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Frühmobilisierung

Zuständigkeiten, Verantwortungen, Meilensteine

Early mobilization

Competencies, responsibilities, milestones

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Zusammenfassung

Hintergrund

Frühmobilisation ist ein evidentes und interprofessionelles Konzept zur Verbesserung der Ergebnisse einer Intensivbehandlung. Es reduziert psychokognitive Defizite, Delirien sowie ein generelles „deconditioning“, das eine Atrophie der muskulären Atempumpe und der Skelettmuskeln beinhaltet. Dabei ist ein interdisziplinäres Vorgehen unter Berücksichtigung von Mobilisationsstufen aus Sicht der Autoren vorteilhaft. Ziel der Arbeit war es, die Ansichten über die Zusammenarbeit und Zuständigkeiten der beteiligten Berufsgruppen zu explorieren.

Methode

Mittels eines schriftlichen Fragebogens wurde während des 25. Symposiums für Intensivmedizin und Intensivpflege in Bremen am 20.2.2015 eine Umfrage bei 120 Teilnehmern der Sitzung des deutschen Netzwerks Frühmobilisation durchgeführt.

Ergebnisse

Die 102 ausgewerteten Bögen ergaben, dass die meisten Antwortenden zwar der Ansicht sind, Frühmobilisierung basiere auf interprofessioneller Zusammenarbeit, aber nur wenige Aufgaben und Verantwortungen im Kontext der Frühmobilisierung wurden klar einer Berufsgruppe zugeordnet. Meistens würden für die praktische Umsetzung einer Mobilisation von beatmeten Patienten 2 Pflegende sowie ein Physiotherapeut benötigt. Die Umsetzung in der Praxis erfolgt heterogen.

Schlussfolgerung

Es gibt keinen Konsens bezüglich der Zusammenarbeit, Zuständigkeit und Verantwortungen in der Frühmobilisierung von Intensivpatienten. Das bisherige nicht immer von interprofessioneller Kommunikation getragene Arbeiten kann dazu führen, dass vielfältiges Wissen und Erfahrungen der unterschiedlichen Professionen nicht effizient genug eingesetzt werden.

Abstract

Background

Early mobilization is an evident, interprofessional concept to improve the outcome of intensive care patients. It reduces psychocognitive deficits and delirium and attenuates a general deconditioning, including atrophy of the respiratory pump and skeletal muscles. In this regard the interdisciplinary approach of early mobilization, taking into account different levels of mobilization, appears to be beneficial. The purpose of this study was to explore opinions on collaboration and tasks between different professional groups.

Method

During the 25th Bremen Conference on Intensive Medicine and Nursing on 20 February 2015, a questionnaire survey was carried out among the 120 participants of the German Early Mobilization Network meeting.

Results

In all, 102 questionnaires were analyzed. Most participants reported on the interdisciplinarity of the approach, but none of the tasks and responsibilities concerning early mobilization can be assigned to a single professional group. The practical implementation of mobilizing orally intubated patients may require two registered nurses as well as a physical therapist. Implementation in daily practice seems to be heterogeneous.

Conclusions

There is no consensus regarding collaboration, competencies, and responsibilities with respect to early mobilization of intensive care patients. The approach to date has been characterized by a lack of interprofessional communication, which may lead to an inefficient use of the broad and varied base of knowledge and experienceof the different professions.

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Notes

  1. Es sind stets Personen aller Geschlechter gemeint. Zur besseren Lesbarkeit wurde die männliche Form gewählt.

Literatur

  1. Abrams D, Javidfar J, Farrand E, Mongero LB, Agerstrand CL, Ryan P, Zemmel D, Galuskin K, Morrone TM, Boerem P, Bacchetta M, Brodie D (2014) Early mobilization of patients receiving extracorporeal membrane oxygenation: a retrospective cohort study. Crit Care 18(1):R38. doi:10.1186/cc13746

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, Veale K, Rodriquez L, Hopkins RO (2007) Early activity is feasible and safe in respiratory failure patients. Crit Care Med 35(1):139–145

