2.50
Hdl Handle:
http://hdl.handle.net/10755/157065
Category:
Abstract
Type:
Presentation
Title:
Patient Response to Therapeutic Mobility Activities: Molecules to Outcomes
Author(s):
Winkelman, Chris; Gordon, Nahida
Author Details:
Chris Winkelman, RN, PhD, CCRN, ACNP, Case Western Resrve University, Cleveland, Ohio, USA, email: chris.winkelman@case.edu; Nahida Gordon
Abstract:
POSTER PURPOSE: This study examined effects of therapeutic mobility activities among patients who experienced prolonged mechanical ventilation (MV). Serum inflammatory markers, interleukin (IL)-6 and IL-10, were analyzed for changes after activity. IL-6 and IL-10 were also examined for their association with patientsÆ outcomes of delirium, discharge muscle strength, duration of mechanical ventilation, length of stay in the intensive care unit (ICU), and disposition after ICU (ie, death, long-term care, or home). BACKGROUND/SIGNIFICANCE:Progressive mobility includes continuous lateral rotation, range of motion, chair-sitting, and walking. Reports indicate progressive mobility is safe and decreases both duration of MV and length of stay in some ICU patients. However, the mechanism of benefit for this therapy is not well characterized. One explanation is that mobility activity affects the inflammatory profile to prevent molecular and systemic complications; reducing complications is congruent with the research priorities of the American Association of Critical-Care Nurses. METHOD: This was a prospective study with a period of routine care followed by implementation of a therapeutic mobility protocol in an urban academic hospital. Biomarkers of inflammation were collected before and after 20 minutes of activity for 3 consecutive days and then weekly until the patient was discharged from the ICU. Patient outcomes of muscle strength, delirium, complications from bed rest, MV duration, ICU length of stay, and disposition after the ICU were collected for 80 patients admitted to surgical and medical ICUs. We hypothesized that activity would reduce the proinflammatory profile and a profile of anti-inflammation would be associated with better outcomes among participants. RESULTS: The average participant was 66 years old (mean); 51% were male. Sixty percent were white, had pulmonary (25%) or cardiac (19%) admitting diagnoses with moderate-to-high acuity (mean APACHE III scores of 71) and 2 to 3 comorbid conditions, and received MV 7 days (mean) before enrollment. IL-6 averaged 82.3 pg/mL at rest (range, 0.78 - 795) and 80.8 pg/mL (1.08 - 780) after activity. IL-10 was 32.4 pg/mL (1.9 - 1858) at rest and 36.6 pg/mL (1.7 - 2115) after activity. Differences in IL-10 were associated with a longer duration of activity, when patients' characteristics (eg, age, sex) were held constant. There was a marginal association with biomarkers and discharge to dependent care. CONCLUSIONS: Findings indicate duration of activity influences anti-inflammation in chronically critically ill adults with prolonged mechanical ventilation, suggesting a biological mechanism for the benefit of progressive mobility among these patients. Unlike studies of patients with sepsis and trauma patients, biological markers of inflammation were not associated with outcomes. It may be that adults with prolonged MV may have unique biologic responses to critical illness.
Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titlePatient Response to Therapeutic Mobility Activities: Molecules to Outcomesen_GB
dc.contributor.authorWinkelman, Chrisen_GB
dc.contributor.authorGordon, Nahidaen_GB
dc.author.detailsChris Winkelman, RN, PhD, CCRN, ACNP, Case Western Resrve University, Cleveland, Ohio, USA, email: chris.winkelman@case.edu; Nahida Gordonen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157065-
dc.description.abstractPOSTER PURPOSE: This study examined effects of therapeutic mobility activities among patients who experienced prolonged mechanical ventilation (MV). Serum inflammatory markers, interleukin (IL)-6 and IL-10, were analyzed for changes after activity. IL-6 and IL-10 were also examined for their association with patientsÆ outcomes of delirium, discharge muscle strength, duration of mechanical ventilation, length of stay in the intensive care unit (ICU), and disposition after ICU (ie, death, long-term care, or home). BACKGROUND/SIGNIFICANCE:Progressive mobility includes continuous lateral rotation, range of motion, chair-sitting, and walking. Reports indicate progressive mobility is safe and decreases both duration of MV and length of stay in some ICU patients. However, the mechanism of benefit for this therapy is not well characterized. One explanation is that mobility activity affects the inflammatory profile to prevent molecular and systemic complications; reducing complications is congruent with the research priorities of the American Association of Critical-Care Nurses. METHOD: This was a prospective study with a period of routine care followed by implementation of a therapeutic mobility protocol in an urban academic hospital. Biomarkers of inflammation were collected before and after 20 minutes of activity for 3 consecutive days and then weekly until the patient was discharged from the ICU. Patient outcomes of muscle strength, delirium, complications from bed rest, MV duration, ICU length of stay, and disposition after the ICU were collected for 80 patients admitted to surgical and medical ICUs. We hypothesized that activity would reduce the proinflammatory profile and a profile of anti-inflammation would be associated with better outcomes among participants. RESULTS: The average participant was 66 years old (mean); 51% were male. Sixty percent were white, had pulmonary (25%) or cardiac (19%) admitting diagnoses with moderate-to-high acuity (mean APACHE III scores of 71) and 2 to 3 comorbid conditions, and received MV 7 days (mean) before enrollment. IL-6 averaged 82.3 pg/mL at rest (range, 0.78 - 795) and 80.8 pg/mL (1.08 - 780) after activity. IL-10 was 32.4 pg/mL (1.9 - 1858) at rest and 36.6 pg/mL (1.7 - 2115) after activity. Differences in IL-10 were associated with a longer duration of activity, when patients' characteristics (eg, age, sex) were held constant. There was a marginal association with biomarkers and discharge to dependent care. CONCLUSIONS: Findings indicate duration of activity influences anti-inflammation in chronically critically ill adults with prolonged mechanical ventilation, suggesting a biological mechanism for the benefit of progressive mobility among these patients. Unlike studies of patients with sepsis and trauma patients, biological markers of inflammation were not associated with outcomes. It may be that adults with prolonged MV may have unique biologic responses to critical illness.en_GB
dc.date.available2011-10-26T19:23:23Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:23:23Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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