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Abstract: Slide Presentations |

FEASIBILITY OF A PROTOCOL TO IMPLEMENT EARLY PROGRESSIVE MOBILITY AMONG ICU PATIENTS WITH PROLONGED CRITICAL ILLNESS FREE TO VIEW

Chris Winkelman, PhD*; Kimberly Johnson, BSN; Karen Peereboom, BSN; Rana Hejal, MD; James Rowbottom, MD
Author and Funding Information

Case Western Reserve University, Cleveland, OH


Chest


Chest. 2009;136(4_MeetingAbstracts):58S. doi:10.1378/chest.136.4_MeetingAbstracts.58S-g
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Abstract

PURPOSE:  This investigation compared effects of activity in ICU patients receiving mechanical ventilation for >48 hours with and without a protocol for Early Therapeutic Mobility.

METHODS:  Prospective, interventional study with three periods of data collection: a Pre-protocol period of “typical activity,” a Run-in period of mixed typical and protocol activity and a Protocol period. Patients received activity for three consecutive days and then weekly by an interventionist RN during protocol implementation.

RESULTS:  Differences in heart rate, blood pressure, respiratory rate or peripheral oxygenation among patients in any period during activity were not significant, nor were there significant differences in these measures comparing in-bed and out-of-bed activity. Differences in the incidence of bedrest complications such as decreased muscle strength, venothromboembolism, ventilator-associated pneumonia, or pressure ulcers among patients receiving Pre-protocol or Protocol activity were insignificant. Differences in heart rate, blood pressure, respiratory rate or peripheral oxygenation among patients in any period during activity were not significant, nor were there significant differences in these measures comparing in-bed and out-of-bed activity. Differences in the incidence of bedrest complications such as decreased muscle strength, venothromboembolism, ventilator-associated pneumonia, or pressure ulcers among patients receiving Pre-protocol or Protocol activity were insignificant.òParticipants during the Protocol period had significantly reduce ICU length of stay (14.6 vs. 18.7 days) and duration of mechanical ventilation (6.2 vs. 9.6 days) even though acuity as measured by APACHE was higher during the protocol period participants.òSubjects received their first activity earlier during the ICU stay during the Protocol period (day 6 vs. day 9; p<.05).

CONCLUSION:  Our 75% consent rate suggested a surprising interest in activity participation among ICU patients and their decision-makers. Participants began activity earlier during the Protocol period despite significantly higher acuity compared to Pre-protocol participants. Length of stay and duration of mechanical ventilation were reduced with protocolized activity; complications from bedrest were not altered.

CLINICAL IMPLICATIONS:  A protocol for activity achieved earlier progressive mobility activities and reduced length of stay and time of mechanical ventilation for patients with prolonged critical illness.

DISCLOSURE:  Chris Winkelman, University grant monies None; Grant monies (from sources other than industry) The Clinical and Translational Science Collaborative Dahms Clinical Research Unit Grant Number M01 RR00080 and Grant Number UL1 RR024989 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH). This project and its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.; Grant monies (from industry related sources) Hill-Rom (Minneapolis, MN) funded this investigation but did not particpate in study design, execution or data analysis and interpretation.; Shareholder None; Employee None; Fiduciary position (of any organization, association, society, etc, other than ACCP None; Consultant fee, speaker bureau, advisory committee, etc. None; Other None; No Product/Research Disclosure Information

Wednesday, November 4, 2009

10:30 AM - 12:00 PM


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