Intensive care units provide treatment to patients with acute and severe illness and injury. Some people are admitted to surgical intensive care units (SICUs) after an elective or emergency surgical procedure.

Muscle weakness is a common occurrence in patients in the SICU and can predict adverse outcomes and increased length of stay in hospital. Mobilisation in SICU patients is often neglected due to concerns for the patient’s safety and lack of knowledge about how best to approach it.

Mobilising people can, however, potentially improve muscle strength and lead to improved outcomes. Researchers investigated whether a goal-directed mobilisation intervention delivered to critically ill patients in the SICU at an early stage improved mobility, reduced length of stay and increased functional independence.

Participants were patients over the age of 18 who’d been admitted to the SICU and who had been mechanically ventilated for less than 48 hours and were expected to require mechanical ventilation for at least another 24 hours.

The researchers created a score to reflect mobilisation levels in SICU patients called the SICU optimal mobilisation score (SOMS), which ranges from 0 (no mobilisation) to 4 (ambulant). Participants were randomised to either the intervention or control group.

Both received the same level of clinical care, but the intervention group received early, goal-directed mobilisation consisting of setting a daily mobility goal and working with the clinical team to address the goal throughout the day. Changes in the treatment plan were revised until the mobility goal was met.

The primary outcome assessed was patients’ SOMS score during their stay in SICU, and secondary outcomes were their length of stay in SICU and their level of functional mobility upon discharge. All outcomes were measured from day one of admission to the SICU through to discharge.

The group receiving goal-directed mobilisation achieved improved SOMS levels compared to the control group and reached higher levels of mobilisation at an earlier stage in their stay.  Furthermore, compared to the control group, the intervention group had shorter length of stay in the SICU and improved mobility-related functional independence scores.

Implications

Goal-directed mobilisation appears to be effective in improving mobility in patients in the SICU if commenced early on in the patients’ stay, in this case on day one. Improved mobilisation can lead to improved health outcomes, including better muscle strength, and might improve quality of life post discharge by enabling more independence for tasks of daily living. It’s important not to try any mobilisation activities unsupervised in hospital or without the approval of your doctor.

Last Reviewed: 07/12/2019

Norman Swan Medical Communications



References

Schaller, S et al. (2016). Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial. Lancet, 388, 1377– 88. 

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