Movilización segura del paciente en estado crítico: una perspectiva desde la fisiatría
DOI:
https://doi.org/10.28957/rcmfr.v25n1a5Resumen
La movilización temprana ha sido reconocida como un componente fundamental en la prevención primaria, secundaria, y terciaria por su impacto sobre la morbimortalidad global. Sin embargo, los datos de movilización temprana en unidades de cuidados intensivos (UCI) son limitados en cuanto al inicio de la intervención, el tipo de movilidad y el tiempo adecuado de realización. A su vez, existe desconfianza ante los efectos secundarios que puede generar la intervención terapéutica sobre el paciente y aunque existen publicaciones previas en las cuales se describen programas de movilidad temprana, en muchos casos estos pueden no ser generalizables. El objetivo principal de esta revisión narrativa es dar a conocer al personal de salud los parámetros que se deben tener en cuenta para realizar la movilización temprana y segura del paciente en estado crítico.
Biografía del autor/a
Alberto Jiménez Juliao
Médico Fisiatra, Coordinador Académico del Programa de Medicina Física y Rehabilitación, Universidad Militar Nueva
Granada, Hospital Militar Central, Bogotá D.C., Colombia
Yessica Anaya
Residente Programa Medicina Física y Rehabilitación, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá D.C., Colombia
Bibiana Avendaño
Residente Programa Medicina Física y Rehabilitación, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá D.C., Colombia
Jhonatan Gómez
Residente Programa Medicina Física y Rehabilitación, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá D.C., Colombia
Néstor Gómez
Residente Programa Medicina Física y Rehabilitación, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá D.C., Colombia
Julieth Jojoa
Residente Programa Medicina Física y Rehabilitación, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá D.C., Colombia
Luis C. Marroquín
Residente Programa Medicina Física y Rehabilitación, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá D.C., Colombia
José L. Pira
Residente Programa Medicina Física y Rehabilitación, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá D.C., Colombia
Claudia Robayo
Residente Programa Medicina Física y Rehabilitación, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá D.C., Colombia
Paula Suárez
Residente Programa Medicina Física y Rehabilitación, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá D.C., Colombia
Catalina Urrego
Residente Programa Medicina Física y Rehabilitación, Universidad Militar Nueva Granada, Hospital Militar Central, Bogotá D.C., Colombia
Referencias bibliográficas
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2. Morris PE. Moving our critically ill patients: mobility barriers and benefits. Crit Care Clin. 2007; 23(1): 1–20. doi: 10.1016/j. ccc.2006.11.003.
3. Conti AA, Macchi C, Molino Lova R, Gensini GF. Relationship between physical activity and cardiovascular disease. Selected historical highlights. J Sports Med Phys Fitness. 2007; 47(1): 84–90. Available at: http://www.ncbi.nlm nih.gov/ pubmed/17369803
4. Gosselink R, Bott J, Johnson M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine, Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008; 34(7): 1188–99. doi: 10.1007/s00134-008-1026-7.
5. Stiller K, Phillips A. Safety aspects of mobilising acutely ill in patients. Physiother Theory Pract. 2003; 19(4): 239–57. doi: 10.1080/09593980390246751.
6. Amidei C. Mobilisation in critical care: a concept analysis. Intensive rit Care Nurs. 2012; 28(2): 73–81. doi: 10.1016/j. iccn.2011.12.006.
7. Burtin C, Clerckx B, Robbeets C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009; 37(9): 2499–505. doi: 10.1097/ CCM.0b013e3181a38937.
8. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009; 373(9678): 1874–82. doi: 10.1016/S0140-6736(09)60658-9.
9. Pires-Neto RC, Lima NP, Cardim GM, Park M, Denehy L. Early mobilization practice in a single Brazilian nten10.1016/j.jcrc.2015.05.004.
10. Leditschke IA, Green M, Irvine J, Bissett B, Mitchell IA. What are the barriers to mobilizing intensive care patients? Cardiopulm Phys Ther J. 2012; 23(1): 26–9. Available at: http://www.ncbi.nlm.nih. gov/pubmed/24629574.
