Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 152 No. 0304 (2022)

Early mobilisation and rehabilitation in Swiss intensive care units: a cross-sectional survey

  • Yuki Tomonaga
  • Dominik Menges
  • Henock G. Yebyo
  • Thierry Fumeaux
  • Antje Heise
  • Conrad Wesch
  • Matthias Schwenkglenks
  • Milo A. Puhan
DOI
https://doi.org/10.4414/SMW.2022.w30125
Cite this as:
Swiss Med Wkly. 2022;152:w30125
Published
28.01.2022

Summary

BACKGROUND: Patients in intensive care units (ICUs) are at high risk of developing physical, functional, cognitive, and mental impairments. Early mobilisation aims to improve patient outcomes and is increasingly considered the standard of care. This survey aimed to investigate the characteristics, current use and variations of early mobilisation and rehabilitation in Swiss ICUs.

METHODS: We conducted a cross-sectional survey among all ICU lead physicians, who provided data on their institutional characteristics, early mobilisation and rehabilitation practices, and their perceptions of the use and variation of early rehabilitation practices in Switzerland.

RESULTS: The survey response rate was 44% (37/84). Among ICUs caring for adults (34/37), 26 were in the German-speaking region, five in the French-speaking region, and three in the Italian-speaking region. All ICUs regularly involved physiotherapy in the rehabilitation process and 50% reported having a specialised physiotherapy team. All ICUs reported performing early mobilisation, starting within the first 7 days after ICU admission. About half reported the use of a rehabilitation (45%) or early mobilisation protocol (50%). Regular, structured, interdisciplinary rounds or meetings of the ICU care team to discuss rehabilitation measures and goals for patients were stated to be held by 53%.

The respondents stated that 82% of their patients received early mobilisation measures during their ICU stay. Most frequently provided mobilisation measures included passive range of motion (97%), passive chair position in bed (97%), active range of motion muscle activation and training (88%), active side to side turning (91%), sitting on the edge of the bed (94%), transfer from bed to a chair (97%), and ambulation (94%). The proportion of ICUs providing a specific early mobilisation measure, the proportion of patients receiving it, and the time dedicated to it varied across language regions, hospital types, ICU types, and ICU sizes.

Almost one third of the ICU lead physicians considered early rehabilitation to be underused in their own ICU and about half considered it to be underused in Switzerland more generally. ICU lead physicians stressed lack of personnel, financial resources, and time as key causes for underuse. Moreover, they highlighted the importance of early and systematic or protocol-based rehabilitation and interprofessional approaches that are adaptive to the patients' rehabilitation needs and potential.

CONCLUSION: This survey suggests that almost all ICUs in Switzerland practice some form of early mobilisation with the aim of early rehabilitation. However, the described approaches, as well as the reported use of early mobilisation measures were heterogenous across Swiss ICUs.

