Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians.
Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians.
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DOI：
10.2147/jmdh.s99811
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发表时间：
2016
影响因子：
3.3
通讯作者：
Bissett B
中科院分区：
文献类型：
--
作者：
Green M;Marzano V;Leditschke IA;Mitchell I;Bissett B
描述我们的经验和我们开发的实用工具，以促进重症监护室（ICU）作为一个多学科团队的早期动员。尽管有证据支持早期动员可以改善ICU患者的结局，但最近的国际点患病率研究显示，很少有患者在ICU中动员。现有的指南很少解决多学科ICU团队试图将证据转化为实践所面临的实际问题。我们提出了一个全面的战略，在我们的ICU使用安全动员，结合医疗，护理和物理治疗人员的综合技能，以实现安全的结果，并建立一个文化，优先考虑这种干预。一系列的工具和策略，以促进动员在ICU的多学科团队。没有安全无支撑坐位平衡且下肢力量不≥3/5（牛津量表）的患者开始第1阶段活动，包括坐位平衡训练和倾斜床使用。第2阶段活动包括支持或主动负重，必要时使用步态安全带。计划B助记符指导有创通气患者的安全多学科动员，并强调明确阐述的计划在作为一个团队提供这种有价值的治疗中的重要性。这些工具在过去5年中已在三级ICU中使用，不良结局的发生率非常低（<2%）。所描述的工具和策略不仅有助于指导早期动员的实际实施，而且有助于创造一种单位文化，ICU工作人员优先考虑早期动员，每天合作提供尽可能好的护理。这些实用的工具使ICU临床医生能够安全有效地对危重患者实施早期动员。从长远来看，真正多学科的安全动员方法是ICU成功的关键。
To describe our experience and the practical tools we have developed to facilitate early mobilization in the intensive care unit (ICU) as a multidisciplinary team. Despite the evidence supporting early mobilization for improving outcomes for ICU patients, recent international point-prevalence studies reveal that few patients are mobilized in the ICU. Existing guidelines rarely address the practical issues faced by multidisciplinary ICU teams attempting to translate evidence into practice. We present a comprehensive strategy for safe mobilization utilized in our ICU, incorporating the combined skills of medical, nursing, and physiotherapy staff to achieve safe outcomes and establish a culture which prioritizes this intervention. A raft of tools and strategies are described to facilitate mobilization in ICU by the multidisciplinary team. Patients without safe unsupported sitting balance and without ≥3/5 (Oxford scale) strength in the lower limbs commence phase 1 mobilization, including training of sitting balance and use of the tilt table. Phase 2 mobilization involves supported or active weight-bearing, incorporating gait harnesses if necessary. The Plan B mnemonic guides safe multidisciplinary mobilization of invasively ventilated patients and emphasizes the importance of a clearly articulated plan in delivering this valuable treatment as a team. These tools have been used over the past 5 years in a tertiary ICU with a very low incidence of adverse outcomes (<2%). The tools and strategies described are useful not only to guide practical implementation of early mobilization, but also in the creation of a unit culture where ICU staff prioritize early mobilization and collaborate daily to provide the best possible care. These practical tools allow ICU clinicians to safely and effectively implement early mobilization in critically ill patients. A genuinely multidisciplinary approach to safe mobilization in ICU is key to its success in the long term.