February 27, 2024
2 min read
Table of Contents
Key takeaways:
- From the start of rehabilitation, it took a median of 1 day for patients given a mobile patient lift to stand vs. 3 days in the control group.
- These patients also had better physical function at ICU discharge.
Ventilated ICU patients stood up in fewer days with a mobile patient lift plus rehabilitation protocol vs. the protocol alone, according to results published in Critical Care Medicine.
“We anticipate that proactive early mobilization, with the assistance of mobile patient lifts, will play a pivotal role in preventing post-intensive care syndrome,” Ginga Suzuki, PhD, of the Critical Care Center at Toho University Omori Medical Center in Japan, said in a press release.
Data were derived from Suzuki G, et al. Crit Care Med. 2024;doi:10.1097/CCM.0000000000006219.
In a single-center, open-label, randomized controlled trial, Suzuki and colleagues assessed 80 ICU patients expected to receive a minimum of 48 hours of mechanical ventilation to determine if mobile patient lift use promotes early mobilization.
Of the total cohort, 41 patients (median age, 69 years; 73.2% men) received a rehabilitation protocol (control group), whereas 39 patients (median age, 71 years; 46.2% men) received this protocol plus a mobile patient lift to help them with sitting, standing, transfers and walking (intervention group).
Researchers captured mobilization by comparing how long it takes each group to stand from the start of rehabilitation, and this is demonstrated through an ICU mobility scale score of 4 or higher.
Most of the patients in the intervention group used the lift (n = 34; 87.2%), according to researchers.
It only took a median of 1 day for patients receiving the intervention to stand, whereas it took a median of 3 days for control patients to stand (P < .01).
In addition to earlier mobilization, the intervention group had a higher ICU mobility scale score than the control group (6 vs. 4; P < .01) at ICU discharge, signaling more mobility.
Researchers further found significantly increased Functional Status Scores for the ICU (FSS-ICU) among those receiving the intervention vs. the control (20.4 vs. 17.9; P = .04) when assessed at ICU discharge.
In contrast, both groups had similar median Medical Research Council scores (evaluates muscle strength) and Barthel index scores (evaluates ability to complete activities of daily living) at discharge.
A significantly higher mean Sequential Organ Failure Assessment score was found in the intervention group compared with the control group (3.5 vs. 2.2; P = .01) at first standing,
Notably, both groups had comparable findings across several secondary outcomes: median mobilization preparation times, median mobilization cleanup times, median mobilization times, delirium presence, median delirium duration, median ICU stay duration, mean 28-day ventilator-free days, ICU mortality and hospital mortality.
When divided by sex, researchers found significant differences in days to standing between the intervention and control group in both the cohort of women and the cohort of men (P < .01). In terms of FSS-ICU between the two groups, only men showed significant differences (P = .02).
“To draw conclusive evidence for the advantages of early mobilization, further studies should accumulate supportive data,” Suzuki said in the release.
Reference:
Perspective
This study sought to assess the impact of a mobile patient lift on functional levels at ICU discharge. Patients were screened for early mobility initiation criteria 24 hours after intubation. The median time from admission to standing in the control and intervention group was 6 and 4 days. The control and intervention group spent 7 and 5 days mobilizing in the ICU. Upon discharge from the ICU, the intervention group stood earlier with the mobile patient lift and had a higher FSS-ICU of 20.4 than the FSS-ICU score of 17.9 in the control group.
The care in this ICU is commendable as screening for early mobility criteria starts within 24 hours after admission and appears to help drive the management of sedation to enable early mobility. Both groups met inclusion criteria on day 3 following admission and received the same frequency and duration of mobility. The intervention group had a higher level of mobility achieved sooner than the control group. This can be evidence to support the use of a patient mobility lift to overcome barriers such as fear and weakness that prevented earlier standing in the control group.
The mobility inclusion criteria for this study required ventilator settings of positive end-expiratory pressure less than 10 cmH2O and fraction of inspired oxygen less than 0.6. A previous study has shown it is safe and feasible to mobilize intubated patients with a median ratio of arterial partial pressure of oxygen to the fraction of inspired oxygen of 89. Screening for early mobility with more liberal ventilator parameters may enable earlier mobility and prevent escalation of muscular atrophy that later requires support for standing.
Further studies evaluating the need for mobile patient lift when mobility is initiated earlier following intubation as has been accomplished in other studies may help provide more insight into how and when to utilize this equipment.
The lack of impact on delirium is noteworthy as a previous study has shown that delirium duration decreases by 50% when patients are mobilized within 48 hours after intubation. The lack of contrast in the timing of initiation, frequency and duration of mobility may explain the lack of impact on delirium. More information on sedation practices may provide more insight into delirium prevention and management in these patients.
It was also surprising to find that although the FSS-ICU score was higher in the intervention group upon ICU discharge, the Barthel index was the same in both groups upon discharge from the hospital. Further investigation of the mobility provided on the medical floors may be warranted for evaluation of the impact of mobility practices following the ICU.
Ultimately, this study reaffirms that early mobility for intubated patients during mechanical ventilation is safe and feasible. Patient mobility lifts can help facilitate higher levels of mobility earlier in an ICU stay and improve patients’ functional level upon discharge from the ICU. Critical care teams should utilize these findings to focus on early sedation cessation and the personal highest level of mobility for patients on mechanical ventilation.
References:
Bailey P, et al. Crit Care Med. 2007;doi:10.1097/01.CCM.0000251130.69568.87.
Nydahl P, et al. Ann Am Thorac Soc. 2017;doi:10.1513/AnnalsATS.201611-843SR.
Schweickert WD, et al. Lancet. 2009;doi:10.1016/S0140-6736(09)60658-9.
Kali Dayton, DNP, AGACNP
Critical Care Nurse Practitioner
CEO, Dayton ICU Consulting
Host, Walking Home From the ICU podcast