References

  1. Rengel KF, Hayhurst CJ, Pandharipande PP, Hughes CG. Long-term Cognitive and Functional Impairments After Critical Illness. Anesth Analg. 2019 Apr;128(4):772–80. https://doi.org/10.1213/ANE.0000000000004066
  2. Rydingsward JE, Horkan CM, Mogensen KM, Quraishi SA, Amrein K, Christopher KB. Functional Status in ICU Survivors and Out of Hospital Outcomes: A Cohort Study. Crit Care Med. 2016 May;44(5):869–79. https://doi.org/10.1097/CCM.0000000000001627
  3. Koester K, Troeller H, Panter S, Winter E, Patel JJ. Overview of Intensive Care Unit-Related Physical and Functional Impairments and Rehabilitation-Related Devices. Nutr Clin Pract. 2018 Apr;33(2):177–84. https://doi.org/10.1002/ncp.10077
  4. Hashem MD, Parker AM, Needham DM. Early Mobilization and Rehabilitation of Patients Who Are Critically Ill. Chest. 2016 Sep;150(3):722–31. https://doi.org/10.1016/j.chest.2016.03.003
  5. Hofhuis JG, Spronk PE, van Stel HF, Schrijvers GJ, Rommes JH, Bakker J. The impact of critical illness on perceived health-related quality of life during ICU treatment, hospital stay, and after hospital discharge: a long-term follow-up study. Chest. 2008 Feb;133(2):377–85. https://doi.org/10.1378/chest.07-1217
  6. Oeyen SG, Vandijck DM, Benoit DD, Annemans L, Decruyenaere JM. Quality of life after intensive care: a systematic review of the literature. Crit Care Med. 2010 Dec;38(12):2386–400. https://doi.org/10.1097/CCM.0b013e3181f3dec5
  7. Villa P, Pintado MC, Luján J, González-García N, Trascasa M, Molina R, et al.; Functional Status and Quality of Life in Elderly Intensive Care Unit Survivors. Functional Status and Quality of Life in Elderly Intensive Care Unit Survivors. J Am Geriatr Soc. 2016 Mar;64(3):536–42. https://doi.org/10.1111/jgs.14031
  8. Trivedi V, Bleeker H, Kantor N, Visintini S, McIsaac DI, McDonald B. Survival, Quality of Life, and Functional Status Following Prolonged ICU Stay in Cardiac Surgical Patients: A Systematic Review. Crit Care Med. 2019 Jan;47(1):e52–63. https://doi.org/10.1097/CCM.0000000000003504
  9. Fuke R, Hifumi T, Kondo Y, Hatakeyama J, Takei T, Yamakawa K, et al. Early rehabilitation to prevent postintensive care syndrome in patients with critical illness: a systematic review and meta-analysis. BMJ Open. 2018 May;8(5):e019998. https://doi.org/10.1136/bmjopen-2017-019998
  10. Kayambu G, Boots R, Paratz J. Physical therapy for the critically ill in the ICU: a systematic review and meta-analysis. Crit Care Med. 2013 Jun;41(6):1543–54. https://doi.org/10.1097/CCM.0b013e31827ca637
  11. Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J. 2012 Mar;23(1):5–13. https://doi.org/10.1097/01823246-201223010-00002
  12. Cameron S, Ball I, Cepinskas G, Choong K, Doherty TJ, Ellis CG, et al. Early mobilization in the critical care unit: A review of adult and pediatric literature. J Crit Care. 2015 Aug;30(4):664–72. https://doi.org/10.1016/j.jcrc.2015.03.032
  13. Castro-Avila AC, Serón P, Fan E, Gaete M, Mickan S. Effect of early rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis. PLoS One. 2015 Jul;10(7):e0130722. https://doi.org/10.1371/journal.pone.0130722
  14. Doiron KA, Hoffmann TC, Beller EM. Early intervention (mobilization or active exercise) for critically ill adults in the intensive care unit. Cochrane Database Syst Rev. 2018 Mar;3(12):CD010754. https://doi.org/10.1002/14651858.CD010754.pub2
  15. Zhang L, Hu W, Cai Z, Liu J, Wu J, Deng Y, et al. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis. PLoS One. 2019 Oct;14(10):e0223185. https://doi.org/10.1371/journal.pone.0223185
  16. Menges D, Seiler B, Tomonaga Y, Schwenkglenks M, Puhan MA, Yebyo HG. Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Crit Care. 2021 Jan;25(1):16. https://doi.org/10.1186/s13054-020-03446-9
  17. 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. 2020 Jan;35(1):55–62. https://doi.org/10.1177/0885066617728486
  18. Bakhru RN, McWilliams DJ, Wiebe DJ, Spuhler VJ, Schweickert WD ; Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey. Ann Am Thorac Soc. 2016 Sep;13(9):1527–37. https://doi.org/10.1513/AnnalsATS.201601-078OC
