PIONEER EARLY MOBILITY. TRANSFORM CRITICAL CARE.

80% of physicians support automatic orders for mobilization([FOOTNOTE=Jolley SE, Regan-Baggs J, Dickson RP, Hough CL. Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: a cross-sectional survey study. BMCAnesthesiol. 2014;14:84. doi: 10.1186/1471-2253-14-84],[ANCHOR=],[LINK=])

Intensivists oversee ICU patient care. From this vantage, they can prioritize early mobility treatments through practices including:

  • Automatic referrals to physical therapy
  • Spontaneous awakening and breathing trials
  • Scheduling procedures around physical therapy([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=])

THE MOBILIZED ICU

Awareness of the benefits of early mobility in the ICU continues to grow, but actual implementation of early mobility protocols lags behind.([FOOTNOTE=Bakhru RN, Wiebe DJ, McWilliams DJ, Spuhler VJ, Schweickert, WO. An environmental scan for early mobilization practices in U.S. ICUs. Crit Care Med. 2015;43(11):2360–2369. doi: 10.1097/CCM.0000000000001262],[ANCHOR=],[LINK=])

Intensivists can champion early mobility by:

  • Developing protocols or adapting existing ones for their ICUs
  • Incorporating patient mobility status into clinical rounds
  • Working with ICU nurses and physical therapists to prioritize early mobility
  • Including all team members in patient care planning.

Intensivists have options for getting their patients moving.

BUNDLE INTERVENTIONS. AMPLIFY BENEFITS.

50% lower chance of delirium using ABCDEF bundle([FOOTNOTE=*Vs. control group (usual care). 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=])*

When planning a patient’s care regimen, intensivists can use interventions designed to work in concert. The ABCDEF bundle offers one such management strategy. It includes:

  • Awakening and breathing coordination
  • Delirium monitoring/management
  • Early exercise/mobility
  • Family engagement and empowerment

Caregivers using this bundle have reported improved patient outcomes, including less time on mechanical ventilation, less delirium, and greater mobility.4

MOBILIZE SAFELY

Less than 3% adverse events([FOOTNOTE=*Occurring in 22,351 mobilization/rehabilitation sessions. Nydahl P, Sricharoenchai T, Chandra S, et al. Safety of patient mobilization and rehabilitation in the intensive care unit: systematic review with meta-analysis. Ann Am Thorac Soc. 2017;14(5):766–777. doi: 10.1513/AnnalsATS.201611-843SR],[ANCHOR=],[LINK=])*

There is growing evidence that the benefits of early mobility outweigh the risks.1

Intensivists are well-situated to serve as early mobility champions, advocating for it in their ICUs. Adequate training, teamwork, and coordination of patient goals for all members of the early mobility team can reduce adverse events.([FOOTNOTE=Bailey P, Thomsen GE, Spuhler VJ, et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med. 2007 Jan;35(1):139–145. doi: 10.1097/0l.CCM.0000251130.69568.87],[ANCHOR=],[LINK=])