title: Promotion of progressive mobility activities with ventricular assist and extracorporeal membrane oxygenation devices in a cardiothoracic intensive care unit.
abstract: BACKGROUND
  Progressive mobility (PM) is a clinical intervention that influences complications experienced throughout critical illness. Early PM is a relevant topic in critical care practice literature and was principle to introducing a PM care guideline in an acute cardiothoracic/cardiovascular intensive care unit.
  
  
  OBJECTIVE
  A noted challenge in the cardiothoracic/cardiovascular intensive care unit is caring for acute cardiac and pulmonary failure. Often, these patients require prolonged mechanical circulatory support via extracorporeal mechanical oxygenation or a ventricular assist device. This article describes safe and effective progressive mobilization for patients experiencing MCS in a case study format. This article also highlights how a multidisciplinary clinical team supports mobility practice in specific critical care roles.
  
  
  CONCLUSIONS
  Post-intensive care syndrome is composed of various health implications that occur following critical illness. Recent data suggest improved care outcomes when critically ill patients are awake and participate in active physical rehabilitation as early as clinically possible. The case studies presented indicate that mobility, to the point of ambulation, is a feasible clinical expectation when patients present with substantial acute respiratory and cardiac failure and are managed with MCS.
  
  
  CONCLUSIONS
  Development of a PM guideline uses a critical appraisal of practice evidence, highlights multidisciplinary collaboration, and increases progression to ambulation. Mobility for complex patients is attainable, as demonstrated in the postguideline outcomes. The PM guideline provides structure to primary caregivers and promotes safe practices. The PM guideline facilitates an advanced level of care, promotes safe practices, champions holistic recovery, and encourages active patient involvement, goals satisfying to both patients and staff.
authors.affiliation: Jennifer Chavez, MSN, RN, CCRN-CSC, is a level III staff nurse, Evidence Based Practice and Progressive Mobility Nurse Champion in Cardiothoracic Intensive Care Unit. Her clinical interests include translating evidence into practice related to cardiovascular surgery. Shannon Johnson Bortolotto, MS, RN, APN, CCNS, is a critical care clinical nurse specialist. Her clinical interests include incorporating best practices into updated bedside care. Ms Bortolotto's quality improvement initiatives include awakening trials, delirium, progressive mobility, and care of the septic patient. Research interests include gathering data on the patient experience while intubated. Martha Paulson, MSN, RN, CCRN, is a cardiothoracic intensive care unit nurse manager. Her clinical interests include promoting staff engagement and problem solving to improve patient outcomes. Nicole Huntley, BSN, RN, is a level III staff nurse in the surgical intensive care unit. Her clinical interests include nursing interventions to decrease patient falls while promoting safe mobility. Breandan Sullivan, MD, is an assistant professor at the Department of Anesthesiology and Critical Care Medicine and co -medical director of the cardiothoracic intensive care unit. Dr Sullivan's clinical interests include quality improvement, decreasing delirium, and improving multidisciplinary collaboration in cardiovascular surgery. Ashok Babu, MD, is an assistant professor at the Division of Cardiothoracic Surgery. Dr Babu's clinical interests include various clinical publications and research related to cardiovascular surgery.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chavez
authors.forename: Shannon Johnson
authors.initials: SJ
authors.lastname: Bortolotto
authors.forename: Martha
authors.initials: M
authors.lastname: Paulson
authors.forename: Nicole
authors.initials: N
authors.lastname: Huntley
authors.forename: Breandan
authors.initials: B
authors.lastname: Sullivan
authors.forename: Ashok
authors.initials: A
authors.lastname: Babu
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003422:Critical Care; D015199:Extracorporeal Membrane Oxygenation / Q000534:rehabilitation*; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D012131:Respiratory Insufficiency / Q000628:therapy*; D016896:Treatment Outcome