插管,拔管,走动:大流行如何加速需要体外膜氧合的患者早期活动能力的发展和实施

PT Dpt Ccs Kari DiVito, PT Anne K. Swisher, MD Mph J.W. Awori Hayanga
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引用次数: 1

摘要

目的:体外膜肺氧合(ECMO)是严重新冠肺炎感染者迫切需要的一种救生方式。尽管这些患者的流动性此前已被安全地报道为轶事,但没有既定的指导方针可以在疫情期间大幅扩大的患者群体中实施。我们描述了基于团队的安全动员计划(插管、拔管、救护车)的开发和实施。方法:3阶段方案基于患者的警觉性/积极参与能力而发展。物理治疗师确定了初始阶段和进展,并建议护士和/或ECMO专家在熟练会话之间进行活动。结果:104名新冠肺炎重症患者成功实施了流动计划,没有发生重大不良事件。大多数患者(51%)在插管时行走,60%的患者能够在住院后直接出院回家。结论:这种安全、有效的方案允许在需求非常高的时期,在高度复杂的患者群体中扩展物理治疗目标。将早期流动性作为团队目标,增强了购买力,而不是完全依赖康复提供者进行动员。插管、拔管、救护车程序的使用可能有助于其他程序最大限度地减少ECMO人群中不动的并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cannulate, Extubate, Ambulate: How the Pandemic Accelerated Development and Implementation of Early Mobility for Patients Requiring Extracorporeal Membrane Oxygenation
Objective: Extracorporeal membrane oxygenation (ECMO) is a lifesaving modality that was in great demand for persons with severe COVID-19 infection. Although mobility of these patients has previously been safely reported anecdotally, there were no established guidelines to implement in a greatly expanded patient population, as occurred in the pandemic period. We describe the development and implementation of a program (Cannulate, Extubate, Ambulate) for team-based safe mobilization. Methods: The 3-phase protocol advances based on patient alertness/ability to actively participate. A physical therapist determined initial stage and progression and recommended mobility activities for carryover by nurses and/or ECMO specialists between skilled sessions. Results: The mobility program has been successfully implemented for 104 patients with severe COVID-19 without significant adverse events. Most patients (51%) ambulated while cannulated, and 60% were able to discharge directly home after hospitalization. Conclusions: This safe, effective program allowed extension of physical therapy goals in a highly complex patient population during a time of very high demand. Making early mobility a team goal enhanced buy-in, instead of relying exclusively on rehabilitation providers for mobilization. Utilization of the Cannulate, Extubate, Ambulate program may assist other programs to minimize complications of immobility in the ECMO population.
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