Friday April 6, 2007
EARLY MOBILIZATION AND AMBULATION OF VENTILATOR DEPENDENT PATIENTS IN ICU

Today's pearl contributed by:
Christiane Perme, PT CCS
Board Certified Cardiovascular and Pulmonary Clinical Specialist
Senior Physical Therapist
Department of Physical Therapy and Occupational Therapy
The Methodist Hospital,
Texas Medical Center, Houston, Texas
cperme@tmh.tmc.edu


ICU patients have limited mobility due to life support, monitoring equipment, multiple medical problems, and muscle weakness. Early ambulation of mechanically ventilated patients enhances functional outcomes by optimizing cardiopulmonary and neuromuscular status. This intervention can lead to a reduced length of hospital stay, higher functional capability, overall reduced costs, and an increase in the patient’s quality of life.

Bailey and colleagues (1) in his study concluded that early activity is feasible and safe in mechanically ventilated patients. The study also proposes that early activity is a candidate therapy to prevent or treat the neuromuscular complications of critical illness.

Perme and colleagues (2) reported a case of an LVAD (left ventricular assist device) patient who required prolonged mechanical ventilation post-operatively. Early and aggressive physical therapy was provided including ambulation on a portable ventilator. This case suggests that improving mobility of these patients has the potential to facilitate ventilator weaning as well as to improve outcomes of transplantation.

Mechanically ventilated patients in ICU can be safety mobilized when appropriate measures are taken.



References: click to get abstract/article

1. Bailey P, Thomsen G, Spuhler V, Blair R, Jewekes J, Bezdjian L, Veale K, Rodriguez, AS, Hopkins R. Early activity is feasible and safe in respiratory failure patients. Critical Care Medicine 2007.Vol. 35 Number 1.139-145
2. Perme C, Southard R, Joyce D, Noon G, Loebe M. Early mobilization of LVAD recipients who require prolonged mechanical ventilation. Texas Heart Institute Journal 2006; 33:130—3