Problem Background
In critical care nursing, mechanical ventilation can be a life-saving measure, which comes with significant wasting and deterioration problems. It should be noted that “prolonged immobility in patients in the intensive care unit (ICU) can lead to muscle wasting and weakness, longer hospital stays, increased number of days in restraints, and hospital-acquired infections” (Shah et al., 2018, p. 370). There are three key reasons why immobility due to ventilation is dangerous.
Firstly, long-stay patients are more likely to suffer from hospital-acquired infections, such as urinary tract infections (Zhu et al., 2020). Secondly, immobility can cause muscle atrophy, especially in vital muscles such as the diaphragm, mobility, and inspiratory strength (Santana et al., 2018). Thus, using ultrasound protocol, it is critical to assess long-stay patients for muscle wasting and hospital-acquired infections to evaluate the risk against minor potential harms of early mobilisation (Hernandez-Socorro et al., 2018). Therefore, it is essential to analyse how early mobilisation measures can change the adverse effects of mechanical ventilation.
Research Question and Paradigm
The research question: How does an early mobility program impact functional outcomes and length of stay for mechanically ventilated patients in the ICU? The study will be guided by a quantitative paradigm that measures an intervention’s effectiveness in achieving specific outcomes. It was found that “initiation of mobilisation within 48–72 h of mechanical ventilation may be optimal for improving clinical outcomes for mechanically ventilated patients” (Zhang et al., 2019). This research inspired the proposed research question, so a deeper analysis is necessary. Thus, the proposed study will build upon previous research and contribute to understanding the effectiveness of early mobilisation programs in improving the outcomes of mechanically ventilated patients in the ICU.
Research Design
The research design for this study will be a randomised controlled trial. Participants will be randomly assigned to either the intervention group, which will receive an early mobility program, or the control group, which will receive standard care. The study will include patients who are mechanically ventilated and have been in the ICU for more than 48 hours. The sample size will depend on the pool of available patients, but the estimate ranges from 10 to 20 patients. This number is manageable when conducting such a study.
Methods and Tools
The study will involve implementing an early mobility program that includes an ultrasound protocol to guide patient mobilisation. The program will include the assistance of a trained physical therapist to perform exercises like range-of-motion, sitting on the edge of the bed, and standing. The program will be tailored to the patient’s abilities and will progress gradually as tolerated. Functional outcomes will be assessed using the Functional Independence Measure (FIM) and the Barthel Index (Zhang et al., 2019). The length of stay in the ICU and hospital will also be measured.
Data will be collected at baseline, daily during the intervention period, and at discharge from the ICU and hospital. The statistical analysis will involve comparing the outcomes between the intervention and control groups. Descriptive statistics will be used to summarise the data, and inferential statistics will be used to test for significant differences between the groups. A p-value of <0.05 will be considered statistically significant. The study’s findings will help inform the development of interventions to improve the outcomes of mechanically ventilated patients in the ICU.
Reference List
Hernandez-Socorro, C. R. et al. (2018) ‘Assessment of muscle wasting in long-stay ICU patients using a new ultrasound protocol’, Nutrients, 10(12), p. 1849. Web.
Santana, A. F. S. G. et al. (2018) ‘Inspiratory muscle weakness, diaphragm immobility and diaphragm atrophy after neck dissection’, European Archives of Oto-Rhino-Laryngology, 275, pp. 1227–1234. Web.
Shah, S. O. et al. (2018) ‘Early ambulation in patients with external ventricular drains: results of a quality improvement project’, Journal of Intensive Care Medicine, 33(6), pp. 370-374. Web.
Zhang, N. et al. (2019) ‘What is the optimum time for initiation of early mobilization in mechanically ventilated patients? A network meta-analysis’, PLoS One, 14(10), pp. 1-12. Web.
Zhu, C. et al. (2020) ‘Prevalence, incidence, and risk factors of urinary tract infection among immobile inpatients in China: a prospective, multi-centre study’, Journal of Hospital Infection, 104(4), pp. 538-544. Web.