Response 2

Response2.docx

Response – 200- 300 words with references

Does Early Progressive Mobilization Reduce Rates of Ventilator Acquired Pneumonia for Patients with Mechanical Ventilation in the Intensive Care Unit?

Annotated Bibliography

Ambrosino, N., & Vitacca, M. (2018). The patient needing prolonged mechanical ventilation: A narrative review. Multidisciplinary Respiratory Medicine, 13(1), 1-10. https://mrmjournal.biomedcentral.com/articles/10.1186/s40248-018-0118-7

Ambrosin and Vitacca (2018) posit that weaning from mechanical ventilation can significantly help reduce the risks of developing VAP. In their narrative review, Ambrosin and Vitacca (2018) sought to establish the most effective approaches of reducing prolonged use of ventilator support among ICU patients admitted due to pneumonia, given its associated adverse implications. Findings showed that early mobilization and physiotherapy, including cough augmentation techniques, effectively reduce VAP rates among ICU patients with mechanical ventilation (Ambrosin & Vitacca, 2018).

Capell, E. L., Tipping, C. J., & Hodgson, C. L. (2019). Barriers to implementing expert safety recommendations for early mobilisation in intensive care unit during mechanical ventilation: A prospective observational study. Australian Critical Care, 32(3), 185-190. https://doi.org/10.1016/j.aucc.2018.05.005

Capell et al. (2019) argue that despite sufficient evidence supporting the effectiveness of early mobilization in the ICU for patients undergoing mechanical ventilation, the adoption and use of the intervention is still significantly low. The researchers sought to determine the barriers to early mobilization of the patients and the associated implications of using the strategy. Results showed that actively mobilizing patients out of bed is a safe practice without any adverse effects. The main barrier to the early mobilization of the patients was the time constraint.

Lai, C. C., Chou, W., Chan, K. S., Cheng, K. C., Yuan, K. S., Chao, C. M., & Chen, C. M.

(2016). Early mobilization reduces duration of mechanical ventilation and intensive care unit stay in patients with acute respiratory failure. Archives of physical medicine and rehabilitation, 13 Dec. 2016. 98(5), pp 931–939. https://doi.org/10.1016/j.apmr.2016.11.007

The researchers utilized retrospective observational study to determine if early mobilization decreases the length of time a patient stays on mechanical ventilation (MV) and in the intensive care unit (ICU). With a sample size of 153 adults on mechanical ventilation in the ICU, the researchers had two groups, 63 patients in the before protocol group and 90 in the after protocol group. The multidisciplinary care provider team applied protocol of early mobilization within 72 hours of mechanical ventilation in collaboration with patients’ families.After protocol group patients had shorter MV period (4.7d vs 7.5d; P<.001) and ICU stays (6.9d vs 9.9d; P=.001) than did before protocol group patients. The researchers concluded that early introduction of mobilization for patients with MV in the ICU shortened their length of time on mechanical ventilators as well as their ICU stays. The reduction of time on MV and in ICU stay will also reduce the rates of ventilator acquired pneumonia (VAP).

Mokorimban, H & Chayati, N. (2020). The Influence of Progressive Mobilization on Pneumonia

and Decubitus Occurrences in Critical Patients Using Mechanical Ventilator: A Literature Review. Advances in Health Sciences Research, 33. doi.org/ 10.2991/ahsr.k.210115.111

Mokorimban and Chayati, (2020). conducted a literature review to assess the effectiveness of progressive mobilization in patients requiring mechanical ventilation (MV). Ventilator associated pneumonia is a negative effect of MV in patients in the intensive care unit (ICU). Physical activity is needed in the ICU to improve hemodynamic care. The aim of this study was to identify the progressive mobilization on the formation of pneumonia and decubitus ulcers in patients with MV. The Institute for Improvement of Healthcare (IHI) reports that early mobilization (EM) decreases complications such as VAP. This literature review demonstrates that progressive mobilization reduces the incidence of VAP in the ICU by utilizing mobilization earlier in recovery within the first 13 days, but preferably within 48 hours as well as maintaining head of bed elevation. The authors recommend training and adequate knowledge for nurses to implement progressive mobilization.

Nannan, D., Zhigang, Z., Caiyun, Z., Li, Y., Liping, Y., Biantong, J., Yuchen, W., Lingjie, J., & Jinhui, T. (2019). What is the optimum time for initiation of early mobilization in mechanically ventilated patients? A network meta-analysis. Plos One, 14(10). https://doi.org/10.1371/journal.pone.0223151 (Links to an external site.)

