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IN HEALTHCARE LITERATURE Early passive mobilization n A midei, C., & Sole, M. (2013). Physiological responses to passive exercise in adults receiving mechanical ventilation. American Journal of Critical Care, 22(4), 337-348. Muscle loss begins within 24 hours of inactivity in critically ill patients. Mobilization leads to decreased length of stay in intensive care units and improved functional behaviors. Limited research exists on passive range of motion in physiologically unstable patients. The purpose of this quasi-experimental study was to investigate the use of passiveexercise and its effects on pain, cytokine levels, and physiological state of critically ill patients. A convenient sample of 32 adult patients with a mean age of 56.5 years in 3 critical care units at Orlando Regional Medical Center participated between October 2011 and February 2012. Subjects were more than 18 years-old, intubated for less than 48 hours, expected to remain intubated at least 72 hours, walked before admission, and had capability to monitor blood and vital signs. When intervention began, 83 percent of patients were sedated with fentanyl, midazolam, or propofol and the mean length of intubation was 38 hours. Participants started with 20 minutes of rest followed by obtaining cytokine levels, mean blood pressure, heart rate, behavioral pain scale, and oxygen saturation. Patients participated in 20 minutes of continuous passive motion (CPM) with measurements taken at 5, 10, and
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20 minutes. Measurements were taken again after resting an hour. The CPM involved 20 flexion-extensions of bilateral legs every minute. Data analyzed by repeated measures analysis of variance. Patient’s physiological responses insignificantly changed. Pain significantly decreased after 5 and 10 minutes of CPM and remained less after 60 minutes of resting (P=.02). A proinflammatory cytokine called Interleukin 6 decreased throughout the exercise (P=.03) while an antiinflammatory cytokine called interleukin 10 did not significantly change. The ratio of interleukin 6:interleukin 10 significantly decreased after resting an hour post CPM (P=.05) showing passive range of motion does not increase inflammation. Early passive mobilization with CPM can be safe and result in stable vital signs, and decreased pain without increasing inflammation in critically ill patients. Refer to the Early Progressive Mobility Protocol for activity guidelines (American Association of Critical-Care Nurses, 2013).
References American Association of Critical-Care Nurses. (2013). Early Progressive Mobility Protocol. Retrieved from www.aacn.org/wd/practice/ docs/tool%20kits/early-progressive-mobility-protocol.pdf Carly Jesset, Dartmouth Hitchcock Medical Center, Lebanon NH Peggy Jenkins, Bassett Healthcare, Cooperstown NY
Journal of the New York State Nurses Association, Volume 44, Number 2
