在心胸重症监护病房中使用心室辅助装置和体外膜肺氧合装置促进渐进性活动
Promotion of progressive mobility activities with ventricular assist and extracorporeal membrane oxygenation devices in a cardiothoracic intensive care unit.
作者信息
Chavez Jennifer, Bortolotto Shannon Johnson, Paulson Martha, Huntley Nicole, Sullivan Breandan, Babu Ashok
机构信息
Jennifer Chavez, MSN, RN, CCRN-CSC, is a level III staff nurse, Evidence Based Practice and Progressive Mobility Nurse Champion in Cardiothoracic Intensive Care Unit. Her clinical interests include translating evidence into practice related to cardiovascular surgery. Shannon Johnson Bortolotto, MS, RN, APN, CCNS, is a critical care clinical nurse specialist. Her clinical interests include incorporating best practices into updated bedside care. Ms Bortolotto's quality improvement initiatives include awakening trials, delirium, progressive mobility, and care of the septic patient. Research interests include gathering data on the patient experience while intubated. Martha Paulson, MSN, RN, CCRN, is a cardiothoracic intensive care unit nurse manager. Her clinical interests include promoting staff engagement and problem solving to improve patient outcomes. Nicole Huntley, BSN, RN, is a level III staff nurse in the surgical intensive care unit. Her clinical interests include nursing interventions to decrease patient falls while promoting safe mobility. Breandan Sullivan, MD, is an assistant professor at the Department of Anesthesiology and Critical Care Medicine and co -medical director of the cardiothoracic intensive care unit. Dr Sullivan's clinical interests include quality improvement, decreasing delirium, and improving multidisciplinary collaboration in cardiovascular surgery. Ashok Babu, MD, is an assistant professor at the Division of Cardiothoracic Surgery. Dr Babu's clinical interests include various clinical publications and research related to cardiovascular surgery.
出版信息
Dimens Crit Care Nurs. 2015 Nov-Dec;34(6):348-55. doi: 10.1097/DCC.0000000000000141.
BACKGROUND
Progressive mobility (PM) is a clinical intervention that influences complications experienced throughout critical illness. Early PM is a relevant topic in critical care practice literature and was principle to introducing a PM care guideline in an acute cardiothoracic/cardiovascular intensive care unit.
PURPOSE
A noted challenge in the cardiothoracic/cardiovascular intensive care unit is caring for acute cardiac and pulmonary failure. Often, these patients require prolonged mechanical circulatory support via extracorporeal mechanical oxygenation or a ventricular assist device. This article describes safe and effective progressive mobilization for patients experiencing MCS in a case study format. This article also highlights how a multidisciplinary clinical team supports mobility practice in specific critical care roles.
CONCLUSIONS
Post-intensive care syndrome is composed of various health implications that occur following critical illness. Recent data suggest improved care outcomes when critically ill patients are awake and participate in active physical rehabilitation as early as clinically possible. The case studies presented indicate that mobility, to the point of ambulation, is a feasible clinical expectation when patients present with substantial acute respiratory and cardiac failure and are managed with MCS.
CLINICAL IMPLICATIONS
Development of a PM guideline uses a critical appraisal of practice evidence, highlights multidisciplinary collaboration, and increases progression to ambulation. Mobility for complex patients is attainable, as demonstrated in the postguideline outcomes. The PM guideline provides structure to primary caregivers and promotes safe practices. The PM guideline facilitates an advanced level of care, promotes safe practices, champions holistic recovery, and encourages active patient involvement, goals satisfying to both patients and staff.
背景
渐进性活动（PM）是一种临床干预措施，会影响危重症患者在整个病程中出现的并发症。早期PM是危重症护理实践文献中的一个相关话题，也是在急性心胸/心血管重症监护病房引入PM护理指南的原则。
目的
心胸/心血管重症监护病房面临的一个显著挑战是护理急性心功能和肺功能衰竭患者。通常，这些患者需要通过体外膜肺氧合或心室辅助装置进行长时间的机械循环支持。本文以案例研究的形式描述了接受机械循环支持（MCS）的患者进行安全有效的渐进性活动的方法。本文还强调了多学科临床团队如何在特定的危重症护理角色中支持活动实践。
结论
重症后综合征由危重症后出现的各种健康问题组成。最近的数据表明，危重症患者在临床条件允许的情况下尽早清醒并参与积极的身体康复，护理效果会更好。所呈现的案例研究表明，对于患有严重急性呼吸和心力衰竭并接受MCS治疗的患者，达到能够行走程度的活动是一个可行的临床期望。
临床意义
制定PM指南需要对实践证据进行严格评估，突出多学科协作，并增加向行走的进展。如指南发布后的结果所示，复杂患者的活动是可以实现的。PM指南为初级护理人员提供了框架，并促进了安全实践。PM指南有助于提高护理水平，促进安全实践，倡导全面康复，并鼓励患者积极参与，这些目标对患者和工作人员都很有意义。
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