ICU care

Question 2

impact of AC or ICU stay

Answer 2

Adverse Effects of Bed Rest
* Muscle atrophy
* Malnutrition
* Reduced bone density (6
months)
* Pressure injury/vascular
compromise
* Delirium
* Reduction in heart and
lung function
* High risk of pulmonary
complications
 Duration of bed rest
during critical illness
associated with
weakness throughout a
24-month follow-up
 Muscle breakdown
begins within 24 hours of
AC/ICU admission and
declines rapidly during
the first week

Question 3

AC/ICU acquired weakness

Answer 3

AC/ICU Acquired Weakness
* Rapid onset of
symptoms: 24 hours
* Resolve slowly
* Pervasive weakness
* Polyneuropathy
* Difficulty liberating from
mechanical ventilator
(ICU)
 Diaphragm muscle
atrophy begins within18
hours after intubation
 Early activity seems to
be the only treatment
yet shown to improve
long-term physical
function of survivors of
critical illness

Question 4

overall research conclusion

Answer 4

Mobility therapy delivered early in the course of acute
respiratory failure was shown to be:
– Feasible
– Safe
– Cost effective
– Associated with:
* Decreased ICU and hospital LOS
* Decreased duration of mechanical ventilation and days with delirium
* Increased return to independent functional status at hospital
discharge

Question 5

ICU liberation

Answer 5

Geared towards reducing symptoms of pain, agitation,
and delirium (PAD) that are common with ICU stays

Question 6

ABCDEF bundle of improving outcomes for patient in ICU

Answer 6

A: Awakening trials and PAIN Assessment
B: Spontaneous Breathing trials
C: Choice of Analgesic and Sedation
D: Delirium assessment, prevention, and management
E: Early mobilization and Exercise
F: Family participation

Question 7

benefits of ICU liberation

Answer 7

Reduction in duration of mechanical ventilation
* Reduced ICU & hospital length of stay (LOS)
* Increased ability to ambulate at hospital discharge
* Reduction in Post Intensive Care Syndrome (PICS)

Question 8

post intensive care syndrom (PICS)

Answer 8

ICU acquired weakness
* Long-term cognitive impairment
* Depression
* Post-traumatic stress disorder
Additionally:
 Personal and societal costs
 Family/caregiver burden
Post Intensive Care Syndrome (PICS)

Question 9

definition of early mob in ICU

Answer 9

“Early” defined as initial physiologic stabilization, continuing
throughout ICU stay
 Initiating patient mobilization within 48 hours of patient admission
to the ICU through:

Question 10

depth of sedationss for patients in ICU

Answer 10

• Recommend routinely using either daily sedation
  interruption or targeting light level of sedation in

Question 11

spontaneous awakening trial (SAT)

Answer 11

A patient is considered “awake” if able to perform 3 of
the following 4 tasks:
o Opens eyes in response to voice
o Uses eyes to follow the health care provider on request
o Squeezes a hand upon request
o Stick out the tongue upon request
Spontaneous Awakening Trial (SAT)

Question 12

richmond agitation sedation scale (RASS)

Answer 12

4 Combative Overtly combative, violent, immediate danger to staff
+3 Very agitated Pulls or removes tube(s) or catheter(s); aggressive
+2 Agitated Frequent non-purposeful movement, fights ventilator
+1 Restless Anxious but movements not aggressive vigorous
0 Alert and calm
-1 Drowsy Not fully alert, but has sustained awakening (eye-opening/eye contact) to voice (>10
seconds)
-2 Light sedation Briefly awakens with eye contact to voice (<10 seconds)
-3 Moderate sedation Movement or eye opening to voice (but no eye contact)
-4 Deep sedation No response to voice, but movement or eye opening to physical stimulation
-5 Unarousable No response to voice or physical stimulation
Richmond Agitation Sedation Scale (RASS)

Question 13

cognitive changes related to ICU stay

Answer 13

25 to 40% of patients with new onset cognitive changes
 Impaired learning and short-term memory
 Executive function
 Attention
 Contributing factors
 Hypoxemia
 Variable glucose control
 Delirium/sedation
 Sepsis

Question 14

delirium prevention

Answer 14

Performing early mobilization of adult patients in the ICU &
AC whenever feasible to reduce the incidence and duration
of delirium is recommended

Question 15

early mobility exclusion guidelines

Answer 15

Significant doses of increasing vasopressors for hemodynamic
stability (maintain MAP> 60)

• FiO2 80% or .8 and/or PEEP >12
• Acutely worsening respiratory failure
• Neuromuscular paralytics
• Acute evolving neurological or cardiac event with re-assessment for
  mobility every 24 hours
• RASS less than -3 or greater than +2
• Unstable spine or extremity fractures
• Open abdomen, at risk for dehiscence
• Grave prognosis  transitioning to comfort care

Question 16

barriers to early mobility in the ICU

Answer 16

Skeptical clinicians  culture and beliefs
* Rotating, changing, in-experienced personnel
* Minimal resources/time
* Variation in sedation practices
* Timing of PT and OT referrals
* Awkward equipment
* Unclear progression of activities
* Comfort level mobilizing prior to extubation