • Looking at long-term patient-focused outcomes
  • Focusing on interdisciplinary teamwork
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Early intensive care unit mobility therapy in the treatment of acute respiratory failure.

Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, Penley L, Howard A, Dixon L, Leach S, Small R, Hite RD, Haponik E.

  • Prospective study including 230 patients split between a protocol group and usual care group.
  • Used an intensive care unit Mobility Team (critical care nurse, nursing assistant, physical therapist) initiated the protocol within 48 hrs of mechanical ventilation.
  • Protocol was found to be feasible, safe, did not increase costs, and was associated with decreased intensive care unit and hospital length of stay in survivors who received physical therapy during intensive care unit treatment compared with patients who received usual care
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ICU early physical rehabilitation programs: financial modeling of cost savings.

Lord RK, Mayhew CR, Korupolu R, Mantheiy EC, Friedman MA, Palmer JB, Needham DM.

  • A financial model, based on actual experience and published data, projects that investment in an ICU early rehabilitation program
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Family Engagement

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