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Finalized PICOT Question: In mechanically intubated adult patients, how does early mobility compare to standard mobilization, and how do they affect the duration of mechanical ventilation within the ICU?
Literature Search Strategy Employed: Google Scholar and PubMed are the best library databases for searching for the chosen keywords. This literature search used keywords such as ‘intubated adult patients,’ ‘early mobility,’ ‘mechanical ventilation,’ and ‘ICU stay.’
| Criteria | Article 1 | Article 2 | Article 3 | Article 4 |
| APA Reference All peer-reviewed journal articles should be current (published within the last five years) and closely related to the PICOT question developed earlier in this course. Include the GCU permalink, or working link used to access the article. | Menges, D., Seiler, B., Tomonaga, Y., Schwenkglenks, M., Puhan, M. A., & Yebyo, H. G. (2021). Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Critical Care, 25, 1-24. https://link.springer.com/article/10.1186/s13054-020-03446-9 | TEAM Study Investigators, & ANZICS Clinical Trials Group. (2022). Early active mobilization during mechanical ventilation in the ICU. The New England Journal of Medicine, 387(19), 1747-1758. https://www.nejm.org/doi/full/10.1056/NEJMoa2209083 | Alaparthi, G. K., Gatty, A., Samuel, S. R., & Amaravadi, S. K. (2020). Effectiveness, safety, and barriers to early mobilization in the intensive care unit. Critical Care Research and Practice, 2020. https://www.hindawi.com/journals/ccrp/2020/7840743/ | Hermes, C., Nydahl, P., Blobner, M., Dubb, R., Filipovic, S., Kaltwasser, A., … & Schaller, S. J. (2020). Assessment of mobilization capacity in 10 different ICU scenarios by different professions. PLoS One, 15(10). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239853 |
| Purpose/Aim of Study | To find out the effectiveness of systemic early mobilization in improving physical functioning and muscle strength in ICU patients on mechanical ventilators. | To determine whether early mobilization techniques, such as daily physiotherapy and reducing sedation levels, reduce hospital stay compared to usual care. | The authors aimed to summarize different findings about early mobilization in the ICU. | The researchers aimed to differentiate how different nursing professions use the ICU Mobility Score to determine which ICU patients require intervention. |
| Research questions (Qualitative)/Hypothesis (Quantitative) | This qualitative study questioned whether early mobilization will improve muscle strength. | The quantitative study hypothesized that early mobilization leads to shorter hospital stays than usual care. | The qualitative study questioned the effectiveness of different mobilization techniques on different sets of patients. | The quantitative study hypothesized that different professions use the ICU Mobility Score differently. |
| Design Type of quantitative or type of qualitative study design | Systematic review and meta-analysis design. | The researchers used a randomized control trial design. | The researchers used a literature review design. | The researchers used an online survey design. |
| Setting Where did the study take place? What type of setting – inpatient, outpatient, etc.? | The setting was in ICU wards. | The setting was in ICU wards. | The setting was the ICU wards that other authors explored. | The setting was Germany-based healthcare professionals in critical care teams. |
| Sample Number and characteristics of participants | There were 12 eligible participants from a sample of 1304 ICU patients. | There were 750 adult ICU patients on mechanical ventilators. | The researchers collected 56 studies that contributed to the topic of early mobilization. | 515 participants from 788 critical care teams participated in the online survey used in the analysis. |
| Methods Interventions/Instruments | The authors conducted a two-stage systemic literature search on websites such as MEDLINE. | The samples were randomly assigned to receive early, late, or no mobilization. | The researchers used electronic databases such as PubMed, ScienceDirect, and Google Scholar. | In the online survey, the participants used the ICU Mobility Score to diagnose ten fictitious patient scenarios. |
| Analysis How was the data collected and analyzed? | The researchers conducted a meta-analysis to identify the difference between early, late, and no mobilization outcomes. | The frequency of daily mobilization and the duration of hospital stay were analyzed across the different groups of participants. | The researchers reviewed other researchers’ findings on the effectiveness of varying mobilization techniques on different sets of patients. | The researchers used a statistical analysis approach to see how different health professionals utilized the ICU Mobility Score. |
| Outcomes/critical findings of the study and implications for nursing practice (Summary of study results) | Systemic early mobilization was beneficial compared to late or no mobilization, allowing patients to self-dependent faster. | There was no significant difference between hospital stays for the different groups of patients. | Early mobilization positively affected patient outcomes regardless of whether they were on mechanical ventilators. | Different medical practitioners used the ICU Mobility Score differently, which impacted the scenarios when patients received mobilization interventions. |