Research conducted by Nanan et al (2019), early mobilization has been proven to be an effective and safe intervention for preventing complications in mechanically ventilated patients to include ventilator associated pneumonia. However, there is currently no unified definition of the optimal mobilization initiation time, which can hinder widespread clinical implementation and standardization. The purpose of the study was to evaluate the effects of different early mobilization initiation times on mechanically ventilated patients and rank the times for practical consideration. The Chinese Biomedical Literature Database, the Chinese Knowledge Infrastructure, Wanfang Data, PubMed, Cochrane Library, Web of Science, and Embase databases, along with grey literature and reference lists, were searched for randomized control trials that evaluated the effects of early mobilization for improving patient outcomes; databases were searched from inception to October 2018 (Nanan et al. 2019). A total of 15 RCTs involving 1726 patients and seven mobilization initiation times, which were all compared to usual care were included in the analysis (Nanan et al., 2019). Network meta-analysis showed that mechanical ventilation for 48–72 h may be optimal to improve intensive care unit acquired weakness and even decreased the duration of mechanical ventilation. However, there were no significant differences in length of ICU stay according to mobilization initiation time. The results of this study indicate that initiation of mobilization within 48–72 h of mechanical ventilation may be optimal for improving clinical outcomes for mechanically ventilated patients (Nanan et al. 2019).

Ota, H., Kawai, H., Sato, M., Ito, K., Fujishima, S., & Suzuki, H. (2015). Effect of early

mobilization on discharge disposition of mechanically ventilated patients. Journal of Physical Therapy Science, 27(3), 859–864. doi.org/10.1589/jpts.27.859

The researchers from Akita Red Cross Hospital used the medical records of patients on mechanical ventilation (MV) in a high care intensive care (ICU) unit to assess eligibility for study. Patients were excluded if they were less than 18 years old, were expected not to survive MV, or patients with neuromuscular diseases, major burns or cervical spine injuries. Univariate and multivariate logistic regression analysis identified variables. Subjects were divided into two groups based on if they received early mobilization (EM), or not. EM was initiated within two to five days of MV. EM consisted of active and passive range of motion, chest physiology, head of bed elevation, muscle relaxation, and deep breathing. The findings of this study revealed that EM in MV improved prognosis and decreased complication of MV. In the control group patients were more likely to develop pneumonia. Researchers suggest that consensus guidelines for indications for EM in MV are needed to establish clinical standardized practice guidelines.

Taito, S., Shime, N., Yasuda, H., Ota, K., Sarada, K., Lefor, A. K., & Sanui, M. (2018). Out-of-bed mobilization of patients undergoing mechanical ventilation with orotracheal tubes: A survey study. Journal of Critical Care, 2018, 47, pp 173–177. https://doi.org/10.1016/j.jcrc.2018.06.022

The survey study conducted by the investigators sought to ascertain enablers of out-of-bed mobilization of patients on mechanical ventilators in the intensive care unit (ICU). A survey of all intensive care units (ICUs) certified by the Japanese Society of Intensive Care Medicine (excluding pediatric ICUs) was done. A dedicated physical and/or occupational and/or speech therapy team was present in 34 ICUs (20%) of the 168 ICUs . In 86 ICUs (51%), mechanically ventilated patients with orotracheal tubes also routinely underwent out-of-bed mobilization, and 38 ICUs (23%) used a written mobilization protocol. Mobilization activities such as sitting on the edge of bed up to walking in mechanically ventilated patients with orotracheal tubes were performed. The researchers were of the opinion that high level staffing that included physicians, dedicated physical and/or occupational and/or speech therapists, and nursing staff enabled increased rate of out-of-bed mobilization of patients on mechanical ventilators which may reduce the rate of ventilator acquired pneumonia (VAP) in ICU patients.

Tsung-Hsien, W. (2020). Early mobilization on patients with mechanical ventilation in the ICU, physical therapy effectiveness. IntechOpen. https://doi.org/10.5772/intechopen.89984

Research conducted by Tsung-Hsien (2020) concluded that most ventilated critical care patients in the intensive care unit often experience immobility and restraints in order to promote safety. This can cause muscle weakness, cognitive impairments, psychological difficulties, difficult weaning, and increased length of stay (LOS) in the hospital. However, early mobilization promotes improved ventilation, perfusion, muscle strength, and functional capacity. The early mobilization of ventilated patients appears to be safe, with a low risk of potential safety events, even when implemented as part of routine clinical practice. Early mobilization, defined as mobilization within 72h of ICU admission, is well tolerated and feasible. It should be the standard of care. However, implementing early mobilization may need a cultural change in intensive care with an interdisciplinary approach. There have been increases in ventilator associated pneumonia as well as neuromuscular dysfunction that results in both short- and long-term physical functional impairments. The current standard of practice for many ICUs is bed rest. This plays a major role in the development of neuromuscular disorders and functional ability impairments (Tsung-Hsien, 2020). Early mobilization and physical therapy may be able to solve these problems. The complete effects of early mobilization in the ICU for critical care patients needs to be evaluated using a standardized execution protocol to determine the optimal timing, exercise dosage, and progression of mobilization, as well as determining criteria for the intensity and duration of physical therapy most likely to optimize patients’ physical condition during critical illness (Tsung-Hsien, 2020). To achieve early mobilization in clinical practice requires a shift in unit culture and dedication from mobility champions that follow individualized procedures and protocols to ensure safe application at the bedside.

