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Medela - German
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Herz-/Thoraxdrainage literatur
Zeit zum Lesen: 3 min.
Immobility is a critical risk factor for postoperative complications and increases hospital length of stay.2 Complications induced by longer periods of immobility can persist for years after the patient’s discharge3 – hence, patients could benefit from a goal-directed and early mobilization. Stable patients in the ICU are able to participate in mobilization activities.1
Early mobilization means to mobilize the patients out of bed within the first hours of their intensive care stay.4 Early mobilization is important for patients, especially in the ICU, because it delivers many benefits3 for them and ICU staff as well:
Barriers to early mobilization in the ICU include difficulties in handling traditional chest drains. Moreover, even if the patient can be mobilized with a chest drain, this requires disconnection of suction during mobilization and reattachment afterwards. This can lead to an infection risk because of handling mistakes.7
The following infographic summarizes the negative consequences of bed rest in the hospital and the effect of early mobilization on a patient’s recovery time.
Stationäre Physiotherapie und frühe Mobilisierung gelten als therapeutische Strategien zur Verhinderung der Entwicklung einer auf der Intensivstation erworbenen Muskelschwäche (ICUAW). Sie sind mit einer erhöhten Wahrscheinlichkeit verbunden, bei der Entlassung mehr Wegstrecke zurücklegen zu können und demnach fitter zu sein. Die wichtigsten Mobilisierungstechniken für Patienten sind Kinesiotherapie, Transfer- und Lokomotionstraining sowie neuromuskuläre Elektrostimulation und Fahrradergometrie.5
In einer Umfrage bei Patienten und Pflegepersonal zu postoperativen Thoraxdrainage-spezifischen Ergebnissen, vergaben die mit Thopaz+ behandelten Patienten in allen 20 Fragen höhere Werte. Das sie betreuende Pflegepersonal berichtete über bessere Ergebnisse mit digitalen Throaxdrainage Systemen in 8 von 10 Fragen.9
*ERAS®=Enhanced Recovery After Surgery, evidenzbasierte Leitlinien zur Optimierung der Ergebnisse nach der Operation
1. Adler, Joseph; Malone, Daniel (2012): Early Mobilization in the Intensive Care Unit: A Systematic Review. In: Cardiopulmonary Physical Therapy Journal (Vol 23, No 1), 5-13.
2. Batchelor, Timothy J. P.; Rasburn, Neil J.; Abdelnour-Berchtold, Etienne; Brunelli, Alessandro; Cerfolio, Robert J.; Gonzalez, Michel et al. (2018): Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). In: Eur J Cardiothorac Surg 55 (1), S. 91–115. DOI: 10.1093/ejcts/ezy301.
3. Patricia Arias-Fernández, Macarena Romero-Martin, Juan Gómez-Salgado, Daniel Fernández-García: Rehabilitation and early mobilization in the critical patient: systematic review; J. Phys. Ther. Sci. 30: 1193–1201, 2018
4. van Willigen Z, Collings N, Richardson D, et al. Quality improvement: The delivery of true early mobilisation in an intensive care unit. BMJ Quality Improvement Reports 2016;5:u211734.w4726. doi:10.1136/bmjquality. u211734.w4726
5. A.R. Miranda Rocha, B.P. Martinez, V.Z. Maldaner da Silva, L.A. Forgiarini Junior: Early mobilization: Why, what for and how?; Medicina Intensiva (English Edition), Volume 41, Issue 7, October 2017, Pages 429-43;
6. Schaller, Stefan J. (2016): Early goal directed mobilisation in the surgical ICU a randomized controlled trial. In: Lancet (388), 1377-1388.
7. Rathinam, Sridhar; Bradley, Amy; Cantlin, Teresa; Rajesh, Pala B. (2011): Thopaz Portable Suction Systems in Thoracic Surgery: an end user assessment and feedback in a tertiary unit. In: Journal of cardiothoracic surgery 6, S. 59. DOI: 10.1186/1749-8090-6-59.
8. Cerfolio, Robert J.; Bryant, Ayesha S. (2009): The quantification of postoperative air leaks. In: Multimedia manual of cardiothoracic surgery: MMCTS 2009 (409), mmcts.2007.003129. DOI: 10.1510/mmcts.2007.003129.
9. Sihoe, Alan; Fang, Wentao; Liu, Lunxu; Liao, Hu; Liu, Chengwu; Feng, Jian; Zhang, Jitian: Objective and Patient-Reported Outcomes after Lung Resection Surgery are Improved by Digital Chest Drainage System compared to Water Seal System. Results from a Prospective Multicenter Database in China. In: Presented at ESTS, Ireland 2019
10. Ramos Dos Santos, P. M.; Aquaroni Ricci, N.; Aparecida Bordignon Suster, É.; Moraes Paisani, D. de; Dias Chiavegato, L. (2017): Effects of early mobilisation in patients after cardiac surgery: a systematic review. In: Physiotherapy 103 (1), S. 1–12. DOI: 10.1016/j.physio.2016.08.003.
11. Needham DM. Mobilizing patients in the intensive care unit: improving neuromuscular weakness and physical function. JAMA 2008;300:1685–90.
12. Schweickert, William D.; Pohlman, Mark C.; Pohlman, Anne S.; Nigos, Celerina; Pawlik, Amy J.; Esbrook, Cheryl L. et al. (2009): Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. In: Lancet 373 (9678), S. 1874–1882. DOI: 10.1016/S0140-6736(09)60658-9.
