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VOLUME 25 , ISSUE 4 ( April, 2021 ) > List of Articles

ORIGINAL RESEARCH

Effect of Graded Early Mobilization on Psychomotor Status and Length of Intensive Care Unit Stay in Mechanically Ventilated Patients

Bijoy Das, Sanchita Saha, Feroz Kabir, Sazzad Hossain

Keywords : Graded early mobilization, Intensive care unit, Mechanical ventilation, Physiotherapy, Psychological status,Functional status

Citation Information : Das B, Saha S, Kabir F, Hossain S. Effect of Graded Early Mobilization on Psychomotor Status and Length of Intensive Care Unit Stay in Mechanically Ventilated Patients. Indian J Crit Care Med 2021; 25 (4):416-420.

DOI: 10.5005/jp-journals-10071-23789

License: CC BY-NC 4.0

Published Online: 00-04-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: The main purpose of this study was to evaluate the effectiveness of graded early mobilization on psychomotor status and duration of ICU stay of patients with mechanical ventilation. Method: Design: Quasi-experimental study. Setting: BRB Hospitals Limited, Dhaka, Bangladesh. A reputed 500-beddedgeneral hospital with 30 ICU beds. Participants: A total of 30 patients were selected as participants in the study from the hospital. 15 patients were included in the ICU treatment group and the remaining 15 were in the intervention group using the purposive sampling method. Scales used: Functional independence measure (FIM) scale and 7 point generalized anxiety depression (GAD-7) scale. Intervention: Graded early mobilization was provided as an intervention to all participants of the intervention group by a professionally qualified ICU physiotherapist for 10 sessions. Most of the patients received multiple sessions of intervention within a day. Results: In the control group mean FIM score was 17.40 (SD±4.88), and in the intervention group mean score was 65.70 (SD±12.18). The mean difference was statistically significant in the ‘t’ test (p-value > 0.001). In the control group, the mean GAD-7 score was 19.50 (SD±2.71), and in the intervention group the mean GAD-7 score was 7.5 (SD±2.59). The mean difference was statistically significant in the ‘t’ test. (p-value > 0.001). The mean length of ICU stay in the control group was 5.60 (SD±1.07) and in the intervention group it was 3.10 (SD±0.56). The mean difference was statistically significant in the ‘t’ test (p-value > 0.001). Conclusion: This research showed that graded early mobilization was highly effective to improve the motor and psychological status of mechanically ventilated patients and reduce their length of ICU stay.


