Abstract
Objective: Investigate the feasibility of a nurse-led mobility protocol and compare the effects of once- versus twice-daily episodes of early therapeutic mobility (ETM) and low- versus moderate-intensity ETM on serum biomarkers of inflammation and selected outcomes in critically ill adults. Design: Randomized interventional study with repeated measures and blinded assessment of outcomes. Setting: Four adult intensive care units (ICUs) in two academic medical centers. Subjects: Fifty-four patients with > 48 hr of mechanical ventilation (MV). Intervention: Patients were assigned to once- or twice-daily ETM via sealed envelope randomization at enrollment. Intensity of (in-bed vs. out-of-bed) ETM was administered according to protocolized patient assessment. Measurements: Interleukins 6, 10, 8, 15, and tumor necrosis factor-α were collected from serum before and after ETM; change scores were used in the analyses. Manual muscle and handgrip strength, delirium onset, duration of MV, and ICU length of stay (LOS) were evaluated as patient outcomes. Main Results: Hypotheses regarding the inflammatory biomarkers were not supported based on confidence intervals. Twice-daily intervention was associated with reduced ICU LOS. Moderate-intensity (out-of-bed) ETM was associated with greater manual muscle test scores and handgrip strength and reduced occurrence of delirium. Conclusion: Findings from this study suggest that nurses can provide twice-daily mobility interventions that include sitting on the edge of the bed once patients have a stable status without altering a pro-inflammatory serum biomarker profile.
| Original language | English |
|---|---|
| Pages (from-to) | 522-530 |
| Number of pages | 9 |
| Journal | Biological Research for Nursing |
| Volume | 20 |
| Issue number | 5 |
| DOIs | |
| State | Published - Oct 1 2018 |
Bibliographical note
Publisher Copyright:© The Author(s) 2018.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Financial support for this study included the following: National Institutes of Health (NIH): ICU Mobility 1R21 NR10781-01A1. Blood samples were stored at the laboratory of the MetroHealth Clinical and Translation Science Collaborative (CTSC), NIH Funding UL1 TR00439. Blood samples were also stored and analyzed at the Dahms Clinical Unit laboratory at UHCMC, NIH Funding UL1TR 00439-06. Study data were collected and managed using REDCap electron data capture tools hosted at the University Hospital’s Cleveland Medical Center (UHCMC). http://ClinicalTrials.gov Identifier: NCT00999011.
| Funders | Funder number |
|---|---|
| MetroHealth Medical Center Cleveland | NCT00999011 |
| MetroHealth Clinical and Translation Science Collaborative | |
| UHCMC | UL1TR 00439-06 |
| National Institutes of Health (NIH) | 1R21 NR10781-01A1 |
| National Institutes of Health (NIH) | |
| National Institute of Health National Institute of Nursing Research | R21NR010781 |
| National Institute of Health National Institute of Nursing Research | |
| Clinical and Translational Science Collaborative of Cleveland, School of Medicine, Case Western Reserve University | UL1 TR00439 |
| Clinical and Translational Science Collaborative of Cleveland, School of Medicine, Case Western Reserve University |
Keywords
- ICU
- cytokines
- delirium
- mechanical ventilation
- mobility
- muscle strength
- rehabilitation
ASJC Scopus subject areas
- Research and Theory