Evidence - Mobilisation and Rehab in ICU

Question 1

What did Zudin et al, 2013 find about muscle wasting

Answer 1

• looked at acute skeletal muscle wasting in critical illness
• significant wasting occurs after just 7 days
• early mobilisation is best

Question 2

Describe what Marin et al, 2016 found about muscle weakness

Answer 2

• investigated existance and impact of muscle and diaphragm weakness in relation to MV
• 76 ICU patients on MV > 24hrs
• ICUAW occurs post ventilation and often associated with diaphragm dysfunction
• wean from MV ASAP

Question 3

James et al, 2014 looked ad depression and PTSD in ICU patients

Answer 3

• investigated depression and PTSD in 821 pts following ICU
  found:
• depression at 3/12 - 30%
• depression at 1 year = 29%
• 7% symptoms of PTSD at 6/12 or 12/12
• depression largly somatic
• physical disability was primary contributor to depression

Question 4

Pandharipnde et al, 2013 looked at cognitive impairment post critical illness. What did they find?

Answer 4

• looked at long term cognitive impairment after critical illness with mean age of 61 and high severity illness
• 6% had pre-existing cognitive impairments, 74% had delirium, delirium lasts for 4 days, high use of sedatives
• delirium associated with worse cognition at 1 year
• CI: aim to reduce sedatives and opiates to reduce delirium and worse outcomes of cognition

Question 5

Iwashyna et al, 2010 studied cognitive outcomes in ICP patients with sepsis, what did they find?

Answer 5

• ICU pts - cognitive impairment increases with diagnosis of sepsis

Question 6

What did Hopkins et al, 2008 find about mobilisation in ICU

Answer 6

• looked at mobilisaing pts in ICU
• mobilisation out of bed within 72 hrs of M = shortened duration of delirium and less cognitive issues
• CI: mobilise early

Question 7

Morris et al, 2008 looked into mobilisation, what did they discover?

Answer 7

• mobilisation within 48 hrs of commencing MV
  discovered:
• improved function status at DC, muscle strength 6MWT, SF-36
• shortened duration of delirium
• increased MV free days
• shorter LOS

Question 8

What did Morrie et al, 2011 discover?

Answer 8

• Early mobilisation in ICU
• best predictor for improved outcomes in acute respiratory failure
• reduced risk of death or hopsital readmission withing 12/12
  CI: mobilise early

Question 9

Describe what Mazhar et al, found in their 2002 study

Answer 9

• Acute BP regulation after 24hr of bed rest
• 24 hrs bed rest lead to a reduction in sympathetic nerve activity in response to an orthostatic stimulus
• CI: mobilise early