1887
Volume 2017, Issue 1
  • ISSN: 0253-8253
  • E-ISSN: 2227-0426

Abstract

Intensive care patients are at high risk of increased mortality and morbidity and longer hospital stay secondary to prolonged immobility.1 Early mobilization and therapeutic exercises reduce delirium and days on mechanical ventilation, shorten ICU and hospital stay, improve physical function, and reduce healthcare costs.2,3

Mobilization and exercise can be safely implemented for patients receiving mechanical ventilation and continuous hemofiltration.4–6

The incidence of physical deconditioning and other ICU-acquired morbidities are very high among patients with severe respiratory failure. Protocol-directed progressive early mobilizations of these groups of patients are safe and feasible even if they are on ECMO.7,8

Our ECMO patients are evaluated daily to assess hemodynamic and respiratory stability, and suitability for mobilization and exercise program. Assessment includes cardiovascular parameters, ECMO circuit, APTT and arterial blood gas results and targets, sedation level, muscle relaxation use, medical and nursing plan for the day, recent chest X-ray, and ECMO settings and recent changes. Figure 1 illustrates the continuum of early mobility protocol in the Hamad General Hospital Medical Intensive Care Unit (ICU). The mobilization level and exercises determined are based on these assessments. Adequate patient preparation is essential before initiating any exercises or mobilization.

Patient safety is a primary goal and to achieve this, the multidisciplinary ECMO team pays due attention to intravenous lines, ECMO cannulas, and monitoring devices in place. Maintenance of adequate oxygenation and hemodynamic stability has to be assured throughout mobilization and rehabilitation therapy.

The team must ensure that adequate ECMO tubing slack is available to allow safe movement of the patient without undue strain on the circuit, and a dedicated team member, typically a perfusionist or ECMO nurse, will be in charge of monitoring the circuit. ECMO sweep gas and blood flow rates as well as supplemental oxygen may all be increased. Hemodynamic or respiratory instability should be assessed immediately and the session can be stopped without delay. Goal-directed slow progressive early mobilization of ECMO patients is feasible and safe when undertaken by a multidisciplinary team. As evidence supports the implementation of rehabilitation in the ICU, particular attention should be made to incorporate mobility and exercises in the daily routine of ECMO patients.7

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2017-02-14
2019-12-07
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References

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  • Article Type: Research Article
Keyword(s): ECMO , intensive care , mobilization and rehabilitation
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