Chris Winkelman1, Abdus Sattar2, Hasina Momotaz2, Kimberly D Johnson3, Peter Morris4, James R Rowbottom5, John Daryl Thornton6, Sheryl Feeney7, Alan Levine8. 1. 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA. 2. 2 Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA. 3. 3 College of Nursing, University of Cincinnati, Cincinnati, OH, USA. 4. 4 Division of Pulmonary, Critical Care and Sleep Medicine, University of Kentucky HealthCare System, Lexington, KY, USA. 5. 5 Department of Anesthesiology and Perioperative Medicine, University Hospitals, Cleveland Medical Center, School of Medicine, Case Western Reserve University, Cleveland, OH, USA. 6. 6 Pulmonary and Critical Care, MetroHealth Medical Center, Cleveland, OH, USA. 7. 7 The MetroHealth System, Cleveland, OH, USA. 8. 8 Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Abstract
OBJECTIVE: Investigate the feasibility of a nurse-led mobility protocol and compare the effects of once- versus twice-daily episodes of early therapeutic mobility (ETM) and low- versus moderate-intensity ETM on serum biomarkers of inflammation and selected outcomes in critically ill adults. DESIGN: Randomized interventional study with repeated measures and blinded assessment of outcomes. SETTING:Four adult intensive care units (ICUs) in two academic medical centers. SUBJECTS:Fifty-four patients with > 48 hr of mechanical ventilation (MV). INTERVENTION: Patients were assigned to once- or twice-daily ETM via sealed envelope randomization at enrollment. Intensity of (in-bed vs. out-of-bed) ETM was administered according to protocolized patient assessment. MEASUREMENTS: Interleukins 6, 10, 8, 15, and tumor necrosis factor-α were collected from serum before and after ETM; change scores were used in the analyses. Manual muscle and handgrip strength, delirium onset, duration of MV, and ICU length of stay (LOS) were evaluated as patient outcomes. MAIN RESULTS: Hypotheses regarding the inflammatory biomarkers were not supported based on confidence intervals. Twice-daily intervention was associated with reduced ICU LOS. Moderate-intensity (out-of-bed) ETM was associated with greater manual muscle test scores and handgrip strength and reduced occurrence of delirium. CONCLUSION: Findings from this study suggest that nurses can provide twice-daily mobility interventions that include sitting on the edge of the bed once patients have a stable status without altering a pro-inflammatory serum biomarker profile.
RCT Entities:
OBJECTIVE: Investigate the feasibility of a nurse-led mobility protocol and compare the effects of once- versus twice-daily episodes of early therapeutic mobility (ETM) and low- versus moderate-intensity ETM on serum biomarkers of inflammation and selected outcomes in critically ill adults. DESIGN: Randomized interventional study with repeated measures and blinded assessment of outcomes. SETTING: Four adult intensive care units (ICUs) in two academic medical centers. SUBJECTS: Fifty-four patients with > 48 hr of mechanical ventilation (MV). INTERVENTION: Patients were assigned to once- or twice-daily ETM via sealed envelope randomization at enrollment. Intensity of (in-bed vs. out-of-bed) ETM was administered according to protocolized patient assessment. MEASUREMENTS: Interleukins 6, 10, 8, 15, and tumor necrosis factor-α were collected from serum before and after ETM; change scores were used in the analyses. Manual muscle and handgrip strength, delirium onset, duration of MV, and ICU length of stay (LOS) were evaluated as patient outcomes. MAIN RESULTS: Hypotheses regarding the inflammatory biomarkers were not supported based on confidence intervals. Twice-daily intervention was associated with reduced ICU LOS. Moderate-intensity (out-of-bed) ETM was associated with greater manual muscle test scores and handgrip strength and reduced occurrence of delirium. CONCLUSION: Findings from this study suggest that nurses can provide twice-daily mobility interventions that include sitting on the edge of the bed once patients have a stable status without altering a pro-inflammatory serum biomarker profile.
Authors: Chris Winkelman; Abdus Sattar; Hasina Momotaz; Kimberly D Johnson; Peter Morris; Sheryl Feeney; Alan Levine Journal: Crit Care Nurse Date: 2019-10 Impact factor: 1.708
Authors: Emily Anne Smith Bergbower; Cole Herbst; Nan Cheng; Alexander Aversano; Katherine Pasqualini; Cierra Hartline; Devorah Hamby-Finkelstein; Colin Brewer; Stephen Benko; Joseph Fuscaldo Journal: J Community Hosp Intern Med Perspect Date: 2020-09-03