Dirkes Susan M, Kozlowski Charles
Susan M. Dirkes and Charles Kozlowski are staff nurses at the University of Michigan hospital, Ann Arbor, Michigan.
Crit Care Nurse. 2019 Jun;39(3):33-42. doi: 10.4037/ccn2019654.
Early mobility is an element of the ABCDEF bundle designed to improve outcomes such as ventilator-free days and decreased length of stay. Evidence indicates that adherence to an early mobility protocol can prevent delirium and reduce length of stay in the intensive care unit and the hospital and may decrease length of stay in a rehabilitation facility. Yet many barriers exist to implementing early mobility effectively, including patient acuity, uncertainty about when to start mobilizing the patient, staffing and equipment needs, increased costs, and limited nursing time. Implementation of early mobility requires interdisciplinary collaboration, commitment, and tools that facilitate mobility and prevent injury to nurses. This article focuses on aspects of care that can affect patient outcomes, such as preventing delirium, reducing sedation, monitoring the patient's ability to wean from the ventilator, and encouraging early mobility. It also addresses the effects of immobility as well as challenges in achieving mobility and how to overcome them.
早期活动是ABCDEF集束化治疗方案的一个组成部分，旨在改善诸如无呼吸机天数和缩短住院时间等预后指标。有证据表明，遵循早期活动方案可预防谵妄，并缩短重症监护病房和医院的住院时间，还可能缩短康复机构的住院时间。然而，有效实施早期活动存在许多障碍，包括患者病情严重程度、开始让患者活动的时机不确定性、人员配备和设备需求、成本增加以及护理时间有限。实施早期活动需要跨学科协作、投入以及有助于活动并防止护士受伤的工具。本文重点关注可能影响患者预后的护理方面，如预防谵妄、减少镇静、监测患者脱机能力以及鼓励早期活动。它还讨论了不动的影响以及实现活动的挑战和如何克服这些挑战。