    Article  PubMed  Google Scholar 

  3. Balas MC, Vasilevskis EE, Olsen KM, Schmid KK, Shostrom V, Cohen MZ, Peitz G, Gannon DE, Sisson J, Sullivan J, Stothert JC, Lazure J, Nuss SL, Jawa RS, Freihaut F, Ely EW, Burke WJ (2014) Effectiveness and safety of the awakening and breathing coordination, delirium monitoring/management, and early exercise/mobility bundle. Crit Care Med 42(5):1024–1036

    Article  PubMed  PubMed Central  Google Scholar 

  4. Barber EA, Everard T, Holland AE, Tipping C, Bradley SJ, Hodgson CL (2014) Barriers and facilitators to early mobilisation in intensive care: a qualitative study. Aust Crit Care. doi:10.1016/j.aucc.2014.11.001

  5. Barr J, Fraser GL, Puntillo K, Ely EW, Gélinas C, Dasta JF, Davidson JE, Devlin JW, Kress JP, Joffe AM, Coursin DB, Herr DL, Tung A, Robinson BR, Fontaine DK, Ramsay MA, Riker RR, Sessler CN, Pun B, Skrobik Y, Jaeschke R, American College of Critical Care Medicine (2013) Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med 41(1):278–280

    Article  Google Scholar 

  6. Berney SC, Harrold M, Webb SA, Seppelt I, Patman S, Thomas PJ, Denehy L (2013) Intensive care unit mobility practices in Australia and New Zealand: a point prevalence study. Crit Care Resusc 15(4):260–265

    PubMed  Google Scholar 

  7. Berry A, Beattie K, Bennett J, Cross, Cushway S, Hassan A, Longhurst E, Moore R, Phillips D, Plowman E, Scott J, Thomas L, Elliott D (2014) Physical activity and movement: a guideline for critically Ill adults. Agency for Clinical Innovation NSW Government. http://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0005/239783/ACI14-PAM-1-3.pdf. Zugegriffen: 20. Aug. 2015

  8. Borg G (2004) Anstrengungsempfinden und körperliche Aktivität. Dtsch Ärztebl 101(15):1016–1021

    Google Scholar 

  9. Filipovic S (2012) Vom ersten Tag an mobilisiert. Pflegen Intensiv 2:22–27

    Google Scholar 

  10. Garzon-Serrano J, Ryan C, Waak K, Hirschberg R, Tully S, Bittner EA, Chipman DW, Schmidt U, Kasotakis G, Benjamin J, Zafonte R, Eikermann M (2011) Early mobilization in critically ill patients: patients’ mobilization level depends on health care provider’s profession. PM R 3(4):307–313

    Article  PubMed  Google Scholar 

  11. Gosselink R, Bott J, Johnson M, Dean E, Nava S, Norrenberg M, Schönhofer B, Stiller K, van der Leur H, Vincent JL (2008) Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med 34:1188–1199

    Article  CAS  PubMed  Google Scholar 

  12. Gosselink R, Clerckx B, Robbeets C, Vanhullebusch T, Vanpee G, Segers J (2011) Physiotherapy in the intensive care unit. Neth J Crit Care 15(2):S66–S75

    Google Scholar 

  13. Hayes K, Seller D, Webb M, Hodgson M, Holland AE (2011) Ventilator hyperinflation: a survey of current physiotherapy practice in Australia and New Zealand. In: New Zealand. J Physiother 39(3):124–130

    Google Scholar 

  14. Hodgin KE, Nordon-Craft A, McFann KK, Mealer ML, Moss M (2009) Physical therapy utilization in intensive care units: results from a national survey. Crit Care Med 37(2):S1–S8

    Article  Google Scholar 

  15. Hodgson C, Needham D, Haines K, Bailey M, Ward A, Harrold M, Young P, Zanni J, Buhr H, Higgins A, Presneill J, Berney S (2014) Feasibility and inter-rater reliability of the ICU Mobility Scale. Heart Lung 43(1):19–24

    Article  PubMed  Google Scholar 

  16. Hodgson CL, Stiller K, Needham DM, Tipping CJ, Harrold M, Baldwin CE, Bradley S, Berney S, Caruana LR, Elliott D, Green M, Haines K, Higgins AM, Kaukonen KM, Leditschke I, Nickels MR, Paratz J, Patman S, Skinner EH, Young PJ, Zanni JM, Denehy L, Webb SA (2014) Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Crit Care 18(6):658