| Recommendations of the Researcher | The researcher recommends early mobilization because the earlier the intervention, the better the outcomes. | The researchers did not recommend early mobility because it sometimes led to adverse events. | The researchers recommended that nurses use newer mobilization techniques due to technological improvements. | The researchers recommended that critical care teams receive interprofessional training to align mobilization interventions. |
| Explain how this article supports your proposed PICO(T) question and Capstone Change Project. | The study aligns with the PICOT question, focusing on intubated adult ICU patients and mobilization interventions. | The study aligns with the PICOT question, focusing on intubated adult ICU patients and the effect of mobilization interventions on the duration of hospital stay. | This study is connected to the PICOT question as it extends the net to what other researchers have already done. | The study is connected to the PICOT question because it reveals that interpreting the ICU Mobility Score inaccurately could make health professionals miss the 72-hour window that is most suitable for mobilization. |
| Criteria | Article 5 | Article 6 | Article 7 | Article 8 |
| APA Reference (include the GCU permalink or working link used to access the article) | Zhang, C., Wang, X., Mi, J., Zhang, Z., Luo, X., Gan, R., & Mu, S. (2024). Effects of the High-Intensity Early Mobilization on Long-Term Functional Status of Patients with Mechanical Ventilation in the Intensive Care Unit. Critical Care Research and Practice, 2024. https://www.hindawi.com/journals/ccrp/2024/4118896/ | Wang, L., Hua, Y., Wang, L., Zou, X., Zhang, Y., & Ou, X. (2023). The effects of early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Frontiers in Medicine, 10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10336545/ | Watanabe, S., Hirasawa, J., Naito, Y., Mizutani, M., Uemura, A., Nishimura, S., … & Iida, Y. (2023). Association between the early mobilization of mechanically ventilated patients and independence in activities of daily living at hospital discharge. Scientific Reports, 13(1), 4265. https://www.nature.com/articles/s41598-023-31459-1 | Wu, R. Y., Yeh, H. J., Chang, K. J., & Tsai, M. W. (2023). Effects of different types and frequencies of early rehabilitation on ventilator weaning among patients in intensive care units: a systematic review and meta-analysis. Plos one, 18(4). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0284923 |
| Purpose/Aim of Study | The researchers aim to investigate whether high-intensity early mobility interventions improve discharge outcomes for mechanically intubated ICU patients. | The researchers aimed to investigate the effectiveness of standard, systemic, and late mobilization on patient outcomes. | The researchers aimed to determine the effectiveness and barriers of early mobilization in mechanically intubated ICU adult patients. | The researchers aimed to identify the best ventilator-weaning intervention to reduce in-house mortality for patients receiving mechanical intubation. |
| Research questions (Qualitative)/Hypothesis (Quantitative) | This quantitative study hypothesized that high-intensity mobility exercises will improve muscle strength, functional status, and mortality compared to standard treatment. | This meta-analysis study hypothesized that systemic early mobilization (EM) is more effective than standard and late EM in terms of the length of stay in the ICU. | The quantitative research hypothesized that ICU patients who received early intubation could sit by the edge of their beds earlier and start independent activities. | This systemic meta-analytic study hypothesized that early mobilization, especially progressive mobility treatment, would help with ventilator weaning. |
| Design Type of quantitative or type of qualitative study design | The researchers used a randomized controlled trial (RCT) design. | This study used a meta-analysis design with randomized control trials. | The researchers used a multicenter retrospective cohort design. | The researchers used a meta-analysis and systemic review design. |
| Setting Where did the study take place? What type of setting – inpatient, outpatient, etc.? | The setting was in ICU wards. | The meta-analysis focused on systemic early mobilization versus standard and late EM in improving outcomes for ICU patients who are mechanically ventilated. | The setting is six ICU wards in Japan. | The researchers collected data from electronic databases, such as EMBASE and PubMed. |
| Sample Number and characteristics of participants | There were 132 adult participants randomly spread into two groups: one receiving high-intensity early mobility exercises and the other conventional treatment. | This meta-analysis used articles that focused on adult ICU patients on mechanical ventilators. | The sample was ICU patients admitted to six Japanese ICU wards between 2019 and 2020 and received at least 48 hours of mechanical ventilation. | The researchers used randomized control trials for the sample of ICU adult participants. |
