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One of the most common questions we get from families in intensive care is when their loved one can actually get mobilized and out of bed in ICU? Today, I want to give you an example of when that is possible, and I also want to talk about when it’s not possible.

My name is Patrik Hutzel, and I have another quick tip for families in intensive care today.

So, one of the most frequently asked questions we’re getting when families have their loved ones in intensive care is, should they get mobilized? Can they get mobilized? When can’t they get mobilized? Because a lot of ICUs nowadays don’t mobilize early, and there’s so much research out there that says early mobilization will always help with a quicker recovery. It helps with weaning off the ventilator, especially when patients have a breathing tube and a tracheostomy, but also when they’re on BIPAP (bilevel positive airway pressure) or CPAP (continuous positive airway pressure) without a breathing tube or tracheostomy.

So today, I really want to give you an example of a client that we are working with currently and we’re obviously reviewing medical records there daily and we’re recommending the family what questions to ask, what they should push forward with the intensive care teams, and so forth.

Today, I want to give you an example of a gentleman who has been in intensive care for about 2 months now, and he had a cardiac arrest. He’s got an anoxic brain injury, and he has been in bed for 2 months now, and he has not been mobilized.

Now, from my extensive critical care nursing experience, I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager in intensive care for over five years and where I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com, and you can verify it on our intensivecarehotline.com podcast section at intensivecarehotline.com where we’ve done client interviews.

Back to our case today, this gentleman has been in ICU for 2 months. He’s got anoxic brain injury, he’s got myoclonus. EEG (electroencephalograph) has revealed severe anoxic brain injury. MRI brain consistent with severe anoxic brain injury. He’s on Keppra, clonazepam, baclofen for treatment of myoclonus, which is also known as jerking movements. The ICU team will try to decrease the dose both of clonazepam and baclofen slowly and see how he tolerates it.

So, he’s also in chronic respiratory failure with ventilator and tracheostomy dependence. His white cell count remains normal. In the progress notes from the intensive care team, it says failure to thrive. He’s lost a lot of weight and he’s feeding tube dependence. Again, what the intensive care team is documenting the ability and acute physical deconditioning due to acute illness and prolonged hospital course.

Now, what I will say here, and this is also because he has not been mobilized. As far as I can see, there’s absolutely no reason why he can’t get mobilized. He’s hemodynamically stable, he has no fractures, and he needs to get out of bed. Yes, he’s got an anoxic brain injury, but it’s also documented that his neurology is slowly improving, and he would improve more if he was to get mobilized.

What does that look like? Well, it looks like if a patient is immobile and can’t move themselves, they need to be hoisted out of a bed in a recliner chair, or they need to be slide over into a tilt chair, and then be tilted upwards, and sitting up, and that is all possible. A good ICU will do that.

Any good ICU that I worked at, we have always mobilized patients early and that seems to have gone out of the window. ICU seems to want to wash their hands clean, and just let patients wither away in bed. We see that more so in the U.S., in the United States than in other countries. The reason I think we’re seeing it in the United States is that ICUs want to do early tracheostomy, early PEG tube whenever they can, and then send patients to an LTAC. Patients in LTAC won’t get mobilized and have physical therapy either.

So, there’s also nothing in the medications for this gentleman that would stop him from getting mobilized baclofen, clonazepam, heparin, Atrovent, nebulizers, Keppra to prevent seizures, methimazole, and that’s about it. There’s nothing stopping him from getting mobilized. He’s not on inotropes; he’s not on vasopressors. He’s hemodynamically stable.

Now, he’s also on ventilation support still with a PEEP (positive end-expiratory pressure) of 5 and FiO2 of 21% to 25%, and he’s still in a pressure-controlled ventilation mode with a rate of 12 breaths per minute, and he’s over breathing the ventilator. I argue that if he was to get out of bed regularly, and he could sit up, his breathing would get stronger, his breathing muscles would strengthen.

Imagine you’re lying in bed for two months on end and no one’s doing anything with you besides maybe talking to you, the family’s talking to him but the nurses and the doctors, they are not stimulating him and that is really shocking. They’re turning him from side to side so he’s not getting pressure sores, but that is not good enough and patients need to be mobilized as early as possible. Like I said, there is enough research out there that early mobilization is key to recovery and to a quicker recovery.

What is also important to know is, yes, whilst an anoxic brain injury is not a good prognosis, how is the brain going to recover if a patient is not getting out of bed, if they’re not getting stimulated, if they’re not sitting up? Things like sitting them up would make them stronger, gets the blood flowing. You can get patients even in a shower, once they’re out of bed and they can sit up, you can sit them, you can get them in a shower commode, get them to a shower, make them feel like a human, simple things like that will improve the well-being and will help with recovery.

Maybe patients cannot get back to what was their benchmark and what was their normal, but hopefully they can improve regardless. Maybe it comes to where the patient can have a quality of life that is acceptable for the patient and the family, but you have to keep trying, and you have to keep mobilizing patients. It’s absolutely critical. Don’t let any ICU tell you otherwise.

If some of you watching this, have been to different ICUs, maybe, for example, you would have noticed the difference between different ICUs and the nurses, and the physiotherapists can easily mobilize a patient together easily. There should be enough staff. Don’t let anyone tell you there’s not enough staff, there’s no equipment. If they don’t have the equipment, that’s actually pretty scary, that means your loved one is probably not in a good ICU.

So, I hope that helps and explains to you when you can get mobilized. When you can’t get mobilized is simply when you’re hemodynamically unstable, your blood pressure is either too low, too high, you’re on vasopressors, inotropes to support blood pressure or on vasodilators such as GTN (Glyceryl trinitrate)  or SNP (Sodium nitroprusside), or if you have fractures. Those are contraindications or if you’re at high risk of bleeding, or if you’re on high ventilation support, those are contraindications for getting mobilized, but in this case, there’s absolutely no contraindication whatsoever. You should be pushing for mobilization if your loved one is in a similar situation.

We have helped hundreds of members and clients over the years to improve their lives instantly when they have their loved one critically ill intensive care. Like I said, we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com and on our podcast section at intensivecarehotline.com where we’ve done client interviews.

That’s also why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you simply cannot afford to get wrong. I also talk to doctors and nurses directly and I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care. I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have an online membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com. Click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email, and we answer all questions intensive care related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded.  This information, including the access to me and my team, will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets best care and treatment always.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care, click the like button, click the notification bell, comment below what you want to see next, what questions and insights you have from this video.

I also do a weekly YouTube Live where I answer your questions live on a show. You will get notification for the YouTube live if you’re a subscriber to my YouTube channel or a subscriber to my email newsletter at intensivecarehotline.com.

Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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