Early Mobilization in Critical Care

In advance of the first joint British Association of Critical Care Nurses (BACCN) and Irish Association of Critical Care Nurses (IACCN) Conference in Belfast on the 17^th and 18^th of October, we are publishing a blog to highlight how therapeutic seating can assist with early mobilisation and rehabilitation of critical care patients.

Critical Illness

Critical illness is defined as any life-threatening condition that requires pharmacological and/or mechanical support of vital organ functions without which death would be imminent.¹

What problems are associated with surviving Critical illness?

According to the NICE Guidelines, research on the longer-term consequences of critical illness has shown that significant numbers of patients surviving critical illness have important continuing problems. For many, discharge from critical care is the start of an uncertain journey to recovery characterised by, among other problems, weakness, loss of energy and physical difficulties, anxiety, depression, post-traumatic stress (PTS) phenomena and, for some, a loss of mental faculty (termed cognitive function).²

Can Early Mobilisation Improve Outcomes?

The effect of systematic early mobilisation in mechanically ventilated adult ICU patients has shown benefits vs. late mobilisation:

• Muscle strength and physical function.³

Early mobilisation has also shown trends towards improved patient outcomes in terms of:

• Duration of Mechanical Ventilation.
• ICU length of stay.
• Hospital length of stay.⁴

What is the role of sitting in recovery from Critical illness?

Sitting in Bed and in Chairs is amongst the first steps to recovery from Critical illness. This is highlighted in stages 1, 2 and 3 of the ICU Mobility Scale.⁵

How can effective Seating assist the recovery of critical care Patients?

Effective seating for Critical Care Patients should:

• Enable early mobilisation

• Support the seated person’s body

• Enable function

• Manage skin and pressure needs

• Provide comfort

• Ensure safety

What is the Sydney GoFlat™?

The Sydney GoFlat™ was designed to enable safe and efficient transfer of critical care patients

from lying in bed to a fully seated, clinically optimised position offering care professionals new

options in early mobilisation.

What is the Patient experience of the Sydney GoFlat™?

Patients have commented on being comfortable in the chair and a number of Patients have enjoyed been able to use the remote control to reposition themselves. We have seen that Patients are able to communicate with friends, family and staff and to eat and drink in the chair. A number of patients have been able to move outside to aid their recovery.

What is the Staff experience of the Sydney GoFlat™?

Staff have commented that the Chair has enabled the early mobilisation of a broad range of ICU patients, including myopathic, de-conditioned patients. Staff have said that Patients appear very comfortable in the chair. Lateral transfer has been used for certain Patients who cannot be hoisted and feedback is that less staff have been required for lateral transfers vs. hoisting. Staff have also seen that Drop down arms assist with hoisting as well as lateral transfers.

What is next for the Sydney GoFlat™?

The Sydney GoFlat™ has been trialled in multiple Hospitals globally, with ongoing trials and normal use. A Clinical Study with Westmead Hospital, Sydney, Australia is being planned amongst mechanically ventilated patients in the ICU. Seating Matters offer complimentary, no obligation trials of the Sydney GoFlat™.

For more information visit the website, email contact@seatingmatters.com or call 0044(0) 20 3982 2900.

References:

1. Centers for Medicare & Medicaid Services: Medicare Claims Processing Manual. Chapter 12 - Physicians/Nonphysicians Practitioners. 2013Baltimore, MD, Centers for Medicare & Medicaid Services
2. Rehabilitation after critical illness in adults. Clinical guideline [CG83]. Published: 25 March 2009. https://www.nice.org.uk/guidance/cg83
3. Menges, D et al. 2021. Critical Care. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. (2021) 25:16. https://doi.org/10.1186/s13054-020-03446-9
4. Monsees, J et al. 2022. A systematic review of the effect of early mobilization on length of stay for adults in the intensive care unit. Nursing and Critical Care. https://onlinelibrary.wiley.com/doi/full/10.1111/nicc.12785
5. This work was created by Carol Hodgson, Dale Needham, Michael Bailey, Paul Young, Heidi Buhr, Alisa Higgins, Jeff Presneill and Sue Berney, and was originally published in Heart and Lung 2014:43;19-24.DOI: http://dx.doi.org/10.1016/j.hrtlng.2013.11.003 It is licensed under the Attribution – Non Commercial-NoDerivs 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0