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Early Mobility in the ICU: Overview, the Evidence, and the Practice

presented by Ellen Hillegass

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PT Cardiopulmonary Educators: web-based continuing education program partners Cardiopulmonary Specialists: a consulting company CEO Speaker for Genentech: a pharmaceutical company Receives Royalties: Essentials of Cardiopulmonary Physical Therapy and Rehab Notes

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Therapists are often challenged when presented with complex ICU patients. These patients may have cardiovascular and/or pulmonary complications or dysfunction, as well as other medical conditions. They may also have many lines or tubes. This course provides therapists with the evidence of the difficulties associated with early mobilization of these patients, as well as the evidence in favor of early mobility. The evidence-based outcomes and benefits of early mobility will be discussed, along with the barriers to achieving early mobility. An overview of the process for initiating an early mobility program will be presented and helpful resources suggested. The types of patients most effected and the knowledge and skills that the PTs will most need will be presented, along with various interventions that may be utilized.

Meet Your Instructor

Ellen Hillegass, PT, EdD, CCS, FAPTA

Dr. Ellen Hillegass is a physical therapist with APTA board certification in cardiovascular and pulmonary clinical specialty. She currently holds the position of adjunct professor in the departments of physical therapy at Mercer University in Atlanta and Western Carolina University in Cullowhee, NC. Ellen is also the president and CEO of Cardiopulmonary Specialists, a private…

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Chapters & Learning Objectives

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1. Overview of the Problem: Why Early Mobility?

Patients have been kept on bedrest and sedated when seriously ill or on mechanical ventilation for fear of instability, for “rest,” or for fear of tube or IV removal by the patient. As a result, these patients have developed profound muscle weakness, problems with orthostatic hypotension, and aerobic deconditioning. With earlier mobility, patients have demonstrated less weakness, less deconditioning, and fewer long term impairments.

2. What is the Evidence on Early Mobility?

As a result of initiating early mobility, studies have shown decreased length of stay, decreased ICU length of stay, decreased ventilator days, less time until first time out of bed, and less costs. Initiating an early mobility program would cut costs for the hospital as well as improve function.

3. The Barriers to Mobility and Recommendations to Overcome the Barriers

Multiple barriers exist to initiating and maintaining an early mobility program, including sedation, staffing, time requirements, ICU culture, etc. These barriers are discussed as well as recommendations to address, decrease, or remove the barriers.

4. Initiating an Early Mobility Program: Suggestions to Improve Success

Initiating an early mobility program is made easier by learning from others who have implemented a program and can share pitfalls and successes. Developing a team and identifying a champion are some of the keys to success. In addition, ongoing communication and education are also very important to include.

5. Early Mobility Programs

Specific patient populations are discussed, including some of the special considerations that need to be taken with these patients, as well as a discussion of what needs to be considered and how to move these patients. Some of the patient populations that are discussed include the mechanically ventilated patients, patients on ECMO, and patients who have advanced heart failure, including pre- and post VAD, on those IV inotropes, and those with multisystem failure. Included in this section are assists to mobility.

6. What Outcomes Should be Measured?

Measuring the appropriate outcomes is important to demonstrate success of your early mobility program and communicate the functional improvements of the patients as well as the cost savings to the institution. Besides outcomes that can be gathered from the EMR, the physical function measures that should be recorded are discussed.

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