Any ICU's ambulating vented patients?

lovingtheunloved, ASN, RN · Nov 15, 2012

ICU isn't my area, but that sounds like it's about a 3 person job!

Sun0408, ASN, RN · Nov 15, 2012

We don't do it in our dept, obviously trauma's aren't gonna walk all that soon, however, they do walk vented pts in the CCU. They have a portable vent on wheels or they just bag the pt. I have yet to see it but others that have floated there said its wild to see at first :)

missnurse01, MSN, RN · Nov 15, 2012

I have worked in many icu's across the country but only saw it in one and it was pretty rare.

commonsense · Nov 15, 2012

I'm starting to here about vented pts being ambulated with the RN, PT, and RT. Do any of you practive this at you hospital? There's videos on Youtube, which is pretty wild. The pt has a walker with the vent on a rolling table.

I think they only do that in specialized ICU departments located in Crazytown, USA.

brandi-lynn · Nov 15, 2012

At Kaiser in Portland we ambulate our vented pts once or twice daily with RT, PT (or another nurse) and the RN. The pts like it and they get extubated sooner. You use less sedatives because the pts are genuinely tired, less delirium, etc. I love it. Most of the nurses I work with love it too. Of course there are pts who don't qualify to walk, but a lot do. It's great, check it out!

justatraveler · Nov 15, 2012

Some of our patients stand up out of bed, walk in place, and take a few steps over to an easy chair, where they might sit for a few hours or so. :)

sapphire18 · Nov 15, 2012

I wish my hospital did this!

Advanced Practice Columnist / Guide · Nov 15, 2012

We ambulate patients on vents in our ICU. This has been one of our quality initiatives and has been successful so far with the combined effort of nursing and PT. There are numerous articles that address this:

Early Mobilization in the ICU: Improving Patient Outcomes | The American College of Chest Physicians

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286494/pdf/cptj0023-0005.pdf

http://depts.washington.edu/pulmcc/conferences/lungday/Hough%20Mobilization.pdf

http://ptrehab.ucsf.edu/sites/ptrehab.ucsf.edu/files/documents/Early%20Mobilization%20in%20the%20ICU.pdf

The last link is from our institution.

hodgieRN · Nov 16, 2012

That's so awesome! Let me ask you this...What do you say to people that argue pts who can ambulate don't need to be intubated in the first place?

Advanced Practice Columnist / Guide · Nov 16, 2012

That's so awesome! Let me ask you this...What do you say to people that argue pts who can ambulate don't need to be intubated in the first place?

My answer would be that this is a generalization that does not apply to all vented patients. In the same manner, not all patients that are vented are safe to ambulate if they do not fall within the criteria we use in our institution.

Patients that are ready for extubation based on established parameters need to be extubated regardless. Patients with true lung injury (such as due to ARDS) have a longer course of lung recovery which can take time to be liberated from the vent. Some require gradual pressure support wean, some require bi-level ventilatory mode wean. In the meantime, they can start PT and receive assistance with mobilization.

opossum · Nov 16, 2012

I remember first learning about this at an AACN conference last year and was blown away by it - it truly does lead to faster extubations.

However, I think it requires a dedicated team approach of MDs, RNs, RT and PT to make this all happen; in my hospital, that's simply not an option. We're a small, rural hospital and do not have enough staff around to just even get the pt UP. It's sad, because it's something from which a lot of intubated pts could benefit.