著者

Shohei Takatani

雑誌

第46回日本集中治療医学会学術集会

巻号頁・発行日

2019-02-04

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Advances in critical care have led to increased survival and, as a result, the recognition of prolonged physical and psychosocial morbidity after critical illness. Neuromuscular dysfunction has been identified in many intensive care unit (ICU) patients with sepsis, multi organ failure, or prolonged mechanical ventilation and is associated with a longer duration or mechanical ventilation and increased length of ICU and hospital stay [1]. Early Mobility (EM) and engagement is an essential component of the ABCDEF bundle that has been effective in reducing ICU - Acquired weakness as well as an effective intervention to significantly affect delirium. The three ICUs at Stanford Medical Center (SMC) consist of the Cardiovascular ICU, the Medical Surgical Neurological ICU, and the Coronary Care Unit (CCU). Every ICU has a designated rehabilitation team comprised of occupational therapists (OT), physical therapists (PT), speech language pathologists (SLP) and rehabilitation aides (RA). At SMC, over 90% of ICU patients receive consults to PT and OT when medically appropriate, and are initiated on a standard, intermediate, or intensive rehabilitation program based on appropriateness. All rehabilitation programs emphasize the utilization of structured activity programs, progressive exercise programs and safe patient handling equipment such as hospital beds with tilting features, overhead lift systems, chairs with pressure relieving capabilities in order to facilitate safe and effective participation in EM and engagement for both patient and staff. Incorporating family involvement. In order to care for our critically ill patients, we collaborate with interdisciplinary members on a daily basis. EM can be performed by any part of the interdisciplinary team including nurses, physical therapists, occupational therapists, or physicians and it can consist of activities from passive range of motion to ambulation.As a result of our ICU early mobility and engagement rehabilitation program, cardiac surgery and transplant patients’ length of stay (LOS) in the ICU and overall hospital length of stay has been reduced. Additionally, we have also noted a reduction in staff injury rates related to EM and engagement practices in the ICU.EM has been a standard of practice in the ICUs at SMC and the emphasis on early mobility and engagement in structured ICU rehabilitation programs have been very safe and successful for our patients at SMC as well as for the care team members. Through close collaboration with nursing staff, primary medical team members, and other ancillary services, i.e., respiratory therapy (RT), perfusionists, dietitians (RD), we have a strong mobility culture and we continue to strive to provide effective EM and early engagement in our critically ill patients.[1] Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM, Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med 2007; 33:1876-91.