MINIMIZE DAYS ON THE VENTILATOR

3 fewer days on the ventilator([FOOTNOTE=*For patients following an early mobility intervention in seven institutions, compared to patients in same institutions before the intervention. Balas MC, Vasilevskis EE, 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 (VAEs) are linked to a variety of adverse outcomes, such as:

  • More days on the ventilator
  • More days in the hospital
  • Higher hospital mortality rates([FOOTNOTE=Klompas M, Branson R, Eichenwald EC, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(8):915–936. doi: 10.1086/677144],[ANCHOR=],[LINK=])

Respiratory therapists can mitigate these outcomes as they support early mobility interventions.([FOOTNOTE=Muscedere J, Sinuff T, Heyland DK, et al. The clinical impact and preventability of ventilator-associated conditions in critically ill patients who are mechanically ventilated. Chest. 2013;144(5):1453–1460. doi:10.1378/chest.13-0853],[ANCHOR=],[LINK=])

A CRITICAL MEMBER OF THE TEAM

Respiratory therapists, working in conjunction with ICU nurses and physical and occupational therapists, can get patients moving — even walking — with little chance of an adverse event.([FOOTNOTE=Castro E, Turcinovic M, Platz J, et al. Early mobilization: changing the mindset. Crit Care Nurse. 2015;35:e1-5.],[ANCHOR=],[LINK=])

But it takes teamwork. It takes knowledge of roles, agreement on assessment criteria, and good communication — all of which can help ICU patients RISE.

SECURE BREATHING. MOBILIZE PATIENTS.

Less than 1% activity-related 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;35(1):139–145. doi: 10.1097/01.CCM.0000251130.69568.87 ],[ANCHOR=],[LINK=])

For respiratory therapists, early mobility greatly resembles patient transport. In both situations, therapists focus on patient-ventilator interactions, including adjusting the ventilator prior to a session and responding to changes during mobilization. 

As with patient transport, the respiratory therapist must maintain control of the ventilator circuit and airway during all patient position changes.([FOOTNOTE=Archer, DA. Early Mobility in ICU: Respiratory Therapy Role in Mobilizing Ventilated Patients. Accessed June 13, 2017],[ANCHOR=View Conference Notes],[LINK=https://depts.washington.edu/pulmcc/conferences/lungday/Archer.pdf ])

PERCEIVED BARRIERS. REAL PROGRESS.

60% of clinicians report lack of knowledge or skills to mobilize ventilated patients([FOOTNOTE=Koo KY, Choong K, Cook DJ, et al. Early mobilization of critically ill adults: a survey of knowledge, perceptions and practices of Canadian physicians and physiotherapists. CMAJ Open. 2016;4(3):E448–E454. doi:10.9778/cmajo.20160021],[ANCHOR=],[LINK=])

Clinicians may consider mechanical ventilation a barrier to early mobility. But the true barrier may be lack of training on how to do so safely.7,([FOOTNOTE=Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009;373:1874–1882. doi: 10.1016/S0140-6736(09)60658-9],[ANCHOR=],[LINK=]) For example, ICU teams have addressed one key concern, accidental extubation, through staffing and the use of an endotracheal securement device.4

With proper planning, assessments, and teamwork, respiratory therapists can help the clinical team mobilize ventilated patients safely.([FOOTNOTE=Morris PE, Goad A, Thompson C, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med. 2008;36(8):2238–2243. doi: 10.1097/CCM.0b013e318180b90e],[ANCHOR=],[LINK=]),([FOOTNOTE=Archer DA. Early mobility in ICU: respiratory therapy role in mobilizing ventilated patients. Accessed June 13, 2017.],[ANCHOR=View Slides],[LINK=https://depts.washington.edu/pulmcc/conferences/lungday/Archer.pdf ])