Download PDF
intensiv 2016; 24(01): 26-31
DOI: 10.1055/s-0041-107575
CNE Schwerpunkt
Frühförderung
Georg Thieme Verlag KG Stuttgart · New York

Machbarkeit und Grenzen der Frühmobilisierung

Peter Nydahl
1   Universitätsklinikum Schleswig-Holstein, Campus Kiel, Brunswiker Str. 10, 24105 Kiel
,
Nils G. Margraf
2   UKSH, Campus Kiel, Arnold-Heller-Straße 3, Haus 41, Neurozentrum, 24105 Kiel
› Author Affiliations
Further Information

Publication History

Publication Date:
07 January 2016 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Ein Patient erkrankt an einem Guillain-Barré-Syndrom. Innerhalb kurzer Zeit erreichte die Krankheit ihr Maximum und der Patient war gerade noch in der Lage, seinen Unterkiefer zu bewegen. Kann er von einer möglichst frühen Mobilisation profitieren? Was kann man ihm zumuten? Wann nützt die Frühmobilisierung und wann schadet sie? Unser Autorenteam hat die Studienlage zum Thema gesichtet und präsentiert hier die Ergebnisse

 

  • Literatur

  • 1 Jackson JC, Santoro MJ, Ely TM et al. Improving patient care through the prism of psychology: application of Maslow’s hierarchy to sedation, delirium, and early mobility in the intensive care unit. J Crit Care 2014; 29 (3) 438-44
    CrossrefGoogle Scholar
  • 2 Karnatovskaia LV, Gajic O, Bienvenu OJ et al. A holistic approach to the critically ill and Maslow’s hierarchy. J Crit Care 2015; 30 (1) 210-1
    CrossrefGoogle Scholar
  • 3 Nydahl P, Hermes C, Schuchhardt D et al. Frühmobilisierung in Deutschland. Intensiv 2014; 22 (6) 309-315
    Article in Thieme ConnectGoogle Scholar
  • 4 Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin e. V.. Lagerungstherapie und Frühmobilisation zur Prophylaxe oder Therapie von pulmonalen Funktionsstörungen. Online unter www.awmf.org/leitlinien/detail/ll/001–015.html letzter Zugriff 22.09.2015
    Google Scholar
  • 5 Berry A, Beattie K, Bennett J. 2014; Physical Activity and Movement: a Guideline for Critically Ill Adults. Agency for Clinical Innovation NSW Government
    Google Scholar
  • 6 Adler J, Malone D. Early Mobilization in the Intensive Care Unit: A Systematic Review. Cardiopulmonary Physical Therapy Journal 2012; 23 (1) 5-13
    Google Scholar
  • 7 Li Z, Peng X, Zhu B et al. Active Mobilization for Mechanically Ventilated Patients: A Systematic Review. Archives of physical medicine and rehabilitation 2012; DOI: 10.1016/j.apmr. 2012.10.023.
    Google Scholar
  • 8 Stiller K. Physiotherapy in Intensive Care. An Updated Systematic Review. Chest 2013; 144 (3) 825-47
    CrossrefPubMedGoogle Scholar
  • 9 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; 41: 1543-54
    CrossrefPubMedGoogle Scholar
  • 10 Nydahl P, Shricharoenchai T, Chandra S et al. Safety of Patient Mobilization and Rehabilitation in the ICU: A Meta-Analysis. Critical Care Medicine 2015; submitted
    Google Scholar
  • 11 Muehling B, Schelzig H, Steffen P et al. A prospective randomized trial comparing traditional and fast-track patient care in elective open infrarenal aneurysm repair. World J Surg 2009; 33 (3) 577-85
    CrossrefGoogle Scholar
  • 12 Muehling BM, Halter G, Lang G et al. Prospective randomized controlled trial to evaluate „fast-track“ elective open infrarenal aneurysm repair. Langenbecks Arch Surg 2008; 393 (3) 281-7
    CrossrefGoogle Scholar
  • 13 Brummel NE, Girard TD, Ely EW et al. Feasibility and safety of early combined cognitive and physical therapy for critically ill medical and surgical patients: the Activity and Cognitive Therapy in ICU (ACT-ICU) trial. Intensive Care Med 2014; 40 (3) 370-9
    CrossrefPubMedGoogle Scholar
  • 14 Burtin C, Clerckx B, Robbeets C et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med 2009; 37 (9) 2499-505
    CrossrefPubMedGoogle Scholar
  • 15 Chen S, Su CL, Wu YT et al. Physical training is beneficial to functional status and survival in patients with prolonged mechanical ventilation. J Formos Med Assoc 2011; 110 (9) 572-9
    CrossrefGoogle Scholar
