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CI2 > Early Mobilisation & Rehab in ICU > Flashcards

Early Mobilisation & Rehab in ICU Flashcards

1
Q

What systems are affected by bed rest?

A
  • Musculoskeletal
  • Pulmonary
  • CV
  • Integumentary
  • Endocrine
  • Immunological
  • Gastrointestinal
  • Haematological
  • Psychological
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2
Q

What is the relationship between muscle wastage in ICU and organ failure?

A

Muscle wastage gets worse with increasing organ failure

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3
Q

What effects does bed rest have on the pulmonary system?

A
  • Increased RR
  • Increased V/Q mismatch
  • Increased risk atelectasis & pneumonia
  • Decreased MIP
  • Decreased FVC
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4
Q

What effects does bed rest have on the immune & endocrine systems?

A
  • Proinflammatory (decreased production of cellular antioxidants, production of cytokines)
  • Impaired glucose tolerance
  • Decreased vitamin D levels
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5
Q

What effects does bed rest have on the haematological system?

A
  • Decreased red cell mass

- Increased risk venous thrombo-embolism

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6
Q

What effects does bed rest have on the GI system?

A
  • Anorexia & constipation

- Overfeeding is deleterious: Causes accelerated muscle atrophy, increased pro inflammatory markers

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7
Q

What effects does bed rest have on the integumentary system?

A
  • Pressure areas

- Contractures

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8
Q

What are the psychological effects of bed rest?

A
  • Biological rhythms (loss of circadian rhythms)
  • Disturbed sleep
  • Mood/depression
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9
Q

What does evidence show regarding depression in ICU survivors?

A
  • Davydow et al 2012

- 28% had clinically significant depression after sepsis

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10
Q

What did Pandharipande et al 2013 find regarding cognitive outcomes after critical illness?

A
  • 821 patients with high severity of illness
  • 74% had delirium (mean duration 4 days)
  • Duration associated with worse cognition at 12 months
  • High use of sedatives
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11
Q

What did Morris et al 2008 find regarding early mobilisation in ICU?

A

Improves

  • Functional status at hospital discharge
  • Muscle strength
  • 6MWT distance
  • Subjective well-being

Shorter duration of delirium
Increases ventilator free days
Shorter hospital LOS
Reduced risk of death or hospital readmission within 12 months

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12
Q

What is the main barrier to mobilisation in ICU?

A

Safety concerns

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13
Q

What did the study of mobilisation in ICU at TCH find?

A
  • 4 week audit of mobilisation

- 1.1% incidence of adverse outcomes

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14
Q

What have studies found when comparing mobilisation in & out of bed?

A
  • Resistive exercise in bed don’t reverse vascular adaptations to bed rest
  • Pulmonary effects of changing position from sitting in bed to sitting in chair (increase FRC)
  • Cycle ergonometric is NWB (less effect on bone mineral density)
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15
Q

What did the updated systematic review by Stiller 2013 find?

A

Early mobilisation in ICU for adult patients was beneficial in terms of:

  • Functional ability
  • Potential to reduce ICU & hospital LOS
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16
Q

What is the “Plan B” approach to mobilisation of ICU patients?

A
  • Preparation (discussion with MDT, communication with patient, equipment, environment)
  • Leader
  • Airway & emergency equipment (airway secured & cleared)
  • Number of staff
  • Backup plan
17
Q

What equipment should be used during mobilisation for OH&S?

A
  • Slide sheets
  • Chairs
  • Pat slides
  • Ceiling mounted lifters
  • Forearm support frames (check patient’s weight is suitable)
18
Q

What are the CV CIs to mobilisation in ICU?

A
  • Inotropes/vasopressors (not automatic, but need to consider dose)
  • Arrhythmias (if output compromised, new, unstable)
  • AMI (consult cardiology/ICU medical team)
  • Presence of IABP/LVAD
  • Presence of pulmonary artery catheter
  • Any significant blood loss or new decrease in CO
19
Q

What did Khan et al 2002 find regarding bed rest?

A

24 hours of bed rest led to a reduction in sympathetic nerve activity in response to an orthostatic stimulus

20
Q

What are the neurological CIs to mobilisation in ICU?

A
  • ICP management
  • Spinal cord injury management (clear guidelines from neuro surgeons, collars/braces)
  • Presence of drains
  • Seizures
  • Any large drop in GCS
21
Q

What are the respiratory CIs to mobilisation in ICU?

A
  • Threatened airway (awaiting ETT/trache)
  • Large PTX/effusion waiting drainage
  • Prone positioning
  • Imminent extubation
  • Dramatic change in respiratory support (e.g. escalating PEEP)
  • Specific amounts of respiratory support
  • Baseline RR/dyspnoea (e.g. if constantly 35)
22
Q

What are some of the other CIs to mobilisation in ICU?

A
  • Blunt trauma to abdomen (seek general surgery advice)
  • Orthopaedic fracture stabilisation
  • Paralysis/muscle relaxant
  • High risk/evidence of bleeding (low platelets/Hb)
  • Palliation
23
Q

What did Morris et al 2011 find in their follow-up study of mobilisation in ICU?

A

Early mobilisation reduced risk of death or hospital readmission within 12 months

24
Q

What did Bailey et al 2007 find regarding mobilisation in ICU?

A
  • 1449 activity events in 103 patients

- <1% adverse effects

25
Q

What did Schwieckert et al 2009 find regarding mobilisation in ICU?

A
  • Ambulated patients out of bed within 72 hours of mechanical ventilation
  • Intervention group gained functional independence faster
26
Q

What is acute skeletal muscle weakness in ICU associated with?

A

Multi-organ failure (Zudin et al 2013)

27
Q

What is prolonged weaning associated with?

A

ICU acquired weakness & diaphragm dysfunction (Dres et al 2016)

CI2 (17 decks)

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