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hopkins RO, Spuhler VJ, Thomsen GE. (2007) Transforming ICU culture to facilitate early mobility. Crit Care Clin 23(1):81–96

    Article  PubMed  Google Scholar 

  18. Jolley SE, Caldwell E, Hough CL (2014) Factors associated with receipt of physical therapy consultation in patients requiring prolonged mechanical ventilation. Dimens Crit Care Nurs 33(3):160–167

    Article  PubMed  PubMed Central  Google Scholar 

  19. Klas K, Nydahl P, Gosselink R, Beikircher R, Gerovasili V, Hart N, Needham D (2015) Physiotherapy and Early Mobilization in Intensive Care Units. Manuskript

  20. Löllgen H, Ulmer HV (2004) Das „Gespräch“ während der Ergometrie: Die Borg-Skala. Dtsch Arztebl 101:A1014–A1015

    Google Scholar 

  21. Lord RK, Mayhew CR, Korupolu R, Mantheiy EC, Friedman MA, Palmer JB, Needham DM (2013) ICU early physical rehabilitation programs: financial modeling of cost savings. Crit Care Med 41(3):717–724

    Article  PubMed  Google Scholar 

  22. Needham DM, Korupulou R (2010) Rehabilitation quality improvement in an intensive care unit setting: implementation of a quality improvement model. Top Stroke Rehabil 17(4):271–281

    Article  PubMed  Google Scholar 

  23. Norrenberg M, Vincent J-L (2000) A profile of European intensive care unit physiotherapists. Intensive Care Med 26:988–994

    Article  CAS  PubMed  Google Scholar 

  24. Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ, Kaltwasser A, Mende H, Rothaug O, Schuchhardt D, Schwabbauer N, Needham DM (2014) Early mobilization of mechanically ventilated patients: a 1-day point-prevalence study in Germany. Crit Care Med 42(5):1178–1186

    Article  PubMed  Google Scholar 

  25. Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW, BRAIN-ICU Study Investigators (2013) Long-term cognitive impairment after critical illness. N Engl J Med 369(14):1306–1316

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Perme C, Lettvin C, Throckmorton TA, Mitchell K, Masud F (2011) Early mobility and walking for patients with femoral arterial catheters in intensive care unit: a case series. J Acute Care Phys Ther 2(1):30–34 (Spring 2011)

    Article  Google Scholar 

  27. Perme C, Nalty T, Winkelman C, Kenji Nawa R, Masud F (2013) Safety and efficacy of mobility interventions in patients with femoral catheters in the ICU: a prospective observational study. Cardiopulm Phys Ther J 24(2):12–27

    PubMed  PubMed Central  Google Scholar 

  28. Powers J, Bennett SJ (1999) Measurement of dyspnea in patients treated with mechanical ventilation. Am J Crit Care 8(4):254–261

    CAS  PubMed  Google Scholar 

  29. Rahimi RA, Skrzat J, Reddy DR, Zanni JM, Fan E, Stephens RS, Needham DM (2013) Physical rehabilitation of patients in the intensive care unit requiring extracorporeal membrane oxygenation: a small case series. Phys Ther 93(2):248–255

    Article  PubMed  Google Scholar 

  30. Rose L (2011) Interprofessional collaboration in the ICU: how to define? Nurs Crit Care 16(1):5–10

    Article  PubMed  Google Scholar 

  31. Sagebiel L (Hrsg) (2010) Physiotherapeutische Standards des Universitätsklinikum Schleswig Holstein, Campus Lübeck und Kiel, Stabsstelle Organisationsentwicklung, Projekt- und Qualitätsmanagement 2010. Universitätsklinikum Schleswig Holstein

  32. Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, Spears L, Miller M, Franczyk M, Deprizio D, Schmidt GA, Bowman A, Barr R, McCallister KE, Hall JB, Kress JP (2009) Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 373(9678):1874–1882

    Article  PubMed  Google Scholar 

  33. Skinner EH, Berney S, Warrillow S, Denehy L (2008) Rehabilitation and exercise prescription in Australian intensive care units. Physiotherapy 94:220–229