  • 16 Chen YH, Lin HL, Hsiao HF et al. Effects of exercise training on pulmonary mechanics and functional status in patients with prolonged mechanical ventilation. Respir Care 2012; 57 (5) 727-34
    CrossrefGoogle Scholar
  • 17 Chiang LL, Wang LY, Wu CP et al. Effects of physical training on functional status in patients with prolonged mechanical ventilation. Phys Ther 2006; 86 (9) 1271-1281
    CrossrefGoogle Scholar
  • 18 Delaney CP, Zutshi M, Senagore AJ et al. Prospective, randomized, controlled trial between a pathway of controlled rehabilitation with early ambulation and diet and traditional postoperative care after laparotomy and intestinal resection. Dis Colon Rectum 2003; 46 (7) 851-9
    CrossrefGoogle Scholar
  • 19 Medrinal C, Lebret M, Bousta M et al. Effets de la station assise au bord du lit du patient intubé et ventilé. Kinesither Rev 2013; 13 (138) 43-9
    Google Scholar
  • 20 Nava S. Rehabilitation of patients admitted to a respiratory intensive care unit. Arch Phys Med Rehabil 1998; 79: 849-54
    CrossrefGoogle Scholar
  • 21 Porta R, Vitacca M, Gilè LS et al. Supported arm training in patients recently weaned from mechanical ventilation. Chest 2005; 128 (4) 2511-20
    CrossrefGoogle Scholar
  • 22 Routsi C, Gerovasili V, Vasileiadis I et al. Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial. Crit Car 2010; 14: R74
    Google Scholar
  • 23 Schweickert WD, Pohlman MC, Pohlman AS et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 30; 373 (9678) 1874-82
    CrossrefPubMedGoogle Scholar
  • 24 Zanotti E, Felicetti G, Maini M et al. Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: Effect of electrical stimulation. Chest 2003; 124: 292-296
    CrossrefPubMedGoogle Scholar
  • 25 Berney S, Haines K, Skinner EH et al. Safety and feasibility of an exercise prescription approach to rehabilitation across the continuum of care for survivors of critical illness. Phys Ther 2012; 92 (12) 1524-35
    CrossrefGoogle Scholar
  • 26 Berney SC, Harrold M, Webb SA et al. Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc 2013; 15 (4) 260-5
    Google Scholar
  • 27 Clark DE, Lowman JD, Griffin RL et al. Effectiveness of an early mobilization protocol in a trauma and burns intensive care unit: a retrospective cohort study. Phys Ther 2013; 93 (2) 186-96
    CrossrefGoogle Scholar
  • 28 Clini EM, Crisafulli E, Antoni FD et al. Functional recovery following physical training in tracheotomized and chronically ventilated patients. Respir Care 2011; 56 (3) 306-13
    CrossrefGoogle Scholar
  • 29 Damluji A, Zanni JM, Mantheiy E et al. Safety and feasibility of femoral catheters during physical rehabilitation in the intensive care unit. J Crit Care 2013; 28 (4) 535.e9-15
    CrossrefGoogle Scholar
  • 30 Dinglas VD, Parker AM, Reddy DR et al. A quality improvement project sustainably decreased time to onset of active physical therapy intervention in patients with acute lung injury. Ann Am Thorac Soc 2014; 11 (8) 1230-8
    Google Scholar
  • 31 Hanekom S, Louw QA, Coetzee AR. Implementation of a protocol facilitates evidence-based physiotherapy practice in intensive care units. Physiotherapy 2013; 99: 139-145
    CrossrefGoogle Scholar
  • 32 Malkoc M, Karadibak D, Yildirim Y. The effect of physiotherapy on ventilatory dependency and the length of stay in an intensive care unit. Int J Rehabil Res 2009; 32 (1) 85-88
    CrossrefGoogle Scholar
  • 33 Martin UJ, Hincapie L, Nimchuk M et al. Impact of whole-body rehabilitation in patients receiving chronic mechanical ventilation. Crit Care Med 2005; 33 (10) 2259-65
    CrossrefGoogle Scholar
  • 34 Morris PE, Goad A, Thompson C et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008; 36 (8) 2238-43
    CrossrefPubMedGoogle Scholar
  • 35 Norrenberg M, De Backer D, Freidman G et al. Cardiovascular response to passive leg movement in critically ill patients. Clin Intensive Care 1999; 10 (1) 1-6
    CrossrefGoogle Scholar
  • 36 Nydahl P, Ruhl AP, Bartoszek G et al. Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med 2014; 42 (5) 1178-86
