Early mobilization on continuous renal replacement therapy is safe and may improve filter life

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• 作者：Yi Tian Wang (1)
  Terry P Haines (2) (3)
  Paul Ritchie (4)
  Craig Walker (4)
  Teri A Ansell (4)
  Danielle T Ryan (1)
  Phaik-Sim Lim (5)
  Sanjiv Vij (6)
  Rebecca Acs (6)
  Nigel Fealy (7)
  Elizabeth H Skinner (1) (2) (3) (4) (8)
  
  1. Department of Physiotherapy ; Monash Health ; 246 Clayton Road ; Clayton ; Victoria ; 3168 ; Australia
  2. Allied Health Research Unit ; Monash Health ; 400 Warrigal Road ; Cheltenham ; Victoria ; 3192 ; Australia
  3. Department of Physiotherapy ; Faculty of Medicine ; Nursing and Health Science ; Monash University ; McMahons Road ; Frankston ; Victoria ; 3199 ; Australia
  4. Department of Intensive Care ; Monash Health ; 246 Clayton Road ; Clayton ; Victoria ; 3168 ; Australia
  5. Department of Physiotherapy ; Monash Health ; 135 David Street ; Dandenong ; 3175 ; Victoria ; Australia
  6. Department of Intensive Care ; Monash Health ; 135 David Street ; Dandenong ; 3175 ; Victoria ; Australia
  7. Department of Intensive Care ; Austin Health ; Studley Road ; Heidelberg ; Victoria ; 3084 ; Australia
  8. Department of Physiotherapy ; Western Health ; Gordon Street ; Footscray ; Victoria ; 3011 ; Australia
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：August 2014
• 年：2014
• 卷：18
• 期：4
• 全文大小：697 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Despite studies demonstrating benefit, patients with femoral vascular catheters placed for continuous renal replacement therapy are frequently restricted from mobilization. No researchers have reported filter pressures during mobilization, and it is unknown whether mobilization is safe or affects filter lifespan. Our objective in this study was to test the safety and feasibility of mobilization in this population. Methods A total of 33 patients undergoing continuous renal replacement therapy via femoral, subclavian or internal jugular vascular access catheters at two general medical-surgical intensive care units in Australia were enrolled. Patients underwent one of three levels of mobilization intervention as appropriate: (1) passive bed exercises, (2) sitting on the bed edge or (3) standing and/or marching. Catheter dislodgement, haematoma and bleeding during and following interventions were evaluated. Filter pressure parameters and lifespan (hours), nursing workload and concern were also measured. Results No episodes of filter occlusion or failure occurred during any of the interventions. No adverse events were detected. The intervention filters lasted longer than the nonintervention filters (regression coefficient鈥?鈥?3.8 (robust 95% confidence interval (CI)鈥?鈥?.0 to 22.6), P鈥?鈥?.003). In sensitivity analyses, we found that filter life was longer in patients who had more position changes (regression coefficient鈥?鈥?.0 (robust 95% CI鈥?鈥?.6 to 3.5), P鈥?鈥?.007). The nursing workloads between the intervention shift and the following shift were similar. Conclusions Mobilization during renal replacement therapy via a vascular catheter in patients who are critically ill is safe and may increase filter life. These findings have significant implications for the current mobility restrictions imposed on patients with femoral vascular catheters for renal replacement therapy. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12611000733976 (registered 13 July 2011)