Early mobilization in intensive care unit practice

Dr Carol Hodgson, Senior Research Fellow at Australian and New Zealand Intensive Care Research Centre, discusses muscle weakness in the critically ill.

In 2009, during the American Thoracic Society Conference, I heard a presentation from Professor Dale Needham about his hospital implementing a major Intensive Care Unit (ICU) practice change.

Johns Hopkins Hospital, Baltimore, USA, was introducing physical therapists in the ICU to deliver early mobilization during critical illness. Prof Needham was convinced that early mobilization would improve muscle strength; reduce time on mechanical ventilation; and may impact ICU length of stay and longer-term recovery of critically ill patients.

At the end of his presentation I raised my hand and said that in Australia and New Zealand, physiotherapists had been part of the ICU multidisciplinary team for decades. I was concerned that his findings in the USA may not be applicable to Australia and New Zealand. Standard practice was different.

He noted an inescapable conclusion: we had not measured the rate of early mobilization in our country.

A year later I was employed as a Senior Research Fellow at The Australian and New Zealand Intensive Care Research Centre, Monash University, Australia. During my interview for the job, the co-director, Professor Bellomo, asked if I was interested in leading a program of research to investigate the effects of early mobilization in ICU. He described the prevalence of muscle weakness and wasting in critically ill patients as “the last organ we have failed to support”.

For the past five years I have had the pleasure of working with a dedicated and talented team of investigators addressing this important question. The team includes leading ICU medical staff, physiotherapists and nurse research co-ordinators from Australia and New Zealand.

We have completed our 12 site prospective cohort study that found that we rarely mobilize patients during mechanical ventilation, despite having physiotherapists in the ICU.

Over half of our cohort was discharged from ICU with ICU-acquired weakness. We have also learnt that ICU-acquired weakness, diagnosed at ICU discharge, is associated with long-term mortality.

Our team believes that the only way to truly determine the long-term effect of early mobilization during critical illness is through randomized controlled trials (RCT).

As part of this research program, we will complete our pilot RCT in 2015 to determine the feasibility of the early mobilization intervention in Australian and New Zealand ICUs.

Finally, we will plan a definitive Phase III clinical trial to determine the effectiveness of early mobilization on patient-centered outcomes. Stay tuned.

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