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Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers

Authors: Meg E. Harrold, Lisa G. Salisbury, Steve A. Webb, Garry T. Allison, on behalf of the Australia and Scotland ICU Physiotherapy Collaboration

Published in: Critical Care | Issue 1/2015

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Abstract

Introduction

Mobilisation of patients in the intensive care unit (ICU) is an area of growing research. Currently, there is little data on baseline mobilisation practises and the barriers to them for patients of all admission diagnoses.

Methods

The objectives of the study were to (1) quantify and benchmark baseline levels of mobilisation in Australian and Scottish ICUs, (2) compare mobilisation practises between Australian and Scottish ICUs and (3) identify barriers to mobilisation in Australian and Scottish ICUs. We conducted a prospective, observational, cohort study with a 4-week inception period. Patients were censored for follow-up upon ICU discharge or after 28 days, whichever occurred first. Patients were included if they were >18 years of age, admitted to an ICU and received mechanical ventilation in the ICU.

Results

Ten tertiary ICUs in Australia and nine in Scotland participated in the study. The Australian cohort had a large proportion of patients admitted for cardiothoracic surgery (43.3 %), whereas the Scottish cohort had none. Therefore, comparison analysis was done after exclusion of patients admitted for cardiothoracic surgery. In total, 60.2 % of the 347 patients across 10 Australian ICUs and 40.1 % of the 167 patients across 9 Scottish ICUs mobilised during their ICU stay (p < 0.001). Patients in the Australian cohort were more likely to mobilise than patients in the Scottish cohort (hazard ratio 1.83, 95 % confidence interval 1.38–2.42). However, the percentage of episodes of mobilisation where patients were receiving mechanical ventilation was higher in the Scottish cohort (41.1 % vs 16.3 %, p < 0.001). Sedation was the most commonly reported barrier to mobilisation in both the Australian and Scottish cohorts. Physiological instability and the presence of an endotracheal tube were also frequently reported barriers.

Conclusions

This is the first study to benchmark baseline practise of early mobilisation internationally, and it demonstrates variation in early mobilisation practises between Australia and Scotland.
Literature
1.
Chambers MA, Moylan JS, Reid MB. Physical inactivity and muscle weakness in the critically ill. Crit Care Med. 2009;37:S337–46.CrossRef
2.
3.
Griffiths R, Hall J. Intensive care unit-acquired weakness. Crit Care Med. 2010;38:779–87.CrossRef
4.
Hudson L, Lee C. Neuromuscular sequelae of critical illness. N Engl J Med. 2003;348:745–7.CrossRef
5.
Robson W. The physiological after-effects of critical care. Nurs Crit Care. 2003;8:165–71.CrossRef
6.
Vincent JL, Norrenberg M. Intensive care unit-acquired weakness: framing the topic. Crit Care Med. 2009;37:S296–8.CrossRef
7.
8.
9.
de Letter MA, Schmitz PI, Visser LH, Verheul FA, Schellens RL, Op de Coul DA, et al. Risk factors for the development of polyneuropathy and myopathy in critically ill patients. Crit Care Med. 2001;29:2281–6.CrossRef
10.
DeJonghe B, Lacherade JC, Durand MC, Sharshar T. Critical illness neuromuscular syndromes. Crit Care Clin. 2007;23:55–69.CrossRef
11.
Truong AD, Fan E, Brower RG, Needham DM. Bench-to-bedside review: mobilizing patients in the intensive care unit – from pathophysiology to clinical trials. Crit Care. 2009;13:216.CrossRef
12.
13.
Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364:1293–304.CrossRef
14.
Cheung A, Tansey C, Tomlinson G, Diaz-Granados N, Matté A, Barr A, et al. Two-year outcomes, health care use and costs of survivors of adult respiratory distress syndrome. Am J Respir Crit Care Med. 2006;174:538–44.CrossRef
15.
Garland A, Dawson NV, Altmann I, Thomas CL, Phillips RS, Tsevat J, et al. Outcomes up to 5 years after severe, acute respiratory failure. Chest. 2004;126:1897–904.CrossRef
16.
Herridge MS. Legacy of intensive care unit-acquired weakness. Crit Care Med. 2009;37:S457–61.CrossRef
17.
Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Said F, et al. One-year outcomes for survivors of adult respiratory distress syndrome. N Engl J Med. 2003;348:683–93.CrossRef
18.
Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;4, CD003793.
19.
Taylor RS, Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal H, et al. Exercise-based rehabilitation for heart failure. Cochrane Database Syst Rev. 2014;4, CD003331.
20.
Stiller K. Physiotherapy in intensive care: an updated systematic review. Chest. 2013;144:825–47.CrossRef
21.
Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012;23:5–13.CrossRef
22.
23.
24.
25.
Needham D, Korupolu R, Zanni J, Pradhan P, Colantuoni E, Palmer J, et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project. Arch Phys Med Rehabil. 2010;91:536–42.CrossRef
26.
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.CrossRef
27.
Thomsen GE, Snow GL, Rodriguez L, Hopkins RO. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med. 2008;36:1119–24.CrossRef
28.
29.
Harrold ME. Early mobilisation of mechanically ventilated adults in intensive care: implementation of practice change and benchmarking of practice. 2013.
30.
Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36:2238–43.CrossRef
31.
Bourdin G, Barbier J, Burle JF, Durante G, Passant S, Vincent B, et al. The feasibility of early physical activity in intensive care unit patients: a prospective observational one-center study. Respir Care. 2010;55:400–7.PubMed
32.
Needham DM, Korupolu R. Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil. 2010;17:271–81.CrossRef
33.
Leditschke IA, Green M, Irvine J, Bissett B, Mitchell IA. What are the barriers to mobilizing intensive care patients? Cardiopulm Phys Ther J. 2012;23:26–9.CrossRef
34.
Barber EA, Everard T, Holland AE, Tipping C, Bradley SJ, Hodgson CL. Barriers and facilitators to early mobilisation in intensive care: a qualitative study. Aust Crit Care. In press. doi:10.​1016/​j.​aucc.​2014.​11.​001.
35.
Winkelman C, Peereboom K. Staff-perceived barriers and facilitators. Crit Care Nurse. 2010;30:S13–6.CrossRef
Metadata
Title
Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers
Authors
Meg E. Harrold
Lisa G. Salisbury
Steve A. Webb
Garry T. Allison
on behalf of the Australia and Scotland ICU Physiotherapy Collaboration
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-1033-3

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