11. Renaud E, Mesrati F. Paresis Acquired in the Intensive Care Unit. 2002; 288(22): 2859–67. 12. Vincent JL, Norrenberg M. Intensive care
unit-acquired weakness: framing the topic. Crit Care Med. 2009; 37(10 Suppl): 296–8. doi: 10.1097/CCM.0b013e3181b- 6f1e1.
13. Van der Schaaf M, Beelen A, Dongelmans DA, Vroom MB, Nollet F. Functional status after intensive care: a challenge for rehabilitation professionals to improve outcome. J Rehabil Med. 2009; 41(5): 360–6. doi: 10.2340/16501977- 0333.
14. Van der Schaaf M, Beelen A, de Vos R. Functional outcome in patients with critical illness polyneuropathy. Disabil Rehabil. 2004; 26(20): 1189–97. doi: 10.1080/09638280410001724861.
15. Brown CJ, Friedkin RJ, Inouye SK. Older Patients. 2004; 1263–1270. 16. Timmerman RA. Dimensio A Mobility Protocol for Critically Ill Adults. 2007; (October): 175–179.
17. Munin MC, Rudy TE, Glynn NW, Crossett LS, Rubash HE. Early inpatient rehabilitation after elective hip and knee arthroplasty. JAMA. 1998; 279(11): 847–52. Available at: http://www.ncbi. nlm.nih.gov/pubmed/9515999.
18. Mundy LM, Leet TL, Darst K, Schnitzler MA, Dunagan WC. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest. 2003; 124(3): 883–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12970012.
19. Griffiths RD. Effect of passive stretching on the wasting of muscle in the critically Ill: Background. Nutrition. 1997; 13(1): 71–4. doi: 10.1016/S0899- 9007(96)00372-3.
20. Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G. Clinical review: Critical illness polyneuropathy and myopathy. Crit Care. 2008; 12(6): 238. doi: 10.1186/cc7100.
21. Plank D, Clark MA, Andrew B. Progressive patients cellular dehydration and proteolysis in critically ill. 9:9–11.
22. Drolet A, DeJuilio P, Harkless S, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation
in the intensive and intermediate care settings. Phys Ther. 2013; 93(2):197–207. doi: 10.2522/ptj.20110400.
23. Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011; 10(10): 931–41. doi: 10.1016/S14 4-4422(11)70178-8.
24. With I, Illness C. Critical Illness Special Series. 93(2). 25. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl
J Med. 2014; 370(17): 1626–35. doi: 10.1056/NEJMra1209390.
26. Kerbaul F, Brousse M, Collart F, et al. Combination of istopathological and electromyographic patterns can help to evaluate functional outcome of critical ill patients with neuromuscular weakness syndromes. Crit Care. 2004; 8(6): R358– 66. doi: 10.1186/cc2925.
27. Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ. Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry. 1984; 47(11): 1223–31. Available at: http://www.pubmedcentral.nih.gov/articlerender. fcgi?artid=1028091&tool=pmcentrez& rendertype=abstract.
28. Petersen B, Schneider C, Strassburg HM, Schrod L. Critical illness europathy in pediatric intensive care patients. Pediatr Neurol. 1999; 21(4): 749–53. Available at: http://www.ncbi.nlm.nih.gov/ pubmed/10580891.
29. Mendez-Tellez PA, Dinglas VD, Colantuoni E, et al. Factors associated with timing of initiation of physical therapy in patients with acute lung injury. J Crit Care. 2013; 28(6): 980–4. doi: 10.1016/j. jcrc.2013.06.001.
30. Mendez-Tellez PA, Nusr R, Feldman D, Needham DM. Early Physical Rehabilitation in the ICU: A Review for the Neurohospitalist. The eurohospitalist. 2012; 2(3): 6–105. doi: 10.1177/1941874412447631.
31. Agostini F, Dalla Libera L, Rittweger J, et al. Effects of inactivity on human muscle glutathione synthesis by a double-tracer and single-biopsy approach. J Physiol. 2010; 588(Pt 24): 5089–104. doi: 10.1113/jphysiol.2010.198283.
