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Flashcards in 7) Early Mobilization Deck (49):
1

Safe HR range for exercise:

40-130BPM

2

Safe RR range for exercise

5-40 breaths/min

3

Safe SpO2 range for exercise

>88%

4

Safe MAP range for exercise

65-110mmHg

5

Safe systolic BP range for exercise

<200mmHg

6

Safe RPE range for exercise

10-15

7

When should you not have a pt exercise?

If they devo arrhythmia, angina, or complaints of fatigue

8

PMV

Need for mechanical ventilation for >3wks

9

Risk factors for PMV

*Age
*Comorbidity
*Illness severity
*Sepsis
*Duration of ICU delirium

10

Post-ICU Syndrome

Decline in physical, cognitive, or mental status that continues after ICU d/c

11

Long-term complications associated w/PICS:

*Physical dysfxn
*Neuromuscular dysfxn
*Pulmonary dysfxn
*Cognitive decline
*Psychiatric decline
*Decr QOL

12

Is there a recognized rehab protocol for PICS?

No

13

What is ICU-associated weakness

Clinically detected weakness in critically ill pt's where there's no cause other than critical illness

*Refers to bilateral, generalized, & diffuse muscle weakness

14

Types of ICU-AW

*Critical Illness Myopathy (CIM)
*Critical Illness Polyneuropathy (CIP)
*Critical Illness Neuromyopathy (CINM)

15

What needs to be addressed w/ICU-AW?

Pt's fxnl weaknesses

16

Which type of ICU-AW devos later & less frequently but is associated w/long ICU stays?

CIP

17

Clinical Features of ICU-AW

1) Weakness devo after onset of critical illness
2) Weakness involving proximal & distal muscles, limbs, & respiratory muscles
3) Spares CN's
4) MRC score <48/60
5) Dependency on vent
6) Weakness is not related to any underlying critical illness

*Need to have 1,2, & 6, &/or 4 & 5

18

What are important mechanisms for ICU-AW-associated weakness & why?

Immobility & inflammation-->Shift of pro-inflammatory cytokines during critical illness leads to incr systemic infection which causes further muscle damage

*This combined w/production of reactive O2 species (ROS) w/incr anti-oxidative defenses causes further disruption between muscle synthesis & proteolysis

19

True or false: Pt's w/ICU-AW have weakness before there's detectable muscle wasting

True

20

How much of a decrease in strength can ICU-AW pt's see in the first week?

40% decrease

21

How much of a decrease in strength can pt's w/disuse atrophy see in the first week?

5% decrease

22

What is disuse atrophy associated with?

Structural & metabolic changes of muscle:
*Net loss of muscle mass & CSMA
*Decr contractile strength
*Shift from slow twitch to fast twitch fibers

23

Complications associated w/ICU-AW & VIDD

*Incr time on a vent
*Muscle weakness ranging from mild to paralysis
*Adverse effects to the diaphragm
*Hypoglycemia
*Muscle Atrophy
*Muscle fiber shift to type 2
*Protein loss & malnutrition
*Anabolic resistance

24

VIDD

Ventilator Induced Diaphragmatic Dysfunction

25

What can hypoglycemia cause & why?

Decr diaphragmatic strength bc of oxidative stress & decr troponin

26

Risk factors for ICU-AW

*Vent >7days
*Sepsis
*Multi Organ Failure
*Hyperglycemia
*Systemic Inflammatory Response Syndrome
*Corticosteroid Use
*Neuromuscular blockers
*Muscle immobilization

27

What is prolonged mechanical ventilation associated w/?

*Incr oxidative stress
*Oxidative modifications to diaphragmatic proteins
*Upregulation of autophagic system
*Activation of proteolytic pathways
*Muscle atrophy

28

Delirium

Brain dysfxn characterized by acute disturbance of consciousness w/inattention, disorganized thinking, & perceptual disturbances that fluctuate over a short period of time

29

Hypoactive Delirium

Lethargy & inattention

30

Hyperactive Delirium

Agitated & combative

31

Mixed Delirium

*

32

What does delirium do to critical illness?

Complicates it

33

What percentage of vented ICU pt's get delirium?

60-80%

34

What effect does delirium have on pt's even after d/c?

*Prolonged neurocognitive impairments
*Poor fxnl status
*Incr rate of LTC facility entry
*Decr QOL

35

What positions decr dyspnea & why does this work?

Upright & leaning forward w/arms on thighs

*Incr intra-abdominal pressure, which incr the curvature of the diaphragm, so it optimizes the diaphragm's MA & its ability to generate pressure

36

What is ICU exercise prescription based on?

*Analysis of factors that contribute to impaired O2 transport
*Hierarchy of body positions

37

Implications for ICU exercise prescription

*Incorporate active movement w/body changes
*Extremes of body positioning have great benefit
*Upright mobilization incr TV, RR, flow rates, mucocilliary transport, A/W clearance, & cough effectiveness

38

How many PT's will be needed for prone positioning of ICU pt's?

Probably >1

39

Protocols for exercise in the ICU

*Bedside cycling improves MMT, 6MWT, & QOL
*Incr strength=Decr vent time
*Program should be 6wks
*Start w/ROM progressing to positions progressing to amb
*Do bed mobility progressed to transfers & standing
*Do deep breathing
*Tx the whole body
*UBE
*NMES
*IMT
*ECT

40

What is a safe HR range?

40-130BPM

41

What is a safe RR range?

5-40

42

What is a safe SpO2 range?

>88%

43

What is a safe MAP range?

65-110mmHg

44

What is a safe SBP range?

>200mmHg

45

What is a safe range for RPE?

10-15

46

When should you not have a pt do activities?

W/devo of:
*Arrhythmia
*Angina
*Complaints of fatigue

47

If a pt devos arrhythmia, angina, or complains of fatigue, should you exercise them?

No

48

ICU-AW

ICU-Associated Weakness

49

What does upright mobilization incr?

*Tidal Volume
*RR
*Flow rate
*Mucocilliary Transport
*A/W Clearance
*Cough Effectiveness