Matthias Eikermann, MD-PhD Director of Research, Critical Care Division talks about recent advances in care for critically injured patients.
Better reanimation through early mobilization
Improving nerve and muscle function is becoming an increasingly important treatment goal of critical care medicine. Prolonged immobility in the intensive care unit is common and plays an important role in the development of muscle weakness, which may impair patients' functional independence even one year after hospital discharge.
We have learned that it is important to keep sedation mediaction to a minimum, and we know that mobilization of even very sick patients who need artificial ventilation, via physical therapy in the earliest days of critical care, may be helpful in selected patients to improve their well-being. Those activities that we call early mobilization include in-bed excerice such as cycling, sitting at the edge of the bed, transfers out of bed to chair, and gait training - some of which can be helpful in patients suffering from stroke or a heart attack. However, we did not know until recenly if it is also helpful to mobilize critically ill patients early after a major surgical procedure or trauma. In fact, surgical critically ill patients have often severe wound pain, inflammation, recent musculoskeletal trauma - and the presence of drains or other medical devices may also hamper early mobilization efforts.
In a performance improvement initiative to standardize mobilization tharapy in the surgical intensive care unit, we developed the SICU Optimal Mobility Score (SOMS). The SOMS consists of a simple numeric scale that describes patients' mobilization capacity, and an algorithm developed to select the optimal activity level. In surgical critically ill patients presenting without preexisting impairment of functional mobility, the SOMS is a reliable and valid tool to predict mortality, intensive care unit and hospital length of stay.
Based on our data that will be published in Critical Care Medicine by the end of this year, we conclude that strict exclusion criteria for early mobilization should be avoided whenever possible. We believe that the SOMS-guided early mobilization therapy has the potential to improve the outcome and quality of life of surgical intensive care unit patients, and we are currently conducting follow-up studies to better describe this benefit of our performance improvement inititive.
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