Question
What are some early intervention strategies regarding early mobility in the ICU?
Answer
One early intervention strategy is to identify patients that are at risk and intervene early. It is important to establish good communication with the patient and their family. We should assist with goal-setting prior to a decline in cognition, which might occur in patients in the ICU. We should schedule a patient/family meeting within 24 to 48 hours of ICU admission. We want to be proactive with patient and family communication on days three through five. I always feel like if you can get the family on board then the patient is going to succeed. Families want to understand what is going on and how they can help.
Another strategy is to implement early activity and mobility. This includes minimizing unnecessary bed rest and utilizing various positioning strategies, which will aid in wound prevention. Mary Massery is a physical therapist who said, "If you cannot breathe you cannot function." We can utilize her techniques when positioning patients. She has courses that train nurses, RTs, and physical therapists on how to position patients for the most effective ventilation and breathing while performing various activities. Sometimes if a patient is slumping over in their chair it is just a matter of putting a little bolster behind them to help open up their trunk a little bit and spread their shoulders back to help them get air in better.
In regards to mobility, we will start with the range of motion and passive active sitting. Create a sitting schedule to have them sit either at the edge of the bed or in a chair. We want them to bear weight as soon as possible and move into early ambulation. We may need a portable ventilator that can be pushed along with the patient as they mobilize. We also want to have an ongoing assessment of symptoms of multiple organ failure or dysfunction.
This Ask the Expert is an edited excerpt from the course, When Bed Rest Causes Harm: Early Mobilization for the Mechanically Ventilated Patient, presented by Nancy Nathenson, BS, RRT.