| Methods Interventions/Instruments | The researchers used different methods, such as the Perme Score and Barthel Index, to measure whether high-intensity mobility exercises improve muscle strength and functional status. | The intervention group received systemic early mobilization (EM), while the others received standards and late EM. | The primary method was the Barthel Index score, which was used to measure how soon patients start independent activities of daily life. | The researchers tried to differentiate the effectiveness of progressive mobility techniques versus exercise-based physical activity and conventional physical therapy. |
| Analysis How was the data collected and analyzed? | The authors used a statistical analysis to separate the two groups of participants. | The researchers conducted a meta-analysis to differentiate between systemic early mobilization versus standard and late EM. | The researchers used both the logistic regression and the statistical analysis approaches. | The researchers used meta-analysis techniques to differentiate progressive mobility techniques versus exercise-based physical activity and conventional physical therapy. |
| Outcomes/critical findings of the study and implications for nursing practice (Summary of study results) | The researchers confirmed that high-intensity mobility exercises improved muscle strength, functional status, and mortality compared to standard treatment. | Contrary to the researchers’ hypothesis, systemic early mobilization did not significantly affect short- or long-term mortality rates among adult ICU patients under mechanical ventilation. | With 68% of the participants receiving early mobilization, the findings indicated that EM improved the patients’ chances of returning to their daily activities with a Barthel score of over 70. | The researchers found progressive mobility techniques more effective than exercise-based physical activity and conventional physical therapy for ventilator weaning. |
| Recommendations of the Researcher | The researchers recommended high-intensity early mobilization for ICU patients under mechanical ventilators. | Although it does not affect mortality rates, the researchers recommended systemic early mobilization to reduce the length of stay in the ICU. | The researchers recommend additional research to identify barriers to early mobilization. | The researchers recommend progressive mobility techniques as the best early rehabilitation intervention for ICU ventilator weaning. |
| Explain how this article supports your proposed PICO(T) question and Capstone Change Project. | This study is connected to the PICOT question as it confirms the safety and efficacy of high-intensity early mobility interventions. | The study is connected to the PICOT question as it shows systemic early mobilization is not necessarily better than standard and late EM. | This study is connected to the PICOT question as it seeks to determine the effectiveness and barriers of early mobilization in mechanically intubated ICU adult patients. | The study is connected to the PICOT question as it compares progressive mobility to the standard and conventional early mobility techniques. |
References
Alaparthi, G. K., Gatty, A., Samuel, S. R., & Amaravadi, S. K. (2020). Effectiveness, safety, and barriers to early mobilization in the intensive care unit. Critical Care Research and Practice, 2020. https://www.hindawi.com/journals/ccrp/2020/7840743/
Hermes, C., Nydahl, P., Blobner, M., Dubb, R., Filipovic, S., Kaltwasser, A., … & Schaller, S. J. (2020). Assessment of mobilization capacity in 10 different ICU scenarios by different professions. PLoS One, 15(10). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239853
Menges, D., Seiler, B., Tomonaga, Y., Schwenkglenks, M., Puhan, M. A., & Yebyo, H. G. (2021). Systematic early versus late mobilization or standard early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Critical Care, 25, 1-24. https://link.springer.com/article/10.1186/s13054-020-03446-9
TEAM Study Investigators, & ANZICS Clinical Trials Group. (2022). Early active mobilization during mechanical ventilation in the ICU. The New England Journal of Medicine, 387(19), 1747-1758. https://www.nejm.org/doi/full/10.1056/NEJMoa2209083
Wang, L., Hua, Y., Wang, L., Zou, X., Zhang, Y., & Ou, X. (2023). The effects of early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Frontiers in Medicine, 10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10336545/
Watanabe, S., Hirasawa, J., Naito, Y., Mizutani, M., Uemura, A., Nishimura, S., … & Iida, Y. (2023). Association between the early mobilization of mechanically ventilated patients and independence in activities of daily living at hospital discharge. Scientific Reports, 13(1), 4265. https://www.nature.com/articles/s41598-023-31459-1
Wu, R. Y., Yeh, H. J., Chang, K. J., & Tsai, M. W. (2023). Effects of different types and frequencies of early rehabilitation on ventilator weaning among patients in intensive care units: a systematic review and meta-analysis. Plos one, 18(4). https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0284923
Zhang, C., Wang, X., Mi, J., Zhang, Z., Luo, X., Gan, R., & Mu, S. (2024). Effects of the High-Intensity Early Mobilization on Long-Term Functional Status of Patients with Mechanical Ventilation in the Intensive Care Unit. Critical Care Research and Practice, 2024. https://www.hindawi.com/journals/ccrp/2024/4118896/
