ICU-acquired weakness is the acute onset of neuromuscular and functional impairment in critically ill patients.([FOOTNOTE=Vasilevskis EE, Ely EW, Speroff T, Pun BT, Boehm L, Dittus RS. Reducing iatrogenic risks: ICU-acquired delirium and weakness—crossing the quality chasm. Chest. 2010;138(5):1224–1233. doi: 10.1378/chest.10-0466],[ANCHOR=],[LINK=]) Up to 80 percent of ICU patients can develop some form of it,([FOOTNOTE=Jolley SE, Bunnell AE, Hough CL. ICU-acquired weakness. Chest. 2016;150(5):1129–1140. doi: 10.1016/j.chest.2016.03.045],[ANCHOR=],[LINK=]) and it can persist after discharge, sometimes for years.([FOOTNOTE=Hermans G, Van den Berghe G. Clinical review: intensive care unit acquired weakness. Crit Care. 2015;19:274. doi: 10.1186/s13054-015-0993-7],[ANCHOR=],[LINK=])
Early mobility programs can:
ICU-acquired delirium, which can affect the sickest ICU populations, remains poorly understood.([FOOTNOTE=Pandharipande PP, Girard TD, Jackson JC, et al. Long-term cognitive impairment after critical illness. N Engl J Med. 2013;369(14):1306–1316. doi: 10.1056/NEJMoa1301372],[ANCHOR=],[LINK=]) And the length of a patient’s delirium directly correlates with his or her ability or inability to perform activities of daily living.([FOOTNOTE=Brummel NE, Jackson JC, Pandharipande PP, et al. Delirium in the intensive care unit and subsequent long-term disability among survivors of mechanical ventilation. Crit Care Med. 2014;42(2):369–377. doi: 10.1097/CCM.0b013e3182a645bd],[ANCHOR=],[LINK=])
Early mobility, in concert with customized sedation regimens, may reduce delirium and increase functional outcomes at ICU discharge — and beyond.3,9,([FOOTNOTE=Cameron S, Ball I, Cepinskas G, et al. Early mobilization in the critical care unit: a review of adult and pediatric literature. J Crit Care. 2015;30(4):664–672. doi: 10.1016/j.jcrc.2015.03.032],[ANCHOR=],[LINK=])
Dr. Wischmeyer of Duke University gives an overview of the challenges associated with early mobility, and the importance of implementing protocols.
Early mobility — combined with reduced sedation and spontaneous awakening and breathing trials as part of the ABCDEF bundle — can be safely administered to ventilated patients.([FOOTNOTE=Raoof, S, Baumann MH. Ventilator-associated events: the new definition. Am J Crit Care. 2014;23(1):7–9. doi: 10.4037/ajcc2014469.],[ANCHOR=],[LINK=]) And early mobility is associated with fewer days on a ventilator.3,([FOOTNOTE=Balas MC, EE Vasilevskis, Olsen KM, et al. Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility (ABCDE) bundle. Crit Care Med. 2014;42(5):1024–1036. doi: 10.1097/CCM.0000000000000129],[ANCHOR=],[LINK=])
Ventilator-associated events, such as ventilator-associated pneumonia([FOOTNOTE=Hunter, JD. Ventilator associated pneumonia. BMJ. 2012;344:e3325. doi: 10.1136/bmj.e3325.],[ANCHOR=],[LINK=]) and pulmonary embolism,([FOOTNOTE=Stevens, JP, Silva G, Gillis J, et al. Automated surveillance for ventilator-associated events. Chest. 2014;146(6):1612–1618. doi: 10.1378/chest.13-2255],[ANCHOR=],[LINK=]) correlate with longer ICU stays and greater chance of death.14
Cognitive impairment refers to a persistent loss of brain function following a critical illness. Between one- and two-thirds of mechanically ventilated patients suffer from some level of cognitive impairment, with loss of function comparable to traumatic brain injury or even mild Alzheimer’s disease.([FOOTNOTE=Girard TD, Jackson JC, Pandharipande PP, et al. Delirium as a predictor of long-term cognitive impairment in survivors of critical illness. Crit Care Med. 2010;38(7):1513–1520. doi: 10.1097/CCM.0b013e3181e47be1],[ANCHOR=],[LINK=])
Length of delirium has been associated with poorer cognition scores one year post-lCU.10 The reduction in delirium afforded by early mobility treatments lays a foundation for better outcomes that last beyond discharge from the ICU.
Early mobility is part of a comprehensive set of strategies to improve patient outcomes in the ICU. Called the ABCDEF bundle, it comprises the following protocols:
The ABCDEF bundle is associated with shorter ICU and hospital length of stays, less delirium, shorter time on the ventilator, and higher hospital survival rates.18
Access mechanical ventilator training and resources aimed at helping you operate our ventilators with more confidence and achieve better patient outcomes.