    Article  Google Scholar 

  34. Stiller K, Phillips A, Lambert P (2004) The safety of mobilisation and its effects on haemodynamics and respiratory status of intensive care patients. Physiother Theory Pract 20:175–185

    Article  Google Scholar 

  35. Turner DA, Cheifetz IM, Rehder KJ, Williford WL, Bonadonna D, Banuelos SJ, Peterson-Carmichael S, Lin SS, Davis RD, Zaas D (2011) Active rehabilitation and physical therapy during extracorporeal membrane oxygenation while awaiting lung transplantation: a practical approach. Crit Care Med 39(12):2593–2598

    Article  PubMed  Google Scholar 

  36. Vasilevskis EE, Ely EW, Speroff T, Pun BT, Boehm L, Dittus RS (2010) Reducing iatrogenic risks: ICU-acquired delirium and weakness-crossing the quality chasm. Chest 138(5):1224–1233

    Article  PubMed  PubMed Central  Google Scholar 

  37. Winkelman C, Peereboom K (2010) Staff-Perceived Barriers and Facilitators. Crit Care Nurse 30:13–16

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Haus 31, Brunswiker Str. 10, 24105, Kiel, Deutschland

    P. Nydahl BScN

  2. Anästhesie und Intensivpflege, ALIAR – Association luxemburgeoise des Infirmier(e)s en Anästhesie et Réanimation, Dudelange, Luxemburg

    M. Dewes

  3. Akademie der Kreiskliniken Reutlingen, Kreiskliniken Reutlingen GmbH, Steinenbergstr. 31, 72764, Reutlingen, Deutschland

    R. Dubb B.Sc.

  4. Abteilung Physiotherapie, Universitätsklinikum Gießen und Marburg (UKGM) Standort Marburg, Baldinger Straße, 35033, Marburg, Deutschland

    S. Filipovic B.Sc.

  5. Anästhesie und Intensivpflege, HELIOS Klinikum Siegburg, Ringstraße 49, 53721, Siegburg, Deutschland

    C. Hermes

  6. Anästhesie und Intensivpflege, Asklepios Klinik Langen, Röntgenstraße 20, 63325, Langen, Deutschland

    F. Jüttner

  7. Akademie der Kreiskliniken Reutlingen, Kreiskliniken Reutlingen GmbH, Steinenbergstr. 31, 72764, Reutlingen, Deutschland

    A. Kaltwasser B.Sc.

  8. Fachleitung Zentrale Einrichtung Physiotherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Haus 31, Brunswiker Str. 10, 24105, Kiel, Deutschland

    S. Klarmann

  9. Gesundheits- und Krankenpflege, IMC Fachhochschule Krems, Am Campus Krems, 3500, Krems, Österreich

    K. Klas

  10. Anästhesiologie & Intensivmedizin, Neurologische Intensivstation, Klinik für Neurologie, Christophsbad Göppingen, Faurndauerstrasse 6–28, 73035, Göppingen, Deutschland

    H. Mende

  11. Intensiv- und Anästhesiepflege, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37077, Göttingen, Deutschland

    O. Rothaug B.Sc.

  12. Zentrum für Anästhesie, Intensiv- und Notfallmedizin, Zentralklinik Bad Berka GmbH, Robert-Koch-Allee 9, 99437, Bad Berka, Deutschland

    D. Schuchhardt

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  1. P. Nydahl BScN
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  2. M. Dewes
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  4. S. Filipovic B.Sc.
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Correspondence to P. Nydahl BScN.

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Interessenkonflikt

P. Nydahl, M. Dewes, R. Dubb, S. Filipovic, C. Hermes, F. Jüttner, A. Kaltwasser, S. Klarmann, K. Klas, H. Mende, O. Rothaug und D. Schuchhardt geben an, dass kein Interessenkonflikt besteht.

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C. Hermes, Siegburg

A. Kaltwasser, Reutlingen

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Nydahl, P., Dewes, M., Dubb, R. et al. Frühmobilisierung. Med Klin Intensivmed Notfmed 111, 153–159 (2016). https://doi.org/10.1007/s00063-015-0073-4

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