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ICU mobility: What have we learned and what’s next? Catherine “Terri” Hough, MD MSc Professor of Medicine Division of Pulmonary, Critical Care, & Sleep Medicine Harborview Medical Center, University of Washington @Terri_Hough
Transcript of Wake up and smell the coffee! Improving Sedation Practices ... · Wake up and smell the coffee!...
ICU mobility:
What have we learned and what’s next?
Catherine “Terri” Hough, MD MScProfessor of Medicine
Division of Pulmonary, Critical Care, & Sleep Medicine
Harborview Medical Center, University of Washington
@Terri_Hough
Disclosures• Grants
– NHLBI
– NINR
– NCCIH
• Images
– www.nounproject.com
Outline
• What we’ve learned
about ICU Mobility
• What we still need
to learn
• Next steps
Five lessons learned about
ICU mobility
ICU mobility is:
1. Possible
Bailey P. Critical Care Medicine 2007
Schweickert W. Lancet 2009
ICU mobility is:
1. Possible
2. Safe
No signal for early mortality
Devlin J. Critical Care Medicine 2018
Annals of the ATS 2017
48 studies 7546 patients 22351 sessions
536 safety events
(<3% of sessions)
ICU mobility is:
1. Possible
2. Safe
3. Beneficial
Schweickert W. Lancet 2009; Burtin C. Crit Care Med 2009; Schaller S. Lancet 2016
Mobility improves ICU & hospital
outcomes
ICU mobility is:
1. Possible
2. Safe
3. Beneficial
4. Exciting
Devlin J. Critical Care Medicine 2018; Roeseler J. Reanimation 2013
Over 1400 publications in 2017
ICU mobility is:
1. Possible
2. Safe
3. Beneficial
4. Exciting
5. Not done very often
Few ICU patients perform advanced mobility
(sitting at edge or getting out of bed
year authornumber
MV+ETT
% edge of
bed
% out of
bed
2013 Nydahl 401 3% 0%
2013 Berney 200 3% 0%
2017 Jolley 432 9% 7%
2018 Fontella 98 1% 1%
What do we still need
to learn?
Who are the “right” patients?
• Too healthy?
• Too acutely ill?
• Too chronically ill?
• Who is just right?
What is the “right” intervention?
Morris P. JAMA 2016
Fossat G. JAMA 2018
Kho M. BMJ Open 2016
Intervention: What is the “right” time?
Bernhardt J. Lancet 2015; Moss M. AJRCCM 2016; Walsh T. JAMA Int Med 2015
Before 24 hours
After 5 days
After ICU discharge
What are the “right” strategies to maximize
delivery of intervention?
What is the “right” comparator?
What are the “right” co-interventions?
What is the “right” outcome?
(And when do we measure it?)
• Health care utilization
• Strength
• Function
• Participation
• Life satisfaction
What’s next?
Learn more about predictors of disability
• Longitudinal observational studies
– Increasing measurement of pre-ICU function
– Detailed assessment of potential predictors
– Post-ICU evaluation at multiple time points
PREDICT
Larger, multi-center trials
• Increase external validity
• Allow subgroup analyses
• Address patient-
centered outcomes
Study co-interventions
THE NEXIS TRIALNutrition and Exercise in Critical Illness
Identify best outcomes and harmonize
Connolly B. Trials 2018
Focus on implementation
Costa D. Chest 2017; Goddard S. JICS 2018
Summary
• ICU mobility is possible, safe,
beneficial, exciting, and not
done very often
• There are more questions
than answers!
• Lots of work underway
– Stay tuned!
