Innovative ICU Solutions to Prevent and Reduce Delirium and Post–Intensive Care Unit Syndrome

Alawi Luetz, MD, PhD; Julius J. Grunow; Rudolf Mörgeli, MD; Max Rosenthal, MD, PhD; Steffen Weber-Carstens, MD, PhD; Bjoern Weiss; Claudia Spies, MD, PhD

Disclosures

Semin Respir Crit Care Med. 2019;40(5):673-686. 

In This Article

Mobility

Patients spend most of their time in bed during their ICU stay. Bed rest, even in healthy patients, was shown to have a negative impact on mental health and cognition. In a study of healthy volunteers, bed rest, even when combined with isometric exercise training, led to an impaired mental status.[61] It does not surprise that mobility is important in salutogenesis and recovery. In critical illness, early and regular mobilization is recommended in several national guidelines, as it has beneficial effects that extend beyond the physical impairments, positively influence duration of delirium, mechanical ventilation, intensive care unit, and hospital stay.[13,62–64] Nevertheless, the critical care environment, as well as the critical illness itself, impose multiple inherent challenges to early mobilization, leading to low-implementation rates of the current recommendations.[65,66] Common barriers hindering early mobilization in ICUs include lack of staff, logistical issues due to therapeutic devices (e.g., ventilator and infusion pumps), and safety concerns for patients (e.g., tube or line dislocation), and staff.[67]

Other issues include patient refusal, lack of motivation, fatigue, sedation, pain, and delirium as important factors hampering early mobilization. Due to the variety of influencing aspects and possible interventions regarding mobilization, it is important to note that a multimodal approach is necessary to achieve the best possible outcome.

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