Critical care nursing quarterly
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Historically, intensive care cardiac surgery patients remained on bed rest for several days postoperatively to prevent complications and promote rest and healing. Over time, the cardiac surgery discipline has acknowledged the benefits of early mobility, including reduced risk of venous thromboembolism and pulmonary emboli, improved pulmonary toilet, prevention of pneumonia, decreased length of stay, reduced deconditioning, and need for rehabilitation, among others advantages. These benefits have changed clinical practice, with emphasis on early extubation, progressive mobility, and reduced lengths of stay. ⋯ Postoperative day 1 entails transferring from the bed to the chair 2 to 3 times and, if feasible, ambulation in the room and hallway. Patients with pulmonary artery catheters, arterial lines, chest tubes, and mechanical circulatory support devices are included in early progressive mobility to prevent postoperative complications. This article will discuss early progressive mobility in cardiovascular intensive care unit patients, with a focus on specific considerations for patients post-cardiac surgery and those with mechanical circulatory support devices.
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Human skeletal muscles are continually remodeled to match the function required of them. Diameter, strength, and vascular supply are altered when a muscle group experiences contraction and resistance. The purpose of this article is to describe selected muscle signaling pathways that contribute to muscle remodeling. ⋯ Activating signaling pathways may promote preservation of muscle mass and function. Interventions to prevent muscle atrophy have potential to reduce ICU-acquired weakness and positively affect quality of life in survivors after ICU hospitalization. Exploring information generated by genomic and proteomic investigations about muscle signaling pathways can help the ICU clinician evaluate the benefits and risks of interventions to maintain muscle health early in critical illness.
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Mobilizing critically ill patients in the intensive care unit requires careful planning and attention to detail. The risks involved in mobilizing these patients include dislodging equipment, injury to the patient, injury to the caregivers, and physiologic decompensation of the patient. ⋯ There are simple pieces of equipment, already available in the intensive care unit, which can be used to accomplish the mobility goals safely in all patient populations. This article explores how standard hospital equipment can be used to improve patient activity and performance and minimize risk.
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The safety and efficacy of mobility programs for the ventilated patient and the ability to improve outcomes related to immobility of the critically ill are well documented in the literature. Early mobility programs have been proven safe and effective in study. ⋯ Early mobility targets ventilated patients upon admission to ensure that interventions are performed that promote physical therapy at first possible moment. In order to accomplish this innovation, evidence-based practice was used to guide culture change in an intensive care unit and build partnerships among disciplines that worked to achieve the same goals independently.
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As advances in research and technology expand our ability to optimize the short-term outcomes in critical illness, survivors are often left with long-term functional impairments. The complications of bed rest can be nearly as devastating as the illness itself. Prolonged periods of immobility during the acute phase of illness have been linked to severe weakness, self-care deficits, poor quality of life, and mortality in patients up to 5 years after discharge from the intensive care unit. ⋯ Family engagement has been suggested to provide added opportunities for education and tangible knowledge about the patient's condition. Such an approach may be the fuel in motivating patients and families toward a meaningful recovery. Therefore, this article describes the process of incorporating family into an intensive care unit early, progressive, mobility protocol.