Barriers to the implementation and practice of early rehabilitation in critical patients in the ICU
DOI:
https://doi.org/10.5585/22.2023.23261Keywords:
Cuidados críticos, Especialidade de Fisioterapia, Unidades de Terapia Intensiva, ReabilitaçãoAbstract
Introduction: Early rehabilitation can minimize the loss of strength and functionality caused by acquired muscle weakness in the Intensive Care Unit (ICU); however, its practice still faces obstacles for full implementation.
Objective: To identify barriers to the implementation and execution of early rehabilitation in critically ill patients.
Methodology: Barriers related to the patient, the process, structural barriers, and cultural barriers were analyzed through a structured questionnaire. Forty-four healthcare professionals working in the ICUs of two hospitals participated in the survey.
Results: The most cited barriers related to the patient were hemodynamic instability (85.8%), loss of devices (58.9%), and endotracheal intubation (55.3%). In structural barriers, the lack of guidelines or protocols was identified. Cultural and process-related barriers included the absence of a responsible professional to assess patients eligible to start rehabilitation.
Conclusion: The full implementation of early rehabilitation in the two studied hospitals is hindered by numerous barriers, especially those related to the patient and structural issues.
Downloads
References
Halpern NA, Pastores SM. Critical care medicine beds, use, occupancy, and costs in the United States: a methodological review. Crit Care Med. 2015;43(11):2452-9.
Feliciano DV. A influência da mobilização precoce no tempo de internamento na Unidade de Terapia Intensiva. ASSOBRAFIR Ciência [Internet]. 2019 [citado em 1 de maio de 2019]. Disponível em: http://www.uel.br/revistas/uel/index.php/rebrafis/article/view/11702/11486
Gardenghi G, Mesquita JCT. Imobilismo e fraqueza muscular adquirida na unidade de terapia intensiva. Rev Bras Saúde Func. 2016 Dez 5;1(3):47-47.
Latronico N, Gosselink R. A guided approach to diagnose severe muscle weakness in the intensive care unit. Rev Bras Ter Intensiva [Internet]. 2015 [citado em 6 de maio de 2019]; 27(3). Disponível em: http://www.gnresearch.org/doi/10.5935/0103-507X.20150036.
Souza RB, Marques LM, Gonçalves EDC, Costa GFS da, Furtado MV da C, Amaral AG dos S, et al. Efeitos da mobilização precoce em pacientes adultos internados em unidade de terapia intensiva: revisão sistemática / Effects of early mobilization in adult patients admitted to the intensive care unit: systematic review. Brazilian J Develop. 2021 Mar 25;7(3):30427-30441.
Aquim EE, Bernardo WM, Buzzini RF, Azeredo NSGD, Cunha LSD, Damasceno MCP, et al. Brazilian guidelines for early mobilization in intensive care unit. Rev Bras Ter Intensiva [Internet]. 2019 [citado em 18 de setembro de 2023];31(4). Disponível em: http://www.gnresearch.org/doi/10.5935/0103-507X.20190084.
Verceles AC, Wells CL, Sorkin JD, Terrin ML, Beans J, Jenkins T, et al. A multimodal rehabilitation program for patients with ICU acquired weakness improves ventilator weaning and discharge home. J Crit Care. October 2018;47:204-210.
Berry MJ, Morris PE. Early Exercise Rehabilitation of Muscle Weakness in Acute Respiratory Failure Patients. Exerc Sport Sci Rev. October 2013;41(4):208-215.
Ramos Dos Santos PM, Aquaroni Ricci N, Aparecida Bordignon Suster É, de Moraes Paisani D, Dias Chiavegato L. Effects of early mobilisation in patients after cardiac surgery: a systematic review. Physiotherapy. March 2017;103(1):1-12.
Berney SC, Harrold M, Webb AS, Sppelt I, Patman S, Tomas PJ, et al. Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc. 2013;15(5):260-265.
Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med. 2014;42(5):1178-1186.
Dubb R, Nydahl P, Hermes C, Schwabbauer N, Toonstra A, Parker AM, et al. Barriers and strategies for early mobilization of patients in intensive care units. Ann Am Thorac Soc. 2016;13(5):724-730.
Koo, KKY, Choong K, Cook DJ, Herridge M, Newman A, Lo V, et al. Early mobilization of critically ill adults: a survey of knowledge, perceptions, and practices of Canadian physicians and physiotherapists. CMAJ Open. 2016;4(3):e448-454.
Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, et al. Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care. December 4, 2014;18(6):658.
Devlin JW, Skrobik Y, Gélinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. September 2018;46(9):e825-873.
Fontela PC, Lisboa TC, Forgiarini-Júnior LA, Friedman G. Early mobilization in mechanically ventilated patients: a one-day prevalence point study in intensive care units in Brazil. Crit Care. 2017;21(Supl 1):289.
Berney SC, Rose JW, Bernhardt J, Denehy L. Prospective observation of physical activity in critically ill patients who were intubated for more than 48 hours. J Crit Care. 2015;30(4):658-663.
Jolley SE, Regan-Baggs J, Dickson RP, Hough CL. Medical intensive care unit clinician attitudes and perceived barriers towards early mobilization of critically ill patients: a cross-sectional survey study. BMC Anesthesiol. 2014;14:84.
Sibilla A, Nydahl P, Greco N, Mungo G, Ott N, Unger I, et al. Mobilization of mechanically ventilated patients in Switzerland. J Intensive Care Med. January 1, 2020;35(1):55-62.
Timenetsky KT, Serpa Neto A, Assunção MSC, Taniguchi L, Eid RAC, Corrêa TD, et al. Mobilization practices in the ICU: a nationwide 1-day point-prevalence study in Brazil. PLoS One. 2020;15(4):e0230971.
Schallom M, Tymkew H, Vyers K, Prentice D, Sona C, Norris T, et al. Implementation of an interdisciplinary AACN early mobility protocol. Crit Care Nurse. 2020;40(4):e7-17.
Chang LY, Yu HH, Chao YF. The Relationship Between Nursing Workload Quality of Care, and Nursing Payment in Intensive Care Units. J Nurs Res. 2019;27(1):1-9.
Goodson CM, Friedman LS, Mantheiy E, Heckle K, Lavezza A, Toonstra A, et al. Perceived Barriers to Mobility in a Medical ICU: the Patient mobilization attitudes & beliefs survey for the ICU. J Intensive Care. 2018;20(5):1-6.
Schujmann DS, Gomes TT, Lunardi AC, Lamano MZ, Fragoso A, Pimentel M, et al. Impact of a progressive mobility program on the functional status, respiratory and muscular systems of ICU patients: a randomized and controlled trial. Crit Care Med. 2020;20(30):1-7.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 ConScientiae Saúde
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Autores que publicam nesta revista concordam com os seguintes termos:
O(s) autor(es) autoriza(m) a publicação do texto na revista;
O(s) autor(es) garantem que a contribuição é original e inédita e que não está em processo de avaliação em outra(s) revista(s);
A revista não se responsabiliza pelas opiniões, idéias e conceitos emitidos nos textos, por serem de inteira responsabilidade de seu(s) autor(es);
É reservado aos editores o direito de proceder a ajustes textuais e de adequação às normas da publicação;
Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob uma Licença Creative Commons Atribuição-NãoComercial-CompartilhaIgual 4.0 Internacional;
Autores têm permissão e são estimulados a publicar e distribuir seu trabalho online (ex.: em repositórios institucionais ou na sua página pessoal) já que isso pode gerar alterações produtivas, bem como aumentar o impacto e a citação do trabalho publicado;
Em virtude de aparecerem nesta revista de acesso público, os artigos são de uso gratuito, com atribuições próprias, em aplicações educacionais e não-comerciais.
