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Algorithmen zur Frühmobilisierung auf Intensivstationen

Algorithms for early mobilization in intensive care units

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Zusammenfassung

Die Immobilität von Patienten auf Intensivstation kann zu nachhaltigen physischen und kognitiven Nachteilen führen. In den letzten Jahren wurden Maßnahmenbündel zur Rehabilitation entwickelt, die u. a. auch die Frühmobilisierung beinhalten. Die deutsche Leitlinie zur Lagerungstherapie und Frühmobilisierung empfiehlt allgemein die Entwicklung stationsspezifischer Protokolle. Ziel dieser narrativen Übersichtsarbeit ist es, Empfehlungen zur Entwicklung eines Best-Practice-Protokolls im eigenen Arbeitsbereich zu geben. Es wird empfohlen, a) Frühmobilisierung als Teil eines Maßnahmenbündels unter Einbeziehung von regelmäßigem Screening und Management von Wachheit, Schmerz, Angst, Stress, Delir sowie der Gegenwart der Familie umzusetzen, b) spezifische Ein- und Ausschlusskriterien mithilfe eines Ampelsystems für die zu behandelnde Populationen in einem interprofessionellen Prozess zu entwickeln, c) Checklisten zur Risikoeinschätzung und Vorbereitung der Mobilisierung zu verwenden, d) die ICU Mobility Scale zur Zielsetzung und Dokumentation der Mobilisierung zu nutzen, e) relative Sicherheitskriterien für hämodynamische und respiratorische Veränderung sowie die Borg-Skala für eine subjektive Evaluation zu verwenden, f) die Mobilisierung sowie Barrieren, unerwünschte Sicherheitsereignisse und andere Parameter systematisch zu dokumentieren und zu evaluieren.

Abstract

Immobility of patients in intensive care units (ICU) can lead to long-lasting physical and cognitive decline. During the last few years, bundles for rehabilitation were developed, including early mobilization. The German guideline for positioning therapy and mobilization, in general, recommends the development of ICU-specific protocols. The aim of this narrative review is to provide guidance when developing a best practice protocol in one’s own field of work. It is recommended to a) implement early mobilization as part of a bundle, including screening and management of patient’s awareness, pain, anxiety, stress, delirium and family’s presence, b) develop a traffic-light system of specific in- and exclusion criteria in an interprofessional process, c) use checklists to assess risks and preparation of mobilization, d) use the ICU Mobility Scale for targeting and documentation of mobilization, e) use relative safety criteria for hemodynamic and respiratory changes, and Borg Scale for subjective evaluation, f) document and evaluate systematically mobilization levels, barriers, unwanted safety events and other parameters.

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Authors and Affiliations

  1. Pflegeforschung, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Brunswiker Str. 10, 24105, Kiel, Deutschland

    P. Nydahl

  2. Akademie der Kreiskliniken Reutlingen, Kreiskliniken Reutlingen GmbH, Reutlingen, Deutschland

    R. Dubb & A. Kaltwasser

  3. Abteilung Physiotherapie, Universitätsklinikum Marburg, Marburg, Deutschland

    S. Filipovic

  4. Anästhesie und Intensivpflege, HELIOS Klinikum Siegburg, Siegburg, Deutschland

    C. Hermes

  5. Anästhesie und Intensivpflege, Asklepios Paulinen Klinik Wiesbaden, Wiesbaden, Deutschland

    F. Jüttner

  6. Zentrale Einrichtung Physiotherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    S. Klarmann

  7. Klinik für Neurologie, Neurophysiologie, Frührehabilitation und Schlafmedizin, Christophsbad Göppingen, Göppingen, Deutschland

    H. Mende

  8. Institut für Physikalische Medizin und Rehabilitation, Bereich Innere Medizin/Intensivstation, LKH-Universitätskliniken Innsbruck, Innsbruck, Österreich

    S. Nessizius

  9. Universitätsklinik für Physikalische Medizin und Rehabilitation Wien, Wien, Österreich

    C. Rottensteiner

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  1. P. Nydahl
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Correspondence to P. Nydahl.

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P. Nydahl, R. Dubb, S. Filipovic, C. Hermes, F. Jüttner, A. Kaltwasser, S. Klarmann, H. Mende, S. Nessizius und C. Rottensteiner geben an, dass kein Interessenkonflikt besteht.

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Nydahl, P., Dubb, R., Filipovic, S. et al. Algorithmen zur Frühmobilisierung auf Intensivstationen. Med Klin Intensivmed Notfmed 112, 156–162 (2017). https://doi.org/10.1007/s00063-016-0210-8

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