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Mobility Interventions to Improve Outcomes in Patients Undergoing Prolonged Mechanical Ventilation: A Review of the Literature

University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, jic11{at}pitt.edu

Frederick J. Tasota, MSN, RN

University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, Pennsylvania

Leslie A. Hoffman, PhD, RN, FAAN

Department of Acute/Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania

Survivors of critical illness often undergo an extended recovery trajectory. Reduced functional ability is one of several adverse outcomes of prolonged bed rest and mechanical ventilation during critical illness. Skeletal muscle weakness is known to be one of the major phenomena that account for reduced functional ability. Although skeletal muscle weakness is evident after prolonged mechanical ventilation (PMV), few studies have tested the benefits of various types of mobility interventions in this population. The purpose of this article is to review the published research on improving mobility outcomes in patients undergoing PMV. For this review, published studies were retrieved from MEDLINE, PubMed, CINAHL, and the Cochrane Database of Systematic Reviews from January 1990 to July 2007. A total of 10 relevant articles were selected that examined the effect of whole body physical therapy, electrical stimulation (ES), arm exercise, and inspiratory muscle training (IMT). Overall, there is support for the ability of mobility interventions to improve outcomes in patients on PMV but limited evidence of how to best accomplish this goal. Generating more data from multicenter studies and randomized controlled trials is recommended.

Key Words: prolonged mechanical ventilation • long-term mechanical ventilation • critical illness • rehabilitation • physical therapy • exercise • ambulation • mobility • respiratory muscle training • muscle strength • functional status • psychosocial • physiological • movement • weaning

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