“Early mobility happens at a patient's bedside and involves mobilizing a patient who is on a ventilator. A ventilator is a machine that does the work of breathing for a patient and has different settings that can be adjusted based on how much support a patient needs. In order for therapy to be able to safely mobilize a patient on a ventilator, the patient must meet a certain criteria and the settings must be monitored continuously throughout the therapy session.
If the patient's vent setting are appropriate, PT and OT will coordinate a time with nursing to come and work with the patient. If the patient can follow basic commands, they are a good candidate for early mobility. During an early mobility session, one member of the therapy team is in front of the patient monitoring the ventilator and ET tube, and helps move the patient’s legs off the bed (unless the patient can do this on their own). A second therapist is behind the patient on the bed assisting w/trunk elevation and sitting stabilization.
Often, these patients have very poor core/trunk strength, and require significant assistance from the therapists to maintain an upright sitting position for the time required (from as short as 30 seconds up to several minutes). Ideally, we want to try to increase the amount of time a patient can spend upright (often sitting, sometimes standing) every time we see them; and while this is not always possible, it is always the goal. On rare occasions, early mobility patients will be strong enough and stable enough to attempt to stand while connected to the ventilator. Patients are returned to supine (laying down in bed) when their vitals destabilize, they express fatigue either verbally or nonverbally, or indicate they would like to lay down.” — Josie Thulien, Occupational Therapist
How is early mobility helping improve patient outcomes?
“The main outcome we track are days on the vent, which in general have been reduced. The goal across the ICU teams is to reduce vent days for our patients. Credit can be given to many disciplines for that achievement. Doctors, nurses, respiratory therapists, pharmacy, and PT/OT all play a role.” — Brian Devlin, Physical Therapist
Is early mobility a new practice since COVID-19 began?
“Due to advances in modern medicine, many patients survive life threatening critical illness. Physical and Occupational Therapy plays a critical role in improving overall patient functional outcomes. Here at TMCA, PT and OT have been practicing early mobility with critically ill patients for the last 5 years and even more so in the past year due to COVID-19. Patients who engage in early mobility in the critical illness phase demonstrate higher levels of function at discharge, fewer vent days and shorter hospital stay.” — Kim Friend, Physical Therapy and Occupational Therapy Lead
What types of therapy are involved?
“PT and OT work together in a joint treatment to do an overall assessment at the bed side first before moving a patient. Based on certain criteria, we may have the patient remain in laying down for the first few sessions. From there, we progress to increasing the patient's tolerance to sit edge of bed and participate in therapy. The next phases would involve standing, chair transfers, and even walking while ventilated.” — Brian Devlin, PT
How early is this therapy implemented?
“As long as the patient presents medically appropriate, we can begin the same day they are ventilated. The earlier, the better.” — Brian Devlin, PT
What are your biggest takeaways since implementing early mobility?
“The most interesting thing for me about early mobility is how often patients show interest and excitement (as much as one can show excitement in their situations) in movement. Patients, even at the worst moments of their lives, are often happy/relieved to see us, because they are sick of lying in bed and not being able to move.” — Josie Thulien, OT
“The therapy team here at TMCA takes great pride in the work they have done with all critically ill patients on the ventilator, but especially during the COVID 19 pandemic. Due to the debilitating nature of COVID, therapy was involved daily with these patients to help them get home to their families!” — Kim Friend, PT/OT Lead
“Patients remember us working with them and are typically very grateful. Being on the ventilator is a traumatic experience for many of them and they are just really appreciative of the care they receive from all disciplines. The therapists who perform early mobility therapy really appreciate the assistance we receive from our other ICU team members.” — Brian Devlin, PT