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4 Benefits with early mobilisation in ICUs

Time to read: 3 min.

Immobility is a critical risk factor for postoperative complications and increases hospital length of stay.2 Complications induced by longer periods of immobility can persist for years after the patient’s discharge3 – hence, patients could benefit from a goal-directed and early mobilisation. Stable patients in the ICU are able to participate in mobilisation activities.1

Early mobilisation means to mobilise the patients out of bed within the first hours of their intensive care stay.4 Early mobilisation is important for patients, especially in the ICU, because it delivers many benefits3 for them and ICU staff as well:

  • Reduced length of hospital and ICU stay
  • Lesser mortality rates during hospitalisation
  • Better quality of life outcomes5
  • Patient´s functional mobility at hospital discharge6

Barriers to early mobilisation in the ICU include difficulties in handling traditional chest drains. Moreover, even if the patient can be mobilised with a chest drain, this requires disconnection of suction during mobilisation and reattachment afterwards. This can lead to an infection risk because of handling mistakes.7

The following infographic summarises the negative consequences of bed rest in the hospital and the effect of early mobilisation on a patient’s recovery time.

An illustration entitled "Early Mobilization in the ICU".

Early mobilisation is enhanced by using a portable, digital chest drain such as Thopaz+ instead of a traditional water-seal system:

  • Clinicians stated that the digital system is user-friendly and enabled them to mobilise the patient easier and decide effectively when to remove the chest drains.7
  • Nurses found the digital chest drain easy to set up, relieving the patients' daily care.9
  • Patients appreciated that it was portable and lightweight which meant they could mobilise on suction providing safety and flexibility.7
  • Early mobilisation is endorsed by ERAS®*.

The digital drainage system Thopaz+ supports early mobilisation

Rehabilitation and early mobilisation are considered therapeutic strategies to prevent the development of intensive care unit acquired weakness (ICUAW). They are associated with an increased probability of walking more distance at discharge. The main patient mobilisation techniques used are kinesitherapy, transfer and locomotion training, as well as neuromuscular electrical stimulation and cycle ergometry.5

In a clinical study, patients and nurses completed a survey of postoperative chest drain-specific PROs (=Patient-Reported Outcomes). Patients with digital chest drainage reported better scores in all 20 questions asked, and the nurses caring for them also reported better scores for DCD (=digital chest drainage) in 8 of the 10 questions asked.9A chart entitled "Comparison Digital vs. Water Seal".

*ERAS®=Enhanced Recovery After Surgery, evidence-based guidelines designed to help optimise outcomes following surgery

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References

1. Adler, Joseph; Malone, Daniel (2012): Early Mobilization in the Intensive Care Unit: A Systematic Review. In: Cardiopulmonary Physical Therapy Journal (Vol 23, No 1), 5-13.

2. Batchelor, Timothy J. P.; Rasburn, Neil J.; Abdelnour-Berchtold, Etienne; Brunelli, Alessandro; Cerfolio, Robert J.; Gonzalez, Michel et al. (2018): Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). In: Eur J Cardiothorac Surg 55 (1), S. 91–115. DOI: 10.1093/ejcts/ezy301.

3. Patricia Arias-Fernández, Macarena Romero-Martin, Juan Gómez-Salgado, Daniel Fernández-García: Rehabilitation and early mobilization in the critical patient: systematic review; J. Phys. Ther. Sci. 30: 1193–1201, 2018

4. van Willigen Z, Collings N, Richardson D, et al. Quality improvement: The delivery of true early mobilisation in an intensive care unit. BMJ Quality Improvement Reports 2016;5:u211734.w4726. doi:10.1136/bmjquality. u211734.w4726

5. A.R. Miranda Rocha, B.P. Martinez, V.Z. Maldaner da Silva, L.A. Forgiarini Junior: Early mobilization: Why, what for and how?; Medicina Intensiva (English Edition), Volume 41, Issue 7, October 2017, Pages 429-43;

6. Schaller, Stefan J. (2016): Early goal directed mobilisation in the surgical ICU a randomized controlled trial. In: Lancet (388), 1377-1388.

7. Rathinam, Sridhar; Bradley, Amy; Cantlin, Teresa; Rajesh, Pala B. (2011): Thopaz Portable Suction Systems in Thoracic Surgery: an end user assessment and feedback in a tertiary unit. In: Journal of cardiothoracic surgery 6, S. 59. DOI: 10.1186/1749-8090-6-59.

8. Cerfolio, Robert J.; Bryant, Ayesha S. (2009): The quantification of postoperative air leaks. In: Multimedia manual of cardiothoracic surgery: MMCTS 2009 (409), mmcts.2007.003129. DOI: 10.1510/mmcts.2007.003129.

9. Sihoe, Alan; Fang, Wentao; Liu, Lunxu; Liao, Hu; Liu, Chengwu; Feng, Jian; Zhang, Jitian: Objective and Patient-Reported Outcomes after Lung Resection Surgery are Improved by Digital Chest Drainage System compared to Water Seal System. Results from a Prospective Multicenter Database in China. In: Presented at ESTS, Ireland 2019

10. Ramos Dos Santos, P. M.; Aquaroni Ricci, N.; Aparecida Bordignon Suster, É.; Moraes Paisani, D. de; Dias Chiavegato, L. (2017): Effects of early mobilisation in patients after cardiac surgery: a systematic review. In: Physiotherapy 103 (1), S. 1–12. DOI: 10.1016/j.physio.2016.08.003.

11. Needham DM. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA 2008;300:1685–90.

12. Schweickert, William D.; Pohlman, Mark C.; Pohlman, Anne S.; Nigos, Celerina; Pawlik, Amy J.; Esbrook, Cheryl L. et al. (2009): Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. In: Lancet 373 (9678), S. 1874–1882. DOI: 10.1016/S0140-6736(09)60658-9.