Early mobilisation of mechanically ventilated patients : effect on muscle strength and ventilation duration

Abstract

Overview of the topic: Although mechanical ventilation is an effective treatment for patients in the intensive care unit to survive from acute illness, long periods of immobilisation during this time is associated with long-term complications including intensive care unit acquired weakness. This disease can have a negative effect on a number of patient outcomes including muscle strength and ventilation duration. The implementation of early mobilisation during mechanical ventilation would allow for increased physical activity during this time potentially benefiting patient outcomes. In this dissertation, the effect of early mobilisation to maintain muscle strength and reduce ventilation duration will be studied. The research question: Does early mobilisation in mechanically ventilated patients affect muscle strength and ventilation duration? PEO elements: The population (P) studied was mechanically ventilated patients. The exposure (E) observed was early mobilisation. The desired outcomes (O) were maintaining muscle strength and reducing ventilation duration. Method: The elements of the PEO question were used to identify key terms and generate alternative terms. Boolean Operators were used to combine these terms and a systematic search was conducted through various databases including EBSCO, PubMed, and Google Scholar, as well as through manual searching. Inclusion and exclusion criteria were applied to determine the eligible studies. The retrieved studies were then critically appraised by using Critical Appraisal Skills Programme tool. Results: A total of seven studies were identified which included three systematic reviews, two randomised controlled trials and two prospective cohort studies. All studies showed significant results for either maintaining muscle strength or reducing ventilation duration, except for one randomised controlled trial and one prospective cohort study. The randomised controlled trial failed to find statistical differences between the groups whilst the prospective cohort study did not reach statistical significance for ventilation duration. Conclusion: In conclusion, from the evidence gathered there is indication that early mobilisation for mechanically ventilated patients can be beneficial in improving the patient outcomes of muscle strength and ventilation duration. Recommendations: There is a need for further research with more robust methodological base which includes more similar management protocols and guidelines for better evidence. Furthermore, early mobilisation for mechanically ventilated patients should be encouraged more in local practice by providing educational opportunities on the issues and solutions of this practice and through development of a protocol.