  19. 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 May;42(5):1178–86. https://doi.org/10.1097/CCM.0000000000000149
  20. Berney SC, Harrold M, Webb SA, Seppelt I, Patman S, Thomas PJ, et al. Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc. 2013 Dec;15(4):260–5.
  21. Jolley SE, Moss M, Needham DM, Caldwell E, Morris PE, Miller RR, et al.; Acute Respiratory Distress Syndrome Network Investigators. Point Prevalence Study of Mobilization Practices for Acute Respiratory Failure Patients in the United States. Crit Care Med. 2017 Feb;45(2):205–15. https://doi.org/10.1097/CCM.0000000000002058
  22. Widmer M, Matter P, Staub L, Schoeni-Affolter F, Busato A. Regional variation in orthopedic surgery in Switzerland. Health Place. 2009 Sep;15(3):761–8. https://doi.org/10.1016/j.healthplace.2008.12.009
  23. Matter-Walstra KW, Achermann R, Rapold R, Klingbiel D, Bordoni A, Dehler S, et al. Delivery of health care at the end of life in cancer patients of four swiss cantons: a retrospective database study (SAKK 89/09). BMC Cancer. 2014 May;14(1):306. https://doi.org/10.1186/1471-2407-14-306
  24. Busato A, Widmer M, Matter P. Variation in incidence of orthopaedic surgery between populations with basic or basic plus supplementary health insurance in Switzerland. Swiss Med Wkly. 2011 Feb;141:w13152. https://doi.org/10.4414/smw.2011.13152
  25. Ulyte A, Wei W, Dressel H, Gruebner O, von Wyl V, Bähler C, et al. Variation of colorectal, breast and prostate cancer screening activity in Switzerland: influence of insurance, policy and guidelines. PLoS One. 2020 Apr;15(4):e0231409. https://doi.org/10.1371/journal.pone.0231409
  26. Wei W, Ulyte A, Gruebner O, von Wyl V, Dressel H, Brüngger B, et al. Degree of regional variation and effects of health insurance-related factors on the utilization of 24 diverse healthcare services - a cross-sectional study. BMC Health Serv Res. 2020 Nov;20(1):1091. https://doi.org/10.1186/s12913-020-05930-y
  27. Lynch EA, Cadilhac DA, Luker JA, Hillier SL. Inequities in access to inpatient rehabilitation after stroke: an international scoping review. Top Stroke Rehabil. 2017 Dec;24(8):619–26. https://doi.org/10.1080/10749357.2017.1366010
  28. Menges D, Yebyo H, Tomonaga Y, Seiler B, Puhan MA, Schwenkglenks M. Systematic early rehabilitation in adult, mechanically ventilated intensive care patients, (2020). https://www.swissmedicalboard.ch
  29. Swiss Society of Intensive Care (SGI-SSMI-SSMI). (n.d.). https://www.sgi-ssmi.ch/it/home.html
  30. Swiss Society of Intensive Care (SGI-SSMI-SSMI) - Minimale Datensatz der SGI (MDSi). Aktuelle Kennzahlen aus dem Minimalen Datensatz der SGI (MDSi) - Stand 10.06.2019. https://www.sgi-ssmi.ch/de/datensatz.html (accessed 28 Aug 2019)., (n.d.).
  31. COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med. 2020;•••:1–14. https://doi.org/10.1007/s00134-020-06294-x
  32. Swiss Academy Of Medical Sciences. COVID-19 pandemic: triage for intensive-care treatment under resource scarcity. Swiss Med Wkly. 2020 Mar;150:w20229. https://doi.org/10.4414/smw.2020.20229
  33. Tyrrell CS, Mytton OT, Gentry SV, Thomas-Meyer M, Allen JL, Narula AA, et al. Managing intensive care admissions when there are not enough beds during the COVID-19 pandemic: a systematic review. Thorax. 2020; https://doi.org/10.1136/thoraxjnl-2020-215518
  34. Swiss Academy Of Medical Sciences. COVID-19 pandemic: triage for intensive-care treatment under resource scarcity (3rd, updated version). Swiss Med Wkly. 2020 Nov;150:w20401. https://doi.org/10.4414/smw.2020.20401
  35. Swiss Society Of Intensive Care Medicine. Recommendations for the admission of patients with COVID-19 to intensive care and intermediate care units (ICUs and IMCUs). Swiss Med Wkly. 2020 Mar;150:w20227. https://doi.org/10.4414/smw.2020.20227
  36. de Lange DW, Soares M, Pilcher D. ICU beds: less is more? No. Intensive Care Med. 2020 Aug;46(8):1597–9. https://doi.org/10.1007/s00134-020-06089-0
  37. Suter P, Pargger H. Strong second COVID-19 wave calls for a second look at ICU triage guidelines. Swiss Med Wkly. 2020 Nov;150:w20407. https://doi.org/10.4414/smw.2020.20407

Most read articles by the same author(s)

1 2 3 4 > >>