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  1. Aletreby WT, Mumtaz SA, Al Harthy AM, Shahzad SA, Ramadan OE. Outcome of early mobilization of critically ill patients: a propensity score matching trial. Anticoagulation during ECMO: the past, present, and future. J Intensive Crit Care 2018;4(3):13. DOI: 10.21767/2471-8505.100115.
  2. Barlow DH. Anxiety and its disorders: the nature and treatment of anxiety and panic. New York: The Guilford Press; 2004.
  3. Cindy H, Gayle L, Shelley S. Psychological sequelae following ICU admission at a level 1 academic South African hospital.SAJCC 2010;26(2).
  4. Davydow DS, Katon WJ, Zatzick DF. Psychiatric morbidity and functional impairments in survivors of burns, traumatic injuries, and ICU stays for other critical illnesses: a review of the literature. Int Rev Psychiatry 2009;21:531–538. DOI: 10.3109/09540260903343877.
  5. De Jonghe B, Sharshar T, Lefaucher JP, Authier FJ, Durand-Zaleski I, Boussarsar M. Paresis acquired in intensive care unit: a prospective multicenter study. JAMA 2002;288(22):2859–2867. DOI: 10.1001/jama.288.22.2859.
  6. Desai S, Law T, Needham D. Long-term complications of critical care. Crit Care Med 2011;39(2):371–379. DOI: 10.1097/CCM.0b013e3181fd66e5.
  7. Diagnostic and statistical manual of mental disorders. Washington: American Psychiatric Association; 1994.
  8. Drolet A, DeJuilio P, Harkless S, Henricks S, Waters C, Wiliams S. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care setttings. Phys Ther J 2012;93(2):1–11. DOI: 10.2522/ptj.20110400.
  9. Ekiz T, Pazarli AC, Esquinas AM. Early mobilization after mechanical ventilation: a question of details and time. Arch Phys Med Rehabil 2017;98(7):1490. DOI: 10.1016/j.apmr.2017.02.012.
  10. Garnacho-Montero J, Amaya-Villar R, Garcia-Garmendia JL, Madrazo-Osuna J, Ortiz-Leyba C. Effect of critical illness polyneuropathy on the withdrawal from mechanical ventilation and the length of stay in septic patients. Crit Care Med 2005;33(2):349–354. DOI: 10.1097/01.CCM.0000153521.41848.7E.
  11. Gosselink R, Bott J, Johnson M. Physiotherapy for adult patients with critical illness. Recommendation of European Respiratory Society and European Society of Intensive Care Medicine Task force on Physiotherapy for Critically ill patients. Intensive Care Med 2008;34(7):1188–1199. DOI: 10.1007/s00134-008-1026-7.
  12. Grosu HB, Lee YI, Lee J, Eden E, Eikermann M, Rose KM. Paresis acquired in intensive care unit: a prospective multicenter study. JAMA 2012;288(22):2859–2867. DOI: 10.1001/jama.288.22.2859.
  13. Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H, Denehy L. Early mobilization and recovery in mechanically ventilated patients in the ICU: a binational, multi-centre, prospective cohort study. Crit Care 2015;19(1):1–10. DOI: 10.1186/s13054-015-0765-4.
  14. Horta D, Plazas C, Serrano C (1998). The role of The Psychologist in an Intensive Care Unit. Faculty of Psychology PUJ. Unpublished document. [Taken on 02/10/2020]: from: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S1657-92672006000300014.
  15. Jones C, Griffiths RD, Humphris G, Skirrow PM. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 2001;29(3):573–580. DOI: 10.1097/00003246-200103000-00019.
  16. Kress JP, Hall JB. Risk factors among ICU patient and their musculoskeletal features. J Intensive Crit Care 2014;11(3):13. DOI: 10.21567/2471-855.101515.
  17. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med 2014;370:1626–1635. DOI: 10.1056/NEJMra1209390.
  18. Levine S, Nguyen T. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008;36:2238–2243. DOI: 10.1097/CCM.0b013e318180b90e.
  19. Lipshutz A, Gropper M. Aquired neuromuscular weakness and early mobilization in the intensive care unit. Anesthesiology 2013;118(1):202–214. DOI: 10.1097/ALN.0b013e31826be693.
  20. McCarren B, Alison JA, Herbert RD. Manual vibration increases expiratory flow rate via increased intrapleural pressure in healthy adults: an experimental study. Aust J Physiothery 2015;52:267–271. DOI:10.1016/S0004-9514(06)70006-x.