32. Zisberg A, Shadmi E, Sinoff G, Gur- Yaish N, Srulovici E, Admi H. Low mobility during hospitalization and functional decline in older adults. J Am
Geriatr Soc. 2011; 59(2): 266–73. doi: 10.1111/j.1532- 415.2010.03276.x.
33. Médrinal C. La réhabilitation précoce en réanimation: quels résultats? Kinésithérapie, la Rev. 2012; 12(127): 29–38. doi: 0.1016/j.kine.2012.02.003
34. Hodgson CL, Stiller K, Needham DM, et al. Expert consensus and recommendations on safety criteria for active mobilization of echanically ventilated critically ill adults. Crit Care. 2014; 18(6): 1–9. doi: 0.1186/s13054-014-0658-y.
35. Garzon-Serrano J, Ryan C, Waak K, et al. Early Mobilization in Critically Ill Patients : Patients’Mobilization Level Depends on Health Care Provider’s Profession. PMRJ. 2011; 3(4): 307–313. doi: 10.1016/j.pmrj.2010.12.022.
36. Choong K, Foster G, Fraser DD, et al. Acute Rehabilitation Practices in Critically Ill Children: A Multicenter Study. Pediatr Crit Care Med. 2014; 1–10. doi: 10.1097/PCC.0000000000000160.
37. Stiller K, Phillips A, Lambert P. The safety of mobilisation and its effect on haemodynamic and respiratory status of intensive care patients. Physiother Theory Pract. 2004; 20(3): 175–85. doi: 10.1080/09593980490487474.
38. Ambrosino N, Janah N, Vagheggini G. Physiotherapy in critically ill patients. Rev Port Pneumol. 2011; 17(6): 283–8. doi: 0.1016/j.rppneu.2011.06.004.
39. Mehrholz J, Pohl M, Kugler J, Burridge J, Mückel S. Physical ehabilitation for critical illness myopathy and neuropathy ( Protocol ). 014; (1).
40. Lee CM, Fan E. ICU-acquired weakness: what is preventing its rehabilitation in critically ill patients? BMC Med. 2012;1 0: 115. doi: 10.1186/1741-7015-10-115.
41. Bassett RD, Vollman KM, Brandwene L, Murray T. Integrating a multidisciplinary mobility programme into intensive care practice (IMMPTP): a multicentre collaborative. Intensive Crit Care Nurs. 2012; 28(2): 88–97. doi: 10.1016/j. iccn.2011.12.001.
42. Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin. 2007; 23(1): 35–53. doi: 0.1016/j.ccc.2006.11.005.
43. Sricharoenchai T, Parker AM, Zanni JM, Nelliot A, Dinglas VD, Needham DM. Safety of physical therapy interventions in critically ill patients: A single-center prospective evaluation of 1110 intensive care unit admissions. J Crit Care 2014; 29(3): 395–400. doi: 10.1016/j. jcrc.2013.12.012.
44. Lee H, Ko YJ, Suh GY, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015; 30(4): 673–7. doi: 10.1016/j. jcrc.2015.04.012.
45. Patel BK, Pohlman AS, Hall JB, Kress JP. Impact of Early Mobilization on Glycemic Control and Intensive Care Unit-Acquired Weakness in Mechanically Ventilated Critically Ill Patients. CHEST J. 2014; 1–17. doi: 10.1378/chest.13-2046.
46. Garzon-Serrano J, Ryan C, Waak K, et al. Early mobilization in critically ill patients: patients’ mobilization level depends on health care provider’s profession. PM R. 2011; 3(4): 307–13. doi: 0.1016/j. pmrj.2010.12.022.
47. Sundseth A, Thommessen B, Rønning OM. Early mobilization after acute stroke. J Stroke Cerebrovasc Dis. 2014; 23(3): 496–9. doi: 10.1016/j.jstrokecerebrovasdis. 2013.04.012.
48. Bailey PP, Miller RR, Clemmer TP. Culture of early mobility in mechanically ventilated patients. Crit Care Med. 2009; 37(10 Suppl): S429–35. doi: 10.1097/ CCM.0b013e3181b6e227.
