In the intensive care unit (ICU), where patients often face life-threatening conditions and complex treatments, the focus is typically on stabilizing vital signs and managing acute symptoms. However, a growing body of evidence suggests that integrating mobility and physical activity into the care regimen of respiratory patients in the ICU can lead to significant improvements in outcomes. Here’s how mobility can enhance recovery and why it should be a key component of critical care.
The Importance of Mobility in the ICU
1. Reduced Muscle Weakness and Atrophy: Prolonged bed rest can lead to muscle weakness and atrophy, commonly referred to as ICU-acquired weakness (ICU-AW). For respiratory patients, this can exacerbate existing issues with breathing and mobility. Early mobilization helps counteract these effects by maintaining muscle strength and function, which is crucial for effective respiratory muscle performance.
2. Enhanced Respiratory Function: Physical activity stimulates respiratory muscles, improving their strength and endurance. For patients with compromised lung function, such as those with acute respiratory distress syndrome (ARDS) or chronic obstructive pulmonary disease (COPD), this can lead to better ventilation and gas exchange. Mobilization exercises, even if gentle, can aid in improving oxygenation and reducing the need for mechanical ventilation.
3. Decreased Length of ICU Stay: Studies have shown that early mobilization can reduce the length of stay in the ICU. By improving muscle strength and respiratory function, patients are more likely to transition to lower levels of care more quickly.
This reduction in ICU days can also help decrease the risk of complications associated with prolonged ICU stays, such as infections or delirium.
4. Improved Functional Outcomes: Patients who engage in early mobility often experience better functional recovery post-ICU. This means they are more likely to regain their pre-illness level of independence and physical function, leading to a better quality of life after discharge. Functional improvements are particularly important for respiratory patients who need to regain strength to manage activities of daily living.
5. Enhanced Psychological Well-Being: The psychological impact of ICU stay can be significant, with patients often experiencing anxiety, depression, or post-traumatic stress disorder (PTSD). Engaging in mobility and physical activity can help alleviate some of these mental health challenges by providing a sense of progress and control, boosting morale and overall well-being.
Implementing Mobility in the ICU: Best Practices
1. Individualized Mobility Plans: Develop tailored mobility plans based on each patient’s condition, capabilities, and goals. This requires collaboration between ICU physicians, nurses, physical therapists, and respiratory therapists to create a safe and effective mobility strategy.
2. Gradual Progression: Begin with passive range-of-motion exercises and progress to more active activities as the patient’s condition allows. Activities might include sitting up in bed, transferring to a chair, standing, and eventually walking with assistance.
3. Incorporate Breathing Exercises: Combine mobility with respiratory exercises such as diaphragmatic breathing and incentive spirometry. These exercises can further support respiratory muscle strength and improve overall lung function.
4. Multidisciplinary Collaboration: Ensure that the ICU team, including physicians, nurses, and physical therapists, is aligned in their approach to mobility. Regular communication and coordination are key to safely advancing mobility efforts and addressing any potential complications.
5. Monitor and Adjust: Continuously monitor patients for any signs of distress or complications during mobility activities. Adjust the plan as needed to ensure that it remains within the patient’s tolerance levels and health status.
6. Educate and Support: Provide education and support to patients and their families about the benefits of mobility and the role it plays in recovery. Involving families in the mobility process can also enhance patient motivation and compliance.
In-bed Verticalization is a Changing the Way Patients are Mobilized
In-bed Verticalization is a Changing the Way respiratory Patients are POSITIONED AND MOBILIZED.
While proning is often used to improve oxygenation in ARDS and COVID patients, it comes with risks such as pressure ulcers and accidental extubating of ventilated patients. Verticalization can serve as a safer alternative that offers effective ventilation and perfusion distribution while mitigating the challenges associated with prone positioning.
RUSH University Medical Center recognized these benefits early and incorporated Catalyst into their Awake ECMO program, resulting in exceptional outcomes compared to ELSO registry data. With this program the Catalyst is typically ordered on day 2, and the patient is verticalized on day 3. The outcomes of using this method for COVID patients showed a remarkable 83% survival rate compared to the ELSO Registry data of 53% along with 0 reported HAPI’s.
Benefits of in-bed verticalization
1. Improved Lung Function and Oxygenation: Research has shown that placing patients in an upright position increases end-expiratory lung volume and improves oxygen exchange. By helping to expand the lungs and reduce alveolar collapse, verticalization facilitates better oxygenation, which is critical for ARDS and ECMO patients (BioMed Central, Physician’s Weekly)
2. Reduction in Ventilator-Associated Complications: Keeping patients in the supine position for extended periods can increase the risk of complications like ventilator-associated pneumonia (VAP). Verticalization helps reduce this risk by promoting lung expansion and clearing secretions more effectively( BioMed Central)
3. Safe Patient Handling: In-bed verticalization not only helps with outcomes but can keep complex patients upright without the risks of falls, clinician injuries, or dislodgement of critical lines and circuits that can happen with proning and patient transfers.
TAKE A STAND AGAINST MOBILITY AND POSITIONING CHALLENGES
Incorporating mobility into the care of respiratory patients in the ICU is not just a matter of enhancing physical recovery—it’s a holistic approach that addresses physical, psychological, and functional aspects of patient care. By implementing effective mobility strategies, ICUs can improve patient outcomes, reduce the length of hospital stays, and support a more complete and quicker recovery.
As the field of critical care evolves, embracing the role of mobility can lead to transformative changes in how we manage and support respiratory patients in the ICU.
Kreg is Here to Help
Our Catalyst® Bed offers in-bed verticalization for patients up to 750lbs with a push of a button. Top hospitals across the US are preparing their teams and using The Catalyst Bed to optimize outcomes during this season. Our team is here to help your facility get ready for respiratory season by:
- Comprehensive training for your ICU and multidisciplinary teams on how to use the bed
- Reviewing and creating protocols for your respiratory patients
- Facilitating peer to peer discussions on best practices
- Sharing clinical posters from our current customers on the benefits of Verticalization and Continuous Lateral Rotation Therapy for pulmonary health
If you need product training, in-service, or clinical support, contact your local Kreg rep to ensure you get the support you need.