    CrossrefGoogle Scholar
  • 37 Sricharoenchai T, Parker AM, Zanni JM et al. Safety of physical therapy interventions in critically ill patients: a single-center prospective evaluation of 1110 intensive care unit admissions. J Crit Care 2014; 29 (3) 395-400
    CrossrefPubMedGoogle Scholar
  • 38 Stiller K, Phillips A, Lambert P. The safety of mobilisation and its effects on haemodynamics and respiratory status of intensive care patients. Physiother Theory Pract 2004; 20: 175-185
    CrossrefGoogle Scholar
  • 39 Thomsen GE, Snow GL, Rodriguez L et al. Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priority. Crit Care Med 2008; 36 (4) 1119-1124
    CrossrefPubMedGoogle Scholar
  • 40 Wang YT, Haines TP, Ritchie P et al. Early mobilization on continuous renal replacement therapy is safe and may improve filter life. Crit Care 2014; 28; 18 (4) R161
    CrossrefGoogle Scholar
  • 41 Yang PH, Wang CS, Wang YC et al. Outcome of physical therapy intervention on ventilator weaning and functional status. Kaohsiung J Med Sci 2010; 26 (7) 366-372
    CrossrefGoogle Scholar
  • 42 Zanni JM, Korupolu R, Fan E et al. Rehabilitation therapy and outcomes in acute respiratory failure: an observational pilot project. J Crit Care 2010; 25 (2) 254-62
    CrossrefPubMedGoogle Scholar
  • 43 Abrams D, Javidfar J, Farrand E et al. Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study. Crit Care 2014; 27; 18 (1) R38
    CrossrefGoogle Scholar
  • 44 Bailey P, Thomsen GE, Spuhler VJ et al. Early activity is feasible and safe in respiratory failure patients. Crit Care Med 2007; 35 (1) 139-45
    CrossrefPubMedGoogle Scholar
  • 45 Bourdin G, Jack Barbier J, Burle JF et al. The Feasibility of Early Physical Activity in Intensive Care Unit Patients: A Prospective Observational One-Center Study. Respir Care 2010; 55 (4) 400-407
    PubMedGoogle Scholar
  • 46 Chang AT, Boots RJ, Hodges PW et al. Standing with the assistance of a tilt table improves minute ventilation in chronic critically ill patients. Arch Phys Med Rehabil 2004; 85 (12) 1972-6
    CrossrefGoogle Scholar
  • 47 Bahadur K, Jones G, Ntoumenopoulos G. An observational study of sitting out of bed in tracheostomised patients in the intensive care unit. Physiotherapy 2008; 94: 300-305
    CrossrefGoogle Scholar
  • 48 Garzon-Serrano J, Ryan C, Waak K et al. Early mobilization in critically ill patients: patients’ mobilization level depends on health care provider’s profession. Phys Med Rehabil 2011; 3 (4) 307-313
    Google Scholar
  • 49 Genc A, Ozyurek S, Koca U et al. Respiratory and hemodynamic responses to mobilization of critically ill obese patients. Cardiopulm Phys Ther J 2012; 23 (1) 14-8
    Google Scholar
  • 50 Leditschke IA, Green M, Irvine J et al. What are the Barriers to Mobilizing Intensive Care Patients?. Cardiopulmonary Physical Therapy Journal 2012; 23 (1) 26-29
    Google Scholar
  • 51 Montagnani G, Vagheggini G, Panait Vlad E et al. Use of the Functional Independence Measure in people for whom weaning from mechanical ventilation is difficult. Phys Ther 2011; 91 (7) 1109-15
    CrossrefGoogle Scholar
  • 52 Needham DM, Korupolu R, Zanni JM et al. Early physical medicine and rehabilitation for patients with acute respiratory failure: A quality improvement project. Arch Phys Med Rehabil 2010; 91: 536-542
    CrossrefPubMedGoogle Scholar
  • 53 Olkowski BF, Devine MA, Slotnick LE et al. Safety and feasibility of an early mobilization program for patients with aneurysmal subarachnoid hemorrhage. Phys Ther 2013; 93 (2) 208-15
    CrossrefGoogle Scholar
  • 54 Perme C, Lettvin C, Throckmorton TA et al. Early Mobility and Walking for Patients with Femoral Arterial Catheters in Intensive Care Unit: a Case Series. J Acute Care Phys Ther 2011; 2 (1) 30-4
    Google Scholar
  • 55 Perme C, Nalty T, Winkelman C et al. Safety and Efficacy of Mobility Interventions in Patients with Femoral Catheters in the ICU: A Prospective Observational Study. Cardiopulm Phys Ther J 2013; 24 (2) 12-7