49. Hodgson CL, Berney S, Harrold M, Saxena M, Bellomo R. Clinical review: Early patient mobilization in the ICU. Crit Care. 2013; 17(1): 207. doi: 10.1186/ cc11820.
50. Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil. 2013; 94(3): 551–61. doi: 10.1016/j.apmr.2012.10.023.
2. Morris PE. Moving our critically ill patients: mobility barriers and benefits. Crit Care Clin. 2007; 23(1): 1–20. doi: 10.1016/j. ccc.2006.11.003.
3. Conti AA, Macchi C, Molino Lova R, Gensini GF. Relationship between physical activity and cardiovascular disease. Selected historical highlights. J Sports Med Phys Fitness. 2007; 47(1): 84–90. Available at: http://www.ncbi.nlm nih.gov/ pubmed/17369803
4. Gosselink R, Bott J, Johnson M, et al. Physiotherapy for adult patients with critical illness: recommendations of the European Respiratory Society and European Society of Intensive Care Medicine, Task Force on Physiotherapy for Critically Ill Patients. Intensive Care Med. 2008; 34(7): 1188–99. doi: 10.1007/s00134-008-1026-7.
5. Stiller K, Phillips A. Safety aspects of mobilising acutely ill in patients. Physiother Theory Pract. 2003; 19(4): 239–57. doi: 10.1080/09593980390246751.
6. Amidei C. Mobilisation in critical care: a concept analysis. Intensive rit Care Nurs. 2012; 28(2): 73–81. doi: 10.1016/j. iccn.2011.12.006.
7. Burtin C, Clerckx B, Robbeets C, et al. Early exercise in critically ill patients enhances short-term functional recovery. Crit Care Med. 2009; 37(9): 2499–505. doi: 10.1097/ CCM.0b013e3181a38937.
8. Schweickert WD, Pohlman MC, Pohlman AS, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009; 373(9678): 1874–82. doi: 10.1016/S0140-6736(09)60658-9.
9. Pires-Neto RC, Lima NP, Cardim GM, Park M, Denehy L. Early mobilization practice in a single Brazilian nten10.1016/j.jcrc.2015.05.004.
10. Leditschke IA, Green M, Irvine J, Bissett B, Mitchell IA. What are the barriers to mobilizing intensive care patients? Cardiopulm Phys Ther J. 2012; 23(1): 26–9. Available at: http://www.ncbi.nlm.nih. gov/pubmed/24629574.
11. Renaud E, Mesrati F. Paresis Acquired in the Intensive Care Unit. 2002; 288(22): 2859–67. 12. Vincent JL, Norrenberg M. Intensive care
unit-acquired weakness: framing the topic. Crit Care Med. 2009; 37(10 Suppl): 296–8. doi: 10.1097/CCM.0b013e3181b- 6f1e1.
13. Van der Schaaf M, Beelen A, Dongelmans DA, Vroom MB, Nollet F. Functional status after intensive care: a challenge for rehabilitation professionals to improve outcome. J Rehabil Med. 2009; 41(5): 360–6. doi: 10.2340/16501977- 0333.
14. Van der Schaaf M, Beelen A, de Vos R. Functional outcome in patients with critical illness polyneuropathy. Disabil Rehabil. 2004; 26(20): 1189–97. doi: 10.1080/09638280410001724861.
15. Brown CJ, Friedkin RJ, Inouye SK. Older Patients. 2004; 1263–1270. 16. Timmerman RA. Dimensio A Mobility Protocol for Critically Ill Adults. 2007; (October): 175–179.
17. Munin MC, Rudy TE, Glynn NW, Crossett LS, Rubash HE. Early inpatient rehabilitation after elective hip and knee arthroplasty. JAMA. 1998; 279(11): 847–52. Available at: http://www.ncbi. nlm.nih.gov/pubmed/9515999.
18. Mundy LM, Leet TL, Darst K, Schnitzler MA, Dunagan WC. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest. 2003; 124(3): 883–9. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12970012.
