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Experts Confirm

Very Early Mobilization
one key to faster recovery
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Experts Confirm

Very Early Mobilization
one key to faster recovery

at a glance

Vem – clinical benefits

reduce ICU delirium risk
improve vigilance levels
preserve cardiovascular endurance
facilitate breathing
facilitate bowel movement
decrease risk for decubitus
preserve bone density
preserve muscle mass density

Very Early Mobilization in critical care is chosen by clinicians around the world as the number one intervention to prevent the negative effects of immobility. 
Very Early Mobilization enables patients to recover faster and reduces secondary complications associated with immobility.

VEM was shown to be an effective treatment:

  • to decrease risk for decubitus
  • preserve muscle mass and bone density
  • facilitate both breathing and bowel movement
  • improve vigilance levels
  • preserve cardiovascular endurance
  • reduce ICU delirium risk

→ fewer secondary complications and higher vigilance translate into a decrease in required nursing attention.

For ventilated patients, up to three therapists are required to perform early mobilization. Given the strained staff situation of critical care nurses, severely affected patients might not receive optimal therapy.

conventional approach

Manual Mobilization –helpful but challenging

© Schön Kliniken Bad Aibling, used with permission

Manually mobilizing patients that are severely affected or have limited ability to interact is challenging. Besides the physical strain on therapists, several nurses are required to perform therapy, and patient safety can be an issue. When mobilized to the bed-side, breathing tubes and lines can potentially come under strain.

Why are conventional therapy technologies not sufficient?

Conventional tilt tables offer training without leg movement. No leg movement means there is reduced cardiovascular and musculoskeletal training. As leg movements stabilize circulation, training duration is limited when the patient lacks cardiovascular stability required for verticalization.

  • Robotic mobilization with separate “stand-alone” devices requires a potentially hazardous transfer of the patient onto a separate device.
  • Several members of the ward-team are required for this transfer, which can be time consuming and physically straining.

ROBOT-ASSISTED VEM FOR CRITICALLY ILL PATIENTS

70% of the ICU patients in Germany receive manual VEM. 
30% of the patients are so critically ill that manual therapy is suboptimal or too dangerous due to severity of their symptoms.

Reasons for not mobilizing are amongst others paralysis / sedation, unconsciousness, lack of staff or weekends.

VEM assisted by VEMO would enable the clinic personnel to treat even the most critically ill patients

  • as the patient can stay in bed and the bed becomes a therapy device → no dangerous out of bed transfer is needed
  • only one nurse or therapist is required to mobilize the patient → instead of up to three

EXPERTS CONFIRM

PD&MER I Dr. Karin Diserens Neurologist, Head of the Acute Neurorééducation Unit Neurology Department of Clinical Neuroscience – Lausanne University Hospital – Lausanne, Switzerland

Our experience has proven that Very Early Mobilization is instrumental for faster recovery of patients. With VEMO coming up, we will be able to treat our ventilated patients more often, in a very secure environment, with lower physical strain on our nurses and therapists. The idea of transforming the patient bed into a therapy device will allow us to implement early mobilization even more efficiently in our ICU.

References

Needham, D. M., R. Korupolu, et al. (2010). "Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project." Arch Phys Med Rehabil 91(4): 536-542.

M. Morreale, P. Marchione,, A. Pili, A. Lauta, S. Castiglia, A. Spalleone, F. Pierelli, P. Giacomini, “Early versus delayed rehabilitation treatment in hemiplegic patients with ischemic stroke: proprioceptive or cognitive approach?”, in Eur. J. Phys. Rehabil. Med., 2015 July 28

Schweickert, W.D., et al., Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet, 2009. 373(9678): p. 1874-82.

Morris, P.E., et al., Early critical care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med, 2008. 36(8): p. 2238-43.

Chiang, L.L., et al., Effects of physical training on functional status in patients with prolonged mechanical ventilation. Phys Ther, 2006. 86(9): p. 1271-81.

Goemaere, S., et al., Bone mineral status in paraplegic patients who do or do not perform standing. Osteoporos Int, 1994. 4(3): p. 138-43.

Hoenig, H., et al., Case study to evaluate a standing table for managing constipation. SCI Nurs, 2001. 18(2): p. 74-7.

Walter, J.S., et al., Indications for a home standing program for individuals with spinal cord injury. J Spinal Cord Med, 1999. 22(3): p. 152-8.

Chang, A.T., et al., Standing with assistance of a tilt table in critical care: a survey of Australian physiotherapy practice. Aust J Physiother, 2004. 50(1): p. 51-4.

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