    Google Scholar
  • 56 Pohlman MC, Schweickert WD, Pohlman AS et al. Feasibility of physical and occupational therapy beginning from initiation of mechanical ventilation. Crit Care Med 2010; 38 (11) 2089-94
    CrossrefGoogle Scholar
  • 57 Thelandersson A, Cider A, Volkmann R. Cerebrovascular and systemic haemodynamic parameters during passive exercise. Adv Physiother 2010; 12 (1) 58-63
    CrossrefGoogle Scholar
  • 58 Thelandersson A, Volkmann R, Cider A. Blood flow velocity and vascular resistance during passive leg exercise in the critically ill patient. Clin Physiol Funct Imaging 2012; 32 (5) 338-42
    CrossrefGoogle Scholar
  • 59 Winkelman C, Johnson KD, Hejal R et al. Examining the positive effects of exercise in intubated adults in ICU: A prospective repeated measures clinical study. Intensive Crit Care Nurs 2012; 28 (6) 307-18
    CrossrefGoogle Scholar
  • 60 Hashim AM, Joseph LH, Embong J et al. Tilt table practice improved ventilation in a patient with prolonged artificial ventilation support in intensive care unit. Iran J Med Sci 2012; 37 (1) 54-7
    Google Scholar
  • 61 Kho ME, Damluji A, Zanni JM et al. Feasibility and observed safety of interactive video games for physical rehabilitation in the intensive care unit: a case series. J Crit Care 2012; 27 (2) 219.e1-6
    CrossrefGoogle Scholar
  • 62 Nordon-Craft A, Schenkman M, Edbrooke L et al. The physical function intensive care test: implementation in survivors of critical illness. Phys Ther 2014; 94 (10) 1499-507 Skinner, 2009, Australien
    CrossrefGoogle Scholar
  • 63 Skinner EH, Berney S, Warrillow S et al. Development of a physical function outcome measure (PFIT) and a pilot exercise training protocol for use in intensive care. Crit Care Resusc 2009; 11 (2) 110-115
    Google Scholar
  • 64 Zafiropoulos B, Alison JA, McCarren B. Physiological responses to the early mobilisation of the intubated, ventilated abdominal surgery patient. Aust J Physiother 2004; 50 (2) 95-100
    CrossrefGoogle Scholar
  • 65 Titsworth WL, Hester J, Correia T et al. The effect of increased mobility on morbidity in the neurointensive care unit. J Neurosurg 2012; 116 (6) 1379-88
    CrossrefGoogle Scholar
  • 66 Klein K, Mulkey M, Bena JF et al. Clinical and psychological effects of early mobilization in patients treated in a neurologic ICU: a comparative study. Crit Care Med 2015; 43 (4) 865-73
    CrossrefGoogle Scholar
  • 67 Witcher R, Stoerger L, Dzierba AL et al. Effect of early mobilization on sedation practices in the neurosciences intensive care unit: A preimplementation and postimplementation evaluation. J Crit Care 2015; 30 (2) 344-7
    CrossrefGoogle Scholar
  • 68 Khan F. Rehabilitation in Guillian Barre syndrome. Aust Fam Physician 2004; 33 (12) 1013-7
    Google Scholar
  • 69 van Doorn PA, Ruts L, Jacobs BC. Clinical features, pathogenesis, and treatment of Guillain-Barré syndrome. Lancet Neurol 2008; 7 (10) 939-50
    CrossrefPubMedGoogle Scholar
  • 70 Zergiebel D, Dassen H. Vom Kickboxer zum Beatmungspatient. Intensiv 2015; 23 (1) 35-41
    Article in Thieme ConnectGoogle Scholar
  • 71 Dhar R, Stitt L, Hahn AF. The morbidity and outcome of patients with Guillain-Barré syndrome admitted to the intensive care unit. J Neurol Sci 15.01.2008; 264 (1–2) 121-8
    CrossrefGoogle Scholar
  • 72 Mullings KR, Alleva JT, Hudgins TH. Rehabilitation of Guillain-Barré syndrome. Dis Mon 05/2010; 56 (5) 288-92
    CrossrefGoogle Scholar
  • 73 Borg G. Anstrengungsempfinden und körperliche Aktivität. Dtsch Ärztebl 2004; 101 (15) 1016-1021
    Google Scholar
  • 74 AVERT Trial Collaboration group. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 2015; 4; 386 (9988) 46-55
    CrossrefGoogle Scholar
  • 75 Nydahl P, Dewes M, Dubb R et al. Netzwerk Frühmobilisierung. Frühmobilisierung – Zuständigkeiten, Verantwortungen, Meilensteine. Med Klin Intensivmed Notfmed 2015; DOI: 10.1007/s00063–015-0073–4.
    Google Scholar