19. Griffiths RD. Effect of passive stretching on the wasting of muscle in the critically Ill: Background. Nutrition. 1997; 13(1): 71–4. doi: 10.1016/S0899- 9007(96)00372-3.
20. Hermans G, De Jonghe B, Bruyninckx F, Van den Berghe G. Clinical review: Critical illness polyneuropathy and myopathy. Crit Care. 2008; 12(6): 238. doi: 10.1186/cc7100.
21. Plank D, Clark MA, Andrew B. Progressive patients cellular dehydration and proteolysis in critically ill. 9:9–11.
22. Drolet A, DeJuilio P, Harkless S, et al. Move to improve: the feasibility of using an early mobility protocol to increase ambulation
in the intensive and intermediate care settings. Phys Ther. 2013; 93(2):197–207. doi: 10.2522/ptj.20110400.
23. Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol. 2011; 10(10): 931–41. doi: 10.1016/S14 4-4422(11)70178-8.
24. With I, Illness C. Critical Illness Special Series. 93(2). 25. Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl
J Med. 2014; 370(17): 1626–35. doi: 10.1056/NEJMra1209390.
26. Kerbaul F, Brousse M, Collart F, et al. Combination of istopathological and electromyographic patterns can help to evaluate functional outcome of critical ill patients with neuromuscular weakness syndromes. Crit Care. 2004; 8(6): R358– 66. doi: 10.1186/cc2925.
27. Bolton CF, Gilbert JJ, Hahn AF, Sibbald WJ. Polyneuropathy in critically ill patients. J Neurol Neurosurg Psychiatry. 1984; 47(11): 1223–31. Available at: http://www.pubmedcentral.nih.gov/articlerender. fcgi?artid=1028091&tool=pmcentrez& rendertype=abstract.
28. Petersen B, Schneider C, Strassburg HM, Schrod L. Critical illness europathy in pediatric intensive care patients. Pediatr Neurol. 1999; 21(4): 749–53. Available at: http://www.ncbi.nlm.nih.gov/ pubmed/10580891.
29. Mendez-Tellez PA, Dinglas VD, Colantuoni E, et al. Factors associated with timing of initiation of physical therapy in patients with acute lung injury. J Crit Care. 2013; 28(6): 980–4. doi: 10.1016/j. jcrc.2013.06.001.
30. Mendez-Tellez PA, Nusr R, Feldman D, Needham DM. Early Physical Rehabilitation in the ICU: A Review for the Neurohospitalist. The eurohospitalist. 2012; 2(3): 6–105. doi: 10.1177/1941874412447631.
31. Agostini F, Dalla Libera L, Rittweger J, et al. Effects of inactivity on human muscle glutathione synthesis by a double-tracer and single-biopsy approach. J Physiol. 2010; 588(Pt 24): 5089–104. doi: 10.1113/jphysiol.2010.198283.
32. Zisberg A, Shadmi E, Sinoff G, Gur- Yaish N, Srulovici E, Admi H. Low mobility during hospitalization and functional decline in older adults. J Am
Geriatr Soc. 2011; 59(2): 266–73. doi: 10.1111/j.1532- 415.2010.03276.x.
33. Médrinal C. La réhabilitation précoce en réanimation: quels résultats? Kinésithérapie, la Rev. 2012; 12(127): 29–38. doi: 0.1016/j.kine.2012.02.003
34. Hodgson CL, Stiller K, Needham DM, et al. Expert consensus and recommendations on safety criteria for active mobilization of echanically ventilated critically ill adults. Crit Care. 2014; 18(6): 1–9. doi: 0.1186/s13054-014-0658-y.
35. Garzon-Serrano J, Ryan C, Waak K, et al. Early Mobilization in Critically Ill Patients : Patients’Mobilization Level Depends on Health Care Provider’s Profession. PMRJ. 2011; 3(4): 307–313. doi: 10.1016/j.pmrj.2010.12.022.
36. Choong K, Foster G, Fraser DD, et al. Acute Rehabilitation Practices in Critically Ill Children: A Multicenter Study. Pediatr Crit Care Med. 2014; 1–10. doi: 10.1097/PCC.0000000000000160.
