Marcelo Rieder is physiotherapy team leader in the trauma intensive care unit at the Grupo Hospitalar Conceição and professor in cardiorespiratory physiotherapy at the Centro Universitário Metodista in Rio Grande do Sul, Brazil. He is recognised by the Conselho Federal de Fisioterapia e Terapia Ocupacionala as a specialist respiratory physiotherapist.
One way Marcelo keeps up-to-date with developments in early mobilisation and other physiotherapy interventions used in intensive care is by subscribing to the cardiothoracics feed of PEDro’s Evidence in your inbox. Two recent papers have caught Marcelo’s eye.
Arias-Fernandez P, et al. Rehabilitation and early mobilization in the critical patient: systematic review. J Phys Ther Sci 2018;30(9):1193-1201
This systematic review evaluated the effects of rehabilitation and early mobilisation for adults admitted to intensive care for more than 2 days. The authors searched five databases (Bibliotheca Virtual en Salud, CINAHL, PubMed, Scopus, and Web of Science) in order to identify randomized controlled trials, crossover trials, and case-control studies. Unfortunately there was no quantitative synthesis of the 11 included studies. The results of individual studies indicate that, compared to usual care, rehabilitation and early mobilisation increases the total distance walked at discharge. Marcelo says: “Rehabilitation and early mobilisation in intensive care looks promising, but more research is necessary to quantify the size of the treatment effect”.
Nydahl P, et al. Safety of patient mobilization and rehabilitation in the intensive care unit: systematic review with meta-analysis. Ann Am Thorac Soc 2017;14(5):766-777
Safety concerns are a barrier to the widespread use of rehabilitation and early mobilisation in intensive care units. This systematic review synthesised safety events, including falls, removal of endotracheal tubes, removal or dysfunction of intravascular catheters, removal of other catheters/tubes, cardiac arrest, haemodynamic changes, and desaturation. 48 eligible studies evaluating 7,546 patients in 22,351 early mobilisation or rehabilitation sessions were included. Potential safety events occurred in 2.6% of sessions. Marcelo says: “This review reassures me that rehabilitation and early mobilisation in intensive care is safe. It would be really useful if future trials recorded safety events in a consistent way”.