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

ICU Setting as a Barrier and Facilitator of Mobilization

Mobilizing patients on regular wards is already a challenging task due to inadequate room size, furniture, and other obstacles, such as intraveneous (IV) stands, cords, etc.[85] One can imagine that the ICU environment amplifies all these issues through the presence of more devices, multiple IV lines, breathing tubes, monitoring cables, catheters, and even directly life-sustaining devices, such as an extracorporal membran oxygenation (ECMO), increasing the challenges exponentially. Before each procedure, the medical staff prepares, not only the patient but also the environment, to create the best possible setting for the task. Adjusting the bed height, bringing up a chair to the bed before drawing blood, or even setting up an operating room for a complex robot-assisted procedure - establishing an environment that eases and enables ICU facilities are of great importance, and mobilization is not an exception.

Clear floor area is an important factor during mobilization and a recent guideline on the design of ICUs recommends a minimum clear floor area of 4 ft at the head and foot of the bed, as well as 6 ft on either side, in single-patient rooms.[23] When considering these measurements it should be kept in mind that space requirements differ from ICU to ICU due to different patient cohorts, equipments, and beds. Therefore, extra room should be planned according to the specific requirements of critically-ill patients. Furthermore, 4 ft of clear floor area on the foot of the bed is very conservative when it comes to mobilizing a patient with a ventilator, IV poles including different infusion pumps, and possibly an ECMO. As ICUs are often limited to a certain space even when remodeling, increasing patient room size is difficult. However, improving clear floor area might still be possible. The pilot rooms at the Charité Universitätsmedizin in Berlin included modular and movable furniture that allows staff to rearrange the clear floor area within minutes and without additional help. Integrated into the room was also mobilization equipment, specifically a patient lifter, eliminating the need for extra devices that would have to be brought in, and ultimately reducing clear floor area. Including this concept in the room design allowed more space for mobilization and a tailored approach to the patient.

Patient monitoring and intensive care are inseparable, as the need for information about the patient increases with the severity of the disease and the invasiveness of the therapeutic measures. Patient monitoring remains cable-based and often invasive. Vincent and Creteur already hypothesized that future monitoring technology will develop toward noninvasive techniques and an interview-based study involving multiple ICU professionals revealed that an important requirement for future monitoring is that it should be wireless and noninvasive.[86,87] Wireless and noninvasive monitoring would likely benefit the ease of mobilization, as the risk for dislocation of invasive monitoring systems would be eliminated. Furthermore, wireless technology would eliminate the need to always keep the monitoring unit within a wire length of the patient. Future trials will show if innovation in monitoring will improve implementation rates of early mobilization.

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