37. Stiller K, Phillips A, Lambert P. The safety of mobilisation and its effect on haemodynamic and respiratory status of intensive care patients. Physiother Theory Pract. 2004; 20(3): 175–85. doi: 10.1080/09593980490487474.
38. Ambrosino N, Janah N, Vagheggini G. Physiotherapy in critically ill patients. Rev Port Pneumol. 2011; 17(6): 283–8. doi: 0.1016/j.rppneu.2011.06.004.
39. Mehrholz J, Pohl M, Kugler J, Burridge J, Mückel S. Physical ehabilitation for critical illness myopathy and neuropathy ( Protocol ). 014; (1).
40. Lee CM, Fan E. ICU-acquired weakness: what is preventing its rehabilitation in critically ill patients? BMC Med. 2012;1 0: 115. doi: 10.1186/1741-7015-10-115.
41. Bassett RD, Vollman KM, Brandwene L, Murray T. Integrating a multidisciplinary mobility programme into intensive care practice (IMMPTP): a multicentre collaborative. Intensive Crit Care Nurs. 2012; 28(2): 88–97. doi: 10.1016/j. iccn.2011.12.001.
42. Stiller K. Safety issues that should be considered when mobilizing critically ill patients. Crit Care Clin. 2007; 23(1): 35–53. doi: 0.1016/j.ccc.2006.11.005.
43. Sricharoenchai T, Parker AM, Zanni JM, Nelliot A, Dinglas VD, Needham DM. Safety of physical therapy interventions in critically ill patients: A single-center prospective evaluation of 1110 intensive care unit admissions. J Crit Care 2014; 29(3): 395–400. doi: 10.1016/j. jcrc.2013.12.012.
44. Lee H, Ko YJ, Suh GY, et al. Safety profile and feasibility of early physical therapy and mobility for critically ill patients in the medical intensive care unit: Beginning experiences in Korea. J Crit Care. 2015; 30(4): 673–7. doi: 10.1016/j. jcrc.2015.04.012.
45. Patel BK, Pohlman AS, Hall JB, Kress JP. Impact of Early Mobilization on Glycemic Control and Intensive Care Unit-Acquired Weakness in Mechanically Ventilated Critically Ill Patients. CHEST J. 2014; 1–17. doi: 10.1378/chest.13-2046.
46. Garzon-Serrano J, Ryan C, Waak K, et al. Early mobilization in critically ill patients: patients’ mobilization level depends on health care provider’s profession. PM R. 2011; 3(4): 307–13. doi: 0.1016/j. pmrj.2010.12.022.
47. Sundseth A, Thommessen B, Rønning OM. Early mobilization after acute stroke. J Stroke Cerebrovasc Dis. 2014; 23(3): 496–9. doi: 10.1016/j.jstrokecerebrovasdis. 2013.04.012.
48. Bailey PP, Miller RR, Clemmer TP. Culture of early mobility in mechanically ventilated patients. Crit Care Med. 2009; 37(10 Suppl): S429–35. doi: 10.1097/ CCM.0b013e3181b6e227.
49. Hodgson CL, Berney S, Harrold M, Saxena M, Bellomo R. Clinical review: Early patient mobilization in the ICU. Crit Care. 2013; 17(1): 207. doi: 10.1186/ cc11820.
50. Li Z, Peng X, Zhu B, Zhang Y, Xi X. Active mobilization for mechanically ventilated patients: a systematic review. Arch Phys Med Rehabil. 2013; 94(3): 551–61. doi: 10.1016/j.apmr.2012.10.023.
Cómo citar
1.
Jiménez Juliao A, Anaya Y, Avendaño B, Gómez J, Gómez N, Jojoa J, et al. Movilización segura del paciente en estado crítico: una perspectiva desde la fisiatría. Rev. Colomb. Med. Fis. Rehabil. [Internet]. 19 de octubre de 2015 [citado 19 de abril de 2024];25(1):41-52. Disponible en: https://revistacmfr.org/index.php/rcmfr/article/view/132
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