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"apellidos" => "Blanco-uelga" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529984023000368?idApp=UINPBA00004N" "url" => "/25299840/0000003500000001/v1_202402210703/S2529984023000368/v1_202402210703/en/main.assets" ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Response to “Do we actively and early mobilize patients admitted to an intensive care unit during mechanical ventilation?”" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "74" "paginaFinal" => "75" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. Ballesteros-Reviriego, J. Daniel Martí, B. Planas-Pascual" "autores" => array:3 [ 0 => array:4 [ "preGrado" => "PT, MSc" "nombre" => "G." "apellidos" => "Ballesteros-Reviriego" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:4 [ "preGrado" => "PT, PhD" "nombre" => "J." "apellidos" => "Daniel Martí" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:5 [ "preGrado" => "PT, MSc" "nombre" => "B." "apellidos" => "Planas-Pascual" "email" => array:1 [ 0 => "bernat.planas@vallhebron.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Hospital Universitari Vall Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grupo de Trabajo de Rehabilitación Precoz, Sociedad Española de Enfermería Intensiva y Unidades Coronarias (SEEIUC), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Clínic de Barcelona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Réplica a «¿Movilizamos de forma activa y temprana durante la ventilación mecánica a los pacientes ingresados en una unidad de cuidados intensivos?»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">As intensive care unit (ICU) physiotherapists, we would like to point out some of the aspects commented on in the letter to the editor published in Enfermería Intensiva about the active and early mobilisation of patients admitted to the ICU undergoing mechanical ventilation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The letter states that the TEAM study<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> investigated the effects of early mobilisation in ICU patients undergoing invasive mechanical ventilation. Although no significant differences in survival were found, it was noted that early mobilisation did not improve quality of life or function in surviving patients. It is noted that the study has limitations in terms of generalisability of the results and the restrictive definition of early mobilisation used. Although previous research has shown benefits of early rehabilitation, this particular study found no significant difference in long-term survival and showed a higher number of adverse events in the study group. In conclusion, it underlines the importance of careful risk-benefit assessment before implementing early mobilisation in clinical practice.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A review of the literature shows that early mobilisation (EM) appears to be safe with a low incidence of reported adverse events.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">A study involving more than 5000 physiotherapy sessions reported 34 possible safety events, of which only four required treatment, indicating a low proportion of adverse effects.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However, in a systematic review by Schmidt et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> that examined 8492 EM sessions, 104 adverse events related to oxygen desaturations, arrhythmias, ventilator-patient asynchronies, falls or instability, blood pressure changes, catheter loss and one case of Achilles tendon rupture were reported. Although these events occurred in a very small number of sessions (less than 1%), they were significant, highlighting the importance of patient monitoring by trained staff.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Analysing the TEAM<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> study solely on the basis of its conclusions is confusing. Knowledge of the methodological aspects and study limitations is required in order to establish an optimal criterion on the subject.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patients included in the "usual care group" control group received the degree of mobilisation according to the IMS scale (ICU Mobility Scale) normally received in the units where they were admitted. Mobilisation in this group follows the standards recommended in the international guidelines for early mobilisation.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Furthermore, in the "early mobilisation group", the highest degree of mobilisation according to the IMS scale that the patient can safely perform is encouraged and maintained for as long as possible. This level is applied suddenly without prior adaptation.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Because of the methodology described above, we cannot assume that the intervention carried out in this study is representative of standard clinical practice or of the results obtained in previous research. Therefore, it is necessary to analyse with caution both the results and the conclusions obtained.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The fact that the intervention group experienced a higher percentage of adverse effects (9.2% compared to 4.1% in the control group) is a highly predictive indicator that increased early mobilisation similar to that applied in the intervention group of the study may have negative effects on the critically ill patient. Thanks to this finding, we can begin to determine the maximum limit of activity of our patients. More studies are needed to establish optimal training loads and confirm levels that should not be exceeded.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Consequently, it cannot be stated that early mobilisation has negative effects on critically ill patients. The increase in adverse effects in the intervention group is related to a higher intensity that has not been observed in previous studies.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Nor can we ensure that the mobilisation standards set internationally and observed in the control group of said study are met in the Spanish ICUs. The MOViPre study, carried out in 80 ICUs in Spain in 2017, which also used the IMS to record the degree of mobility, showed that active mobilisation out of bed was only carried out in 9.9% of the 10,046 patient-days analysed, whilst exercises in bed or passive transfer accounted for 45.6%. Patients were immobile 42.2% of the days.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Current work must be aimed at improving this situation, promoting multidisciplinary teams with clinical experience, time, and optimal resources to carry out this task.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early active mobilization during mechanical ventilation in the ICU" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "TEAM Study Investigators and the ANZICS Clinical Trials Group" "etal" => true "autores" => array:6 [ 0 => "C.L. Hodgson" 1 => "M. Bailey" 2 => "R. Bellomo" 3 => "K. Brickell" 4 => "T. Broadley" 5 => "H. Buhr" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa2209083" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2022" "volumen" => "387" "paginaInicial" => "1747" "paginaFinal" => "1758" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36286256" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety of patient mobilization and rehabilitation in the intensive care unit: systematic review with meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Nydahl" 1 => "T. Sricharoenchai" 2 => "S. Chandra" 3 => "F.S. Kundt" 4 => "M. Huang" 5 => "M. Fischill" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1513/AnnalsATS.201611-843SR" "Revista" => array:6 [ "tituloSerie" => "Ann Am Thorac Soc" "fecha" => "2017" "volumen" => "14" "paginaInicial" => "766" "paginaFinal" => "777" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28231030" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ten reasons why ICU patients should be mobilized early" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Denehy" 1 => "J. Lanphere" 2 => "D.M. 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MacIntyre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4187/respcare.04566" "Revista" => array:6 [ "tituloSerie" => "Respir Care" "fecha" => "2016" "volumen" => "61" "paginaInicial" => "867" "paginaFinal" => "875" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27235319" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guidelines for early mobilization in the ICU: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.K. Lang" 1 => "M.S. Paykel" 2 => "K.J. Haines" 3 => "C.L. Hodgson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0000000000004574" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2020" "volumen" => "48" "paginaInicial" => "e1121" "paginaFinal" => "e1128" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32947470" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MOviPre group. Variables associated with mobility levels in critically ill patients: a cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Raurell-Torredà" 1 => "S. Arias-Rivera" 2 => "J.D. Martí" 3 => "M.J. Frade-Mera" 4 => "I. Zaragoza-García" 5 => "E. Gallart" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/nicc.12639" "Revista" => array:6 [ "tituloSerie" => "Nurs Crit Care" "fecha" => "2022" "volumen" => "27" "paginaInicial" => "546" "paginaFinal" => "557" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34008238" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/25299840/0000003500000001/v1_202402210703/S2529984023000575/v1_202402210703/en/main.assets" "Apartado" => array:4 [ "identificador" => "74712" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/25299840/0000003500000001/v1_202402210703/S2529984023000575/v1_202402210703/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529984023000575?idApp=UINPBA00004N" ]
Journal Information
Vol. 35. Issue 1.
Pages 74-75 (January - March 2024)
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Vol. 35. Issue 1.
Pages 74-75 (January - March 2024)
Letter to the Editor
Response to “Do we actively and early mobilize patients admitted to an intensive care unit during mechanical ventilation?”
Réplica a «¿Movilizamos de forma activa y temprana durante la ventilación mecánica a los pacientes ingresados en una unidad de cuidados intensivos?»
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