Quote from ChicagoICUNurse
Are we talking orally intubated patient? It seems a little interested to me. I have used a cardiac chair for a "stable" orally intubated ICU patient on several occasions.
I must admit that I didn't read all the thread responses, but one thing pops into my mind regarding the airway. So if the patients extubates themself on the commode, what's the plan to handle that situation?? Then again, I work in neuro ICU and these patients are tubed for a reason.
This truly is nothing that new and has been around for over 30 years that I've been in the ICUs. Commonsense should tell you this is not going to be practical to walk a patient who is immobile due to a TBI or CVA. Those patients may be trached and go to a subacute until they can go to an Acute rehab (if possible) where they may or may not walk again. Very, very different scenario than from a COPD exacerbation or ARDS recovery. This also is not something where a patient just graps his EVD and ventilator and trots over to the toilet. It takes a team effort with all disciplines. Sometimes just having a patient be weight bearing for a few seconds during that move to the cardiac chair can make a big difference in strengthening.
Of course you must be comfortable with airways and know how to test for security. I don't trust all the new commercial holders which we use in neuro ICU so there is nothing tight around the neck. I prefer over the ear with old fashioned tape the same as we did over 30 years ago without problems for moving patients. The patient must also be able to cooperate enough to where they are no longer in restraints and can understand the words "don't pull it out". These patients are also not on sedation or paralytics or HFOV to where if they did lose the tube, there is time to calmly get the patient back to bed or even give them a trial off the ventilator while the RRT and RN stands by to re-intubate if necessary. If you panic, the patient panics and increases their work of breathing. I recommend this only be done in an ICU with experienced and confident health care providers who can convey that confidence to the patient.
I sometimes find it safer than some of the scary moves on IFT ambulances or to CT Scan with 2 trees of pumps, a couple of chest tubes, a ventilator and a patient that just barely meets the size requirements for the sled.
I posted this link earlier.
Johns Hopkins http://www.hopkinsmedicine.org/dome/0711/top_story.cfm
Indepth detail and more references. http://www.medscape.com/viewarticle/704498