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What are Some Early Intervention Strategies Regarding Early Mobility in the ICU?

Nancy Nathenson, RRT

June 1, 2021

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Question

What are some early intervention strategies regarding early mobility in the ICU?

Answer

One early intervention strategy is to identify patients that are at risk and intervene early. It is important to establish good communication with the patient and their family. We should assist with goal-setting prior to a decline in cognition, which might occur in patients in the ICU. We should schedule a patient/family meeting within 24 to 48 hours of ICU admission. We want to be proactive with patient and family communication on days three through five. I always feel like if you can get the family on board then the patient is going to succeed. Families want to understand what is going on and how they can help.

Another strategy is to implement early activity and mobility. This includes minimizing unnecessary bed rest and utilizing various positioning strategies, which will aid in wound prevention. Mary Massery is a physical therapist who said, "If you cannot breathe you cannot function." We can utilize her techniques when positioning patients. She has courses that train nurses, RTs, and physical therapists on how to position patients for the most effective ventilation and breathing while performing various activities. Sometimes if a patient is slumping over in their chair it is just a matter of putting a little bolster behind them to help open up their trunk a little bit and spread their shoulders back to help them get air in better.

In regards to mobility, we will start with the range of motion and passive active sitting. Create a sitting schedule to have them sit either at the edge of the bed or in a chair. We want them to bear weight as soon as possible and move into early ambulation. We may need a portable ventilator that can be pushed along with the patient as they mobilize. We also want to have an ongoing assessment of symptoms of multiple organ failure or dysfunction.

This Ask the Expert is an edited excerpt from the course, When Bed Rest Causes Harm: Early Mobilization for the Mechanically Ventilated Patientpresented by Nancy Nathenson, BS, RRT.


nancy nathenson

Nancy Nathenson, RRT

Nancy is a respiratory therapist with 35 plus years of experience from ICU to Rehabilitation to Community, providing education and training in disease prevention, respiratory programs, and personal wellness. She has worked as a liaison and consultant with EMS and Medical Transport for nearly 20 years providing education and training and competencies on ventilator and tracheostomy management and safe patient transport. A pioneer and leader in population health management, her teaching strategies are evidence-based, interdisciplinary, and address clinical health outcomes holistically and with a health equity lens. Nancy currently serves as a Community Asthma and COPD Expert for the Allergy and Asthma Network.  


Related Courses

When Bed Rest Causes Harm: Early Mobilization for the Mechanically Ventilated Patient
Presented by Nancy Nathenson, RRT
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  'The presenation'   Read Reviews
This course describes how early mobilization counteracts the negative impacts of prolonged bed rest on ventilator patients. Components of successful early mobilization programs are described, including potential barriers to implementation, specific benefits to the patient and hospital outcomes.

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Minding Gaps in Safe Patient Transport - RT and EMS Joint Task Force Series: Humidification Principles and Transport Guidelines
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Minding the Gaps in Safe Patient Transport - RT and EMS Joint Taskforce Series: Collaboration, Communication and Care Management
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Continuity of safe patient transport requires specialized care and key elements in building relationships between RT, EMS, and Medical Transport within the community. The course delivers an in-depth look at the relationship between RT and EMS skilled providers' experience and decisions in transferring complex pulmonary patients as they strove to keep them safe. Education and training needs, communication tools, potential risks, and care strategies for the best possible outcomes are examined.

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