Zusammenfassung
Hintergrund
Die aktuelle Studienlage zeigt ein heterogenes Bild zur Effektivität von Frühmobilisation, d. h. Mobilisation innerhalb von 72 h nach Intensivaufnahme. Ebenfalls wird die Evidenz in aktuellen Reviews und den Leitlinien als unzureichend angesehen. Dies führt zur Unsicherheit und verminderten Umsetzung im Alltag.
Fragestellung
Wie stellt sich die aktuelle Evidenz zum Thema Frühmobilisation dar? Welche positiven Effekte sind für welche Intensivpatienten zu erwarten? Welche Lücken in der Evidenz gibt es?
Ergebnisse
Wird Mobilisation innerhalb von 72 h nach Intensivaufnahme strukturiert umgesetzt, kann ein Muskelmasseerhalt sowie eine Funktionalitätsverbesserung erwartet werden. Zusätzlich sollte die Mobilisierung in ein Maßnahmenbündel, wie das ABCDEF-Konzept, eingebettet werden. Die Umsetzung eines derartigen Gesamtkonzepts zeigte ebenfalls ein positives Outcome in großen Studien. Frühmobilisation ist sicher: Ein endotrachealer Tubus stellt per se keine Kontraindikation für eine Mobilisierung dar. Lücken in der Evidenz gibt es bei speziellen Patientengruppen: 1) bei neurologischen und neurochirurgischen Patienten, wo es lediglich Hinweise aus Beobachtungsstudien gibt und 2) bei Patienten, die zuvor funktionell abhängig waren. Sowohl die Art und Weise als auch die optimale Dosierung von Mobilisation sind hier noch unklar.
Schlussfolgerung
Frühmobilisation auf der Intensivstation ist sicher und verbessert das Outcome kritisch kranker Patienten. Weitere Studien sind notwendig, um die Frage nach der optimalen Dosierung und Dauer insbesondere bei neurologischen/neurochirurgischen Patienten zu klären.
Abstract
Background
Early mobilization is defined as intervention within the first 72 h after intensive care unit (ICU) admission. According to the current state of relevant studies, evidence on early mobilization in critically ill patients is still inconsistent. This leads to insecurity in caretakers and subsequently to incomplete implementation in German ICUs.
Objectives
What type of intervention is suitable for certain patient groups? Which issues remain unresolved?
Results
To obtain best possible outcomes, early mobilization should be initiated during the first 72 h after ICU admission. Implementation of early mobilization improves clinical outcome and should be integrated in a patient-centered bundle (such as ABCDEF). Mechanical ventilation is not a contraindication to intervention. Evidence in neurocritical care as well as functionally dependent patients is still low. Mode of intervention and dosage of early mobilisation remain unclear.
Conclusion
Early mobilization is safe and feasible, resulting in improved outcomes in surgical and medical ICU patients. Further studies are necessary to evaluate the optimal dosage and duration of intervention, especially in neurocritical care patients.
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K. Fuest gibt an, dass kein Interessenkonflikt besteht. S.J. Schaller gibt den Besitz kleinerer Mengen von Wertpapieren von Firmen, die dem Gesundheitssektor angehören (Rhön-Klinikum AG, Siemens AG, Bayer AG, Alphabeth Inc.) an. Dieser Wertpapierbesitz hat die das Manuskript betreffenden Entscheidungen nicht beeinflusst.
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Fuest, K., Schaller, S.J. Frühmobilisation auf der Intensivstation. Med Klin Intensivmed Notfmed 114, 759–764 (2019). https://doi.org/10.1007/s00063-019-0605-4
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DOI: https://doi.org/10.1007/s00063-019-0605-4