Effects of robotic-assisted early mobilization versus conventional mobilization in intensive care unit patients: prospective interventional cohort study with retrospective control group analysis.

BACKGROUND: Approximately one in three survivors of critical illness suffers from intensive-care-unit-acquired weakness, which increases mortality and impairs quality of life. By counteracting immobilization, a known risk factor, active mobilization may mitigate its negative effects on patients. In this single-center trial, the effect of robotic-assisted early mobilization in the intensive care unit (ICU) on patients' outcomes was investigated. METHODS: We enrolled 16 adults scheduled for lung transplantation to receive 20 min of robotic-assisted mobilization and verticalization twice daily during their first week in the ICU (intervention group: IG). A control group (CG) of 13 conventionally mobilized patients after lung transplantation was recruited retrospectively. Outcome measures included the duration of mechanical ventilation, length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months. RESULTS: During the first week in the ICU, the intervention group received a median of 6 (interquartile range 3-8) robotic-assisted sessions of early mobilization and verticalization. There were no statistically significant differences in the duration of mechanical ventilation (IG: median 126 vs. CG: 78 h), length of ICU stay, muscle parameters evaluated by ultrasound, and quality of life after three months between the IG and CG. CONCLUSION: In this study, robotic-assisted mobilization was successfully implemented in the ICU setting. No significant differences in patients' outcomes were observed between conventional and robotic-assisted mobilization. However, randomized and larger studies are necessary to validate the adequacy of robotic mobilization in other cohorts. TRIAL REGISTRATION: This single-center interventional trial was registered in clinicaltrials.gov as NCT05071248 on 27/08/2021.

Robot-assisted early mobilization for intensive care unit patients: Feasibility and first-time clinical use.

BACKGROUND: Early mobilization is only carried out to a limited extent in the intensive care unit. To address this issue, the robotic assistance system VEMOTION® was developed to facilitate (early) mobilization measures more easily. This paper describes the first integration of robotic assistance systems in acute clinical intensive care units. OBJECTIVE: Feasibility test of robotic assistance in early mobilization of intensive care patients in routine clinical practice. SETTING: Two intensive care units guided by anesthesiology at a German university hospital. PARTICIPANTS: Patients who underwent elective surgery with postoperative treatment in the intensive care unit and had an estimated ventilation time over 48 h. METHODS: Participants underwent robot-assisted mobilization, scheduled for twenty-minute sessions twice a day, ten times or one week, conducted by nursing staff under actual operational conditions on the units. No randomization or blinding took place. We assessed data regarding feasible cutoff points (in brackets): the possibility of enrollment (x ≥ 50 %), duration (pre- and post-setup (x ≤ 25 min), therapy duration (x = 20 min), and intervention-related parameters (number of mobilizing professionals (x ≤ 2), intensity of training, events that led to adverse events, errors or discontinuation). Mobilizing professionals rated each mobilization regarding their physical stress (x ≤ 3) and feasibility (x ≥ 4) on a 7 Point Likert Scale. An estimated sample size of at least twenty patients was calculated. We analyzed the data descriptively. RESULTS: Within 6 months, we screened thirty-two patients for enrollment. 23 patients were included in the study and 16 underwent mobilization using robotic assistance, 7 dropped out (enrollment eligibility = 69 %). On average, 1.9 nurses were involved per therapy unit. Participants received 5.6 robot-assisted mobilizations in mean. Pre- and post-setup had a mean duration of 18 min, therapy a mean of 21 min. The robot-assisted mobilization was started after a median of 18 h after admission to the intensive care unit. We documented two adverse events (pain), twelve errors in handling, and seven unexpected events that led to interruptions or discontinuation. No serious adverse events occurred. The mobilizing nurses rated their physical stress as low (mean 2.0 ±â€¯1.3) and the intervention as feasible (mean 5.3 ±â€¯1.6). CONCLUSIONS: Robot-assisted mobilization was feasible, but specific safety measures should be implemented to prevent errors. Robotic-assisted mobilization requires process adjustments and consideration of unit staffing levels, as the intervention does not save staff resources or time. REGISTRATION: clinicaltrials.org TRN: NCT05071248; Date: 2021/10/08; URL https://clinicaltrials.gov/ct2/show/NCT05071248. TWEETABLE ABSTRACT: Robot-assisted early mobilization in intensive care patients is feasible and no adverse event occurred.

[The use of robotic and technical systems for early mobilization of intensive care patients: A scoping review]. / Der Einsatz von robotischen und technischen Systemen zur Frühmobilisation von Intensivpatient_innen.

The use of robotic and technical systems for early mobilization of intensive care patients: A scoping review Abstract: Background: Intensive care patients are often subjected to immobility for too long. However, when they are mobilized early, positive effects on patient outcomes, such as improvement in physical function, can be demonstrated. One of the reasons for rare mobilization is that too less therapeutic equipment is available. Aims: This paper provides an overview of previous research on early robot- or technology-assisted mobilization of intensive care patients. Which robotic and technical aids are used in studies on early mobilization of adult intensive care patients by nurses or physiotherapists? What effect of early mobilization using robotic and technical systems on patient outcomes are reported in the studies? Methods: A systematic literature search was undertaken within the Databases Medline, Web of Science, CINAHL, Cochrane Library, Embase, IEEE Xplore, Scopus and WTI between May and July 2020 and in January 2022. In addition, a marginal search was performed via GoogleScolar and ResearchGate in the first search run. Results: 27 publications were included (9 RCTs, 7 texts and opinions, 3 cross-sectional studies, 2 case-control studies, 2 literature reviews, 2 case reports, 2 quasi-experimental intervention studies). It is evident that electronic bed-mounted exercise bicycles and tilt tables are the most commonly used assistive devices. There is an inconsistent data situation with regard to different patient outcomes. Conclusion: Further research on the use of technical and robotic early mobilization is, particularly in relation to different study populations, needed. Early mobilization robotics is not yet part of standard care.

Robot-assisted early mobilization of intensive care patients: a feasibility study protocol.

BACKGROUND: Early mobilization positively influences the outcome of critically ill patients, yet in clinical practice, the implementation is sometimes challenging. In this study, an adaptive robotic assistance system will be used for early mobilization in intensive care units. The study aims to evaluate the experience of the mobilizing professionals and the general feasibility of implementing robotic assistance for mobilization in intensive care as well as the effects on patient outcomes as a secondary outcome. METHODS: The study is single-centric, prospective, and interventional and follows a longitudinal study design. To evaluate the feasibility of robotic-assisted early mobilization, the number of patients included, the number of performed VEM (very early mobilization) sessions, and the number and type of adverse events will be collected. The behavior and experience of mobilizing professionals will be evaluated using standardized observations (n > 90) and episodic interviews (n > 36) before implementation, shortly after, and in routine. Patient outcomes such as duration of mechanical ventilation, loss of muscle mass, and physical activity will be measured and compared with a historical patient population. Approximately 30 patients will be included. DISCUSSION: The study will provide information about patient outcomes, feasibility, and the experience of mobilizing professionals. It will show whether robotic systems can increase the early mobilization frequency of critically ill patients. Within ICU structures, early mobilization as therapy could become more of a focus. Effects on the mobilizing professionals