Wang, J., Ren, D., Liu, Y., Wang, Y., Zhang, B., & Xiao, Q. (2020). Effects of early mobilization on the prognosis of critically ill patients: A systematic review and meta-analysis. International journal of nursing studies, 110, 103708. https://doi.org/10.1016/j.ijnurstu.2020.103708

The objective of this study was to determine the implications of early mobilization on critically ill patients. Findings revealed that early mobilization was associated with reducing ICU-related complications for various conditions, including VAP, and a lower incidence of ICU-acquired weakness (ICU-AW) (Wang et al., 2018). These findings support my study because they imply that an early mobilization is a practical approach to reducing VAP rates among patients with mechanical ventilation in the ICU.

Zhang, L., Hu, W., Cai, Z., Liu, J., Wu, J., Deng, Y., Yu, K., Chen, X., Zhu, L., Ma, J., & Qin, Y. (2019). Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PloS one, 14(10), e0223185. https://doi.org/10.1371/journal.pone.0223185

Zhang et al. (2019) sought to determine the implications of early mobilization among critically ill patients admitted in the ICU. The systematic review and meta-analysis demonstrated that the strategy has a positive effect on the health outcomes of patients. Findings showed that early mobilization significantly reduces the risks of respiratory failure by increasing the number of mechanical ventilation free days (six studies, 745 patients, standardized mean difference (SMD): 0.17, 95% CI [0.02, 0.31]; p = 0.023, I2 = 35.5%). The strategy also increased the number of discharged-to-home patients (seven studies, 793 patients, RR: 1.16, 95% CI [1.00, 1.34]; p = 0.046), thereby contributing to a reduction in the number of individuals admitted to the respiratory ICU (Zhang et al., 2019).

References

Capell,E. L., Tipping, C. J., & Hodgson, C. L. (2019). Barriers to implementing expert safety recommendations for early mobilisation in intensive care unit during mechanical ventilation: A prospective observational study. Australian critical care :official journal of the Confederation of Australian Critical Care Nurses, 32(3), 185–190. https://doi.org/10.1016/j.aucc.2018.05.005

Elsayed, A. A., Dahroug, A. H., & Halawa, A. M. (2020). Role of early progressive mobilization protocol on outcomes of mechanically ventilated patients with pneumonia. Research and Opinion in Anesthesia and Intensive Care, 7(4), 275. https://doi.org/10.4103/roaic.roaic_106_19

Hashem, M., Nelliot, A., Needham, D. (2016). Early mobilization and rehabilitation in the ICU: moving back to the future. Respiratory Care, 61(7) 971-979; doi: 10.4187/respcare.04741

Lai, C. C., Chou, W., Chan, K. S., Cheng, K. C., Yuan, K. S., Chao, C. M., & Chen, C.M (2016). Early mobilization reduces duration of mechanical ventilation and intensive care unit stay in patients with acute respiratory failure. Archives of physical medicine and rehabilitation, 13 Dec 2016, 98(5), 931–939 https://doi.org/10.1016/j.apmr.2016.11.007

Modi, A. R., & Kovacs, C. S. (2020). Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention. Cleveland Clinic Journal of Medicine, 87(10), 633-639. https://doi.org/10.3949/ccjm.87a.19117

Mokorimban, H & Chayati, N. (2020). The Influence of Progressive Mobilization on Pneumonia and Decubitus Occurrences in Critical Patients Using Mechanical VentilatorA Literature Review. Advances in Health Sciences Research, 33,https://dx.doi.org/10.2991/ahsr.k.210115.111

Ota, H., Kawai, H., Sato, M., Ito, K., Fujishima, S., & Suzuki, H. (2015). Effect of early mobilization on discharge disposition of mechanically ventilated patients. Journal of Physical Therapy Science, 27(3), 859–864. doi.org/10.1589/jpts.27.859

Papazian, L., Klompas, M., & Luyt, C. E. (2020). Ventilator-associated pneumonia in adults: A narrative review. Intensive Care Medicine, 46(5), 888-906. https://doi.org/10.1007/s00134-020-05980-0

Taito, S., Shime, N., Yasuda, H., Ota, K., Sarada, K., Lefor, A. K., & Sanui, M. (2018). Out-of-bed mobilization of patients undergoing mechanical ventilation with orotracheal tubes: A survey study. Journal of Critical Care, 47, pp 173–177. https://doi.org/10.1016/j.jcrc.2018.06.022

Torres, A., Niederman, M. S., Chastre, J., Ewig, S., Fernandez-Vandellos, P., Hanberger, H., Kollef, M., Li Bassi, G., Luna, C. M., Martin-Loeches, I., Paiva, J. A., Read, R. C., Rigau, D., François Timsit, J., Welte, T., & Wunderink, R. (2018). Summary of the international clinical guidelines for the management of hospital-acquired and ventilator-acquired pneumonia. ERJ open research, 4(2), 00028-2018. https://doi.org/10.1183/23120541.00028-2

Tsung-Hsien, W. (2020). Early mobilization on patients with mechanical ventilation in the ICU, physical therapy effectiveness.IntechOpen. https://doi.org/10.5772/intechopen.89984

Zomorodi, M., Topley, D., & McAnaw, M. (2012). Developing a mobility protocol for early

mobilization of patients in a surgical/trauma ICU. Critical care research and practice,

2012, 964547. https://doi.org/10.1155/2012/964547