  21. Meesen RL, Dendale P, Cuypers K. Neuromuscular electrical stimulation as a possible means to prevent muscle tissue wasting in artificially ventilated and sedated patients in the intensive care unit: a pilot study. Neuromodulation 2010;13(4):315–320. DOI:10.1111/j.1525-1403.2010.00294.x.
  22. Meng Y, Zhan-Ying Ma, Meng-Jie L, Chu-Yun C, Yi Jin. Early mobilization for mechanically ventilated patients in the intensive care unit: a systematic review and meta-analysis. Front Nurs 2018;5(4). DOI: 10.1515/fon-2018-0039.
  23. Morris PE. Moving our critically ill patients: mobility barriers and benefits. Crit Care Clin 2007;23(1):1–20. DOI: 10.1016/j.ccc.2006.11.003.
  24. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L. 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.
  25. Morris PE, Griffin L, Berry M. Receiving early mobility during an intensive care unit admission is a predictor of improved outcomes in acute respiratory failure. Am J Med Sci 2011;341(5):373–377. DOI: 10.1097/MAJ.0b013e31820ab4f6.
  26. Myers DG. Therapy. Psychology. 9th Ed. New York: Worth Publishers; 2010.
  27. Narasimman S, Mohammad H. Early mobilization in ICU. Current perspective and future directions. Physio Times 2010;2:18–23.
  28. Nyland BA, Spilman SK, Halub ME, Lamb KD, Jackson JA, Oetting TW. A preventative respiratory protocol to identify trauma subjects at risk for respiratory compromise on a general in-patient ward. Respir Care 2016;61(12):1580–157. DOI: 10.4187/respcare.04729.
  29. Patman S, Sanderson D, Blackmore M. Physiotherapy following cardiac surgery: is it necessary during the intubation period? Aust J Physiother 2001:;47(1):7–16.DOI: 10.1016/S0004-9514(14)60294-4.
  30. Pohlman MC, Schweickert WD, Pohlman AS. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med 2010;38(11):2089–2094. DOI: 10.1097/CCM.0b013e3181f270c3.
  31. Poulsen JB, Møller K, Jensen CV, Weisdorf S, Kehlet H, Perner A. Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shock. Crit Care Med 2011;39(3):456–461. DOI: 10.1097/CCM.0b013e318205c7bc.
  32. Priyakshi B, Narasimman S, D’silva C, Shabari K. Effect of graded early mobilization versus routine physiotherapy on the length of intensive care unit stay in mechanically ventilated patients: a randomized controlled study. Int J Health Allied Sci 2012;1(3):172–177. DOI: 10.4103/2278-344X.105081.
  33. Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA 2013;310(15):1591–1600. DOI:10.1001/jama.2013.278481.
  34. Rodriguez PO, Setten M, Maskin LP. Muscle weakness in septic patients requiring mechanical ventilation: protective effect of transcutaneous neuromuscular electrical stimulation. J Crit Care 2012;27(3):319.e1–319.e8. DOI: 10.1016/j.jcrc.2011.04.010.
  35. Sareen J, Cox BJ, Afifi TO, de Graaf R, Asmundson GJ, et al. Anxiety disorders and risk for suicidal ideation and suicide attempts: a population-based longitudinal study of adults. Arch Gen Psychiatry 2005;62(11):1249–1257. DOI: 10.1001/archpsyc.62.11.1249.
  36. Sommers J, Engelbert RH, Dettling-Ihnenfeldt D, Gosselink R, Spronk PE, Nollet F. Physiotherapy in the intensive care unit: evidence-based, expert-driven, practical statement and rehabilitation recommendations. Clin Rehabil 2015;29(11):1051–1063. DOI: 10.1177/0269215514567156.
  37. Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin 2007;23(1):35–53. DOI: 10.1016/j.ccc.2006.11.005.
  38. Turner JM, Smith PC, Ramchandani C, Begen FM, Padkin A. The acute psychobiological impact of the intensive care experience on relatives. Psychol Health Med 2016;21(1):20–26. DOI: 10.1080/13548506.2014.997763.
  39. Van Der Kolk BA, McFarlane AC, Weisaeth L. Traumatic stress: the effects of overwhelming experience on mind, body and society. New York: Guilford Publications; 2006.
  40. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67(6):361–370.DOI: 10.1111/j.1600-0447.1983.tb09716.x.
  41. Sharon AS. Mechanical Ventilation Learning Pakage, CNC, Liverpool ICU, SWSLHD; 2016. pp. 16–38.
  42. Mahajan BK. Methods of biostatistics for medical students and research workers. Jaypee Brothers medical publishers (p) limited; 2005. pp. 130–156.
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