Mobilisation auf Intensivstationen: Intensivpflegezimmer und Medizintechnik können helfen

Zusammenfassung

(Früh-)Mobilisation ist ein wichtiges Element auf der Intensivstation – es dient der Prävention und Therapie der durch eine kritische Erkrankung verursachten Einschränkungen der körperlichen Funktion. Aufgrund diverser Barrieren werden die aktuellen Leitlinien-Ziele aber nicht immer erreicht. In diesem Beitrag geht es um die Integration des Intensivpflegezimmers und moderner Medizintechnik in die Frühmobilisation zur Überwindung dieser Barrieren.

Abstract

Intensive Care Unit patients frequently develop physical impairments, mainly weakness, during their ICU stay. Early mobilization is a central therapeutic element in patients on an intensive care unit to prevent and treat these physical sequelae to conserve independence. Different barriers such as lacking patient motivation, insufficient staffing and fear of dislocating vascular access or the airway led to insufficient implementation of current guideline recommendation. Integration of modern medical equipment as well as the adequate ICU room concepts is a promising option to overcome those barriers.

Allowing for sufficient free floor area when planning an ICU – maybe through the integration of mobile elements – is likely to ease early mobilization and should be thoroughly considered when building or remodeling an ICU. Furthermore, wireless monitoring has been deemed necessary and could potentially decrease the fear regarding dislocation due to less cable or lines that need to be managed during mobilization.

Virtual reality is a rapidly evolving field and while in ICU patients it could so far only show to reduce stress level it has been shown to improve rehabilitation in stroke patients. It is imaginable that its integration in mobilization on the ICU will boost patientsʼ motivation. Trials are still outstanding.

Robotics integrated in the ICU bed or in form of exoskeletons are currently being piloted in critically ill patients with many expected benefits due to the ability to support patients tailored to their individual needs, reduce staff requirements as the robotics will cover support function and improved duration and intensity of mobilization as for example the patient can be ambulated without ever leaving the bed, which also translates into potentially reduced fear regarding dislocation of the airway or vascular access.

Currently, evidence on the benefits regarding the integration of ICU rooms as well as modern medical technology into the process of (early) mobilization is lacking but especially in the sector of robotics a huge potential is to be suspected.

Kernaussagen

• (Früh-)Mobilisation ist sicher und für Patient*innen auf der Intensivstation empfohlen.

• Häufige Barrieren für die (Früh-)Mobilisation sind fehlende Motivation der Patient*innen, limitierte Personalressourcen und die Sorge vor Dislokationen, z. B. des Atemwegs, verschiedener Gefäßzugänge oder anderer Katheter.

• (Früh-)Mobilisation sollte bei der Planung einer Intensivstation bedacht werden und die freie Fläche in den Behandlungszimmern dementsprechend optimiert werden.

• Die Integration von Virtual Reality in die (Früh-)Mobilisation von Intensivstationspatient*innen ist eine vielversprechende Option für die Zukunft.

• Die Nutzung von Robotik im Rahmen der (Früh-)Mobilisation hat das Potenzial, viele der vorhandenen Barrieren zu adressieren und darüber die (Früh-)Mobilisationspraxis zu verbessern.

• Zum aktuellen Zeitpunkt fehlt die Evidenz zum Einfluss der freien Fläche im Behandlungszimmer sowie der Nutzung von Virtual Reality und Robotik auf die (Früh-)Mobilisation bei kritisch kranken Patient*innen.

Schlüsselwörter

Behandlungszimmer - Exoskelett - (Früh-)Mobilisation - Robotik - Virtual Reality

Key words

early ambulation - robotics - virtual reality - exoskeletons - ICU concepts

Publication History

Article published online:
12 January 2022

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