Booth Kathryn, Rivet Josh, Flici Richelle, Harvey Ellen, Hamill Mark, Hundley Douglas, Holland Katelyn, Hubbard Sandra, Trivedi Apurva, Collier Bryan
Carilion Roanoke Memorial Hospital, Roanoke, Virginia (Mss Booth, Flici, Holland, and Hubbard; Drs Rivet, Harvey, Hamill, Collier, and Trivedi; and Mr Hundley); and Virginia Tech Carilion School of Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia (Dr Collier).
J Trauma Nurs. 2016 Sep-Oct;23(5):284-9. doi: 10.1097/JTN.0000000000000234.
The intensive care unit (ICU) trauma population is at high risk for complications associated with immobility. The purpose of this project was to compare ICU trauma patient outcomes before and after implementation of a structured progressive mobility (PM) protocol. Outcomes included hospital and ICU stays, ventilator days, falls, respiratory failure, pneumonia, or venous thromboembolism (VTE). In the preintervention cohort, physical therapy (PT) consults were placed 53% of the time. This rose to more than 90% during the postintervention period. PT consults seen within 24 hr rose from a baseline 23% pre- to 74%-94% in the 2 highest compliance postintervention months. On average, 40% of patients were daily determined to be too unstable for mobility per protocol guidelines-most often owing to elevated intracranial pressure. During PM sessions, there were no adverse events (i.e., extubation, hypoxia, fall). There were no significant differences in clinical outcomes between the 2 cohorts regarding hospital and ICU stays, average ventilator days, mortality, falls, respiratory failure, or pneumonia overall or within ventilated patients specifically. There was, however, a difference in the incidence of VTE between the preintervention cohort (21%) and postintervention cohort (7.5%) (p = .0004). A PM protocol for ICU trauma patients is safe and may reduce patient deconditioning and VTE complications in this high-risk population. Multidisciplinary commitment, daily protocol reinforcement, and active engagement of patients/families are the cornerstones to success in this ICU PM program.
重症监护病房（ICU）的创伤患者发生与活动受限相关并发症的风险很高。本项目的目的是比较结构化渐进性活动（PM）方案实施前后ICU创伤患者的预后。预后指标包括住院时间和ICU停留时间、呼吸机使用天数、跌倒、呼吸衰竭、肺炎或静脉血栓栓塞（VTE）。在干预前的队列中，物理治疗（PT）会诊的安排率为53%。在干预后的时期，这一比例上升到了90%以上。在干预后依从性最高的两个月中，24小时内接受PT会诊的比例从基线时的23%上升到了74%-94%。根据方案指南，平均有40%的患者每天被判定因过于不稳定而无法活动——最常见的原因是颅内压升高。在PM疗程期间，没有发生不良事件（即拔管、缺氧、跌倒）。在住院时间和ICU停留时间、平均呼吸机使用天数、死亡率、跌倒、呼吸衰竭或肺炎方面，两个队列的总体临床预后或具体在使用呼吸机的患者中均无显著差异。然而，干预前队列（21%）和干预后队列（7.5%）的VTE发生率存在差异（p = 0.0004）。针对ICU创伤患者的PM方案是安全的，并且可能减少这一高危人群的身体机能衰退和VTE并发症。多学科协作、每日强化方案以及患者/家属的积极参与是这个ICU PM项目成功的基石。
