Authors (including presenting author) :
Choi WM(1), Lau CKD(1), Lee YW(1), Chan KH(2), Au TK(1), Cheung YW(1)
Affiliation :
(1)Physiotherapy Department, Tseung Kwan O Hospital, (2)Department of Medicine, Tseung Kwan O Hospital
Introduction :
Due to aging population and increasing survival from critical illness, the burden of physical impairment of ICU patients is also expanding. Current literatures suggested early mobilization could improve their physical function, reduce duration of delirium, ICU acquired weakness (ICUAW), length on mechanical ventilation and ICU length of stay. However, feasibility and safety are the main concerns to widespread implementation.
Objectives :
1. To investigate level of training achieved (feasibility) and incidence of adverse event (safety) 2. To explore the effect of early mobilization on physical and functional outcomes
Methodology :
1. Provide physiotherapist auto-screening for all ICU cases and select patients suitable for early mobilization based on the exclusion criteria listed in the manual of COC Grade in physiotherapy. 2. Offer different levels of physical training based on patients’ general conditions, haemodynamic stability and conscious level during weekdays 3. Discuss patients’ rehabilitation potential and progress with ICU physicians 4. Collect pre-and-post training physical outcomes on the date of first and last physiotherapy sessions in ICU 5. Review logistics and implementation of early mobilization program
Result & Outcome :
Result: Between August and October 2021, 63 ICU patients were screened and 57 patients were recruited for early mobilization. For training on bed, 5 patient received passive mobilization whereas 26 performed active exercises or supine cycling. 13% of patients (N=7) received rehabilitation in sitting and 33% of patients (N=19) were able to perform standing or ambulation training. The Medical Research Council (MRC) sum score increased from 35.9 to 48.2 and the ICU mobility scale improved from 0.6 to 3.4. Wilcoxon Ranked tests were conducted with IBM SPSS Statistics 21.0 and both outcomes showed statistically significant improvement (p<0.05). Total 347 treatment sessions were given and there was no serious adverse event such as haemodynamic instability, fall, dislodged line/ tubes or marked change in dyspnoea or conscious level. Conclusion: ICU early mobilization for properly selected patients is feasible and safe. Effective communication with ward staff is a crucial facilitator for smooth program implementation. Nearly half of patients could be mobilized in either sitting or standing positions. Timely rehabilitation also improved patients’ muscle strength and functional status.
