Repositioning the critically ill patient

Mobilising mechanically ventilated patients in ICU by sitting and standing out of bed has been demonstrated as feasible and safe.1 There have been multiple studies demonstrating successful outcomes combined with low rates of serious adverse events.2,3

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The upright position - The major physical benefits of getting the ventilated ICU patient into a standing position have been identified as improving respiratory function as well as for increasing musculoskeletal strength. Whilst getting the ventilated weak patient up to a standing position by using a standing/tilting device, the physiotherapists will be able to work with the patient on weight bearing, lower limb exercises, passive stretches, and balance. It can also work as a support in the progression towards active mobilisation.4

A standing position during mechanical ventilation improves the respiratory function, compliance and oxygen, and it stimulates autonomic activity, and reduces cardiac stress from compression.5,6,7 Results have shown a clear improvement in oxygen uptake and the patient’s circulation did not become unstable.8,9 

Sitting in a reclined seating position is an alternative - using a positioning device where the degree of reclining can be altered to meet the patient’s need, provides an important advantage for patients who are very weak.10,11,12

For patients unable to stand, sitting in a chair helps prevent hypovolemia,13 redistributes skin pressure, changes resting muscle length, assists orientation and load vertebrae to limit calcium loss, and promotes cartilage nutrition.14

Arjo Rental provides both flexibility and choice, allowing access to a bespoke solution which includes the latest equipment to support in and out of bed mobilisation / repositioning whilst channelling limited financial resources to where they are most needed. Click below to see how an ICU solution from Arjo can assist with repositioning the critically ill patient.

Learn about our ICU Early Mobilistation solutions

References
1. McWilliamsD, Atkins G, HodsonJ et al. (2016) The Sara Combilizer® as an early mobilization aid for critically ill patients: A prospective before and after study. AustCritCare, 30(4): 189-195
2. McWilliams D, WeblinJ, Atkins G et al. (2014) Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: A quality improvement project. Journal of critical care. 30(1):13-8
3. McWilliams et al - McWilliams, D., Weblin, J, Atkins G, BionJ, Williams J, Elliott C, Whitehouse T, Snelson, C (2015) Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: A quality improvement project https://ac.els-cdn.com/S0883944114004018/1-s2.0-S0883944114004018-main.pdf?_tid=bbfbe6bb-84e8-45fb-bc7d-637ead0adc7f&acdnat=1543992106_1a51321ab63f5ff36cc8286da33a762d [Accessed December 2018]
4.Chang AT, Boots R, Hodges PW, ParatzJ.(2004) Standing with assistance of a tilt table in intensive care: a survey of Australian physiotherapy practice. AustJ Physiother. 2004;50 (1):51-4. PMID:14987193
5.Hoste, E.A.,C.D.Roosens, et al.(2005)."Acute effects of upright position on gas exchange in patients with acute respiratory distress syndrome." JIntensiveCareMed20(1):43-­‐49.]McWilliams D, WeblinJ, Atkins G et al. (2015) Enhancing rehabilitation of mechanically ventilated patients in the intensive care unit: a quality improvement project. J CritCare, 30(1): 13–8
6.Richard JCM, Lefebvre JC (2011) Positioning of patients with acute respiratory distress syndrome: combining prone and upright makes sense. CritCare. 2011 15 (6): 1019 published on line December 15, 2011. Doi: 10.1186/cc10560 PMCID: PMC3388640
7.Gosselink,R.,J.Bott,etal.(2008)."Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine Task Force on Physiotherapy for Critically Ill Patients."IntensiveCareMed34(7):1188-­‐1199).
8.Dueck,M.,WindA.,TrieschmannU.,SchinkU.(2010)."Respiratory effects and safety of an intermittent standing position during mechanical ventilation European Society of Intensive Care Congress, Barcelona Spain..
9.McWilliams D, Atkins G, HodsonJ et al. (2016) The Sara Combilizer® as an early mobilization aid for critically ill patients: A prospective before and after study. AustCritCare, 30(4): 189-195
10.Dean,E.,Perme,C.(2008)."Effects of positioning and mobilisation". Physiotherapy for Respiratory and Cardic Problems, Adults and Paediatrics. UK, Churchill Livingstone Elsevier.
11.Dean E (1999) The effect of positioning and mobilisation on oxygen transport. Cited in ProyrJA, Webber BA (eds) (2008) Physiotherapy for Respiratory and Cardiac Problems, 2nd edition.LondonChurchill Livingstone, 121-36.
12.Richard JCM, Lefebvre JC (2011) Positioning of patients with acute respiratory distress syndrome: combining prone and upright makes sense. CritCare. 2011 15 (6): 1019 published on line December 15, 2011. Doi: 10.1186/cc10560 PMCID: PMC3388640
13.Wenger,N.K.(1982)."Early ambulation: the physiologic basis revisited."AdvCardiol31:138-­‐141.
14.Hough, A. (2001). Physiotherapy in Respiratory Care: An Evidence-­‐Based Approach to Respiratory and Cardiac Management,, Menage Learning EMEA