Abstract

Purpose: This project presents a case of an individual that was a candidate for early mobilization in an acute care intensive care unit (ICU), and answers the following PICO question via evidence-based analysis: Is early mobilization more beneficial than traditional therapeutic interventions for patients in the ICU on mechanical ventilation? Background: Acute care physical therapy in the ICU differs widely from hospital to hospital. Because of this, there are no easy-to-follow guidelines for providing the best therapeutic interventions for patients in the ICU. Typically, physical therapy in this setting is delayed, or provided infrequently, until the patients are transferred to other floors of the hospital. However, there has recently been a shift towards mobilizing patients in the ICU sooner, and more frequently, secondary to emerging research showing beneficial results with patients in this setting receiving what is currently termed "early mobilization". Case Description: Ms M was a 76 year-old female admitted to the emergency room with gradual onset and worsening abdominal pain. The patient later tested positive for Clostridium difficile (C-diff) which led to the development of a toxic megacolon. Ms. M received a total abdominal colectomy, required mechanical ventilation post-surgically, and was admitted to the ICU. She was subsequently referred to physical therapy while in the ICU. Outcomes: A review of the current available evidence revealed that early mobilization was typically far more beneficial for patients in the ICU on mechanical ventilation than the current usual care for these same patients. The usual care groups received physical therapy very sporadically, while the early mobilization interventions typically followed a very structured protocol. Also, several studies demonstrated the feasibility of implementing early mobilization protocols that were very safe and effective. While most protocols required more interdisciplinary communication and higher staffing of physical therapists specifically for the ICU, several studies showed that providing early mobilization was cheaper in regards to average hospital costs for patients. Discussion: This case presentation described a patient in the ICU who required mechanical ventilation secondary to a rare condition requiring surgical intervention. The purpose of this investigation was to determine if the patient would have benefitted from receiving physical therapy interventions within the first 72 hours of intubation. Over the past 10 years there have been a growing number of studies that have investigated the potential benefits of early mobilization in the ICU. Several studies investigated the feasibility of implementing a mobility protocol in the ICU. Researchers found very few adverse events related to mobilizing these patients in the ICU, with positive results related to independent functionality, ambulation, and decreases in cost of hospital stays. Some studies found inconclusive results, while others found positive outcomes including increased independence with performance of activities of daily living (ADLs), decreased incidence of ICU acquired weakness, increased ambulation abilities at discharge, and a greater chance of patients returning home at discharge. Patients in early mobilization groups received far more physical therapy sessions than patients in the usual care groups. Instead of waiting to mobilize this patient in the ICU that was mechanically ventilated, greater results may have been accomplished if she had received mobilization in a timelier manner.

Provenance

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Document Type

Capstone

First Advisor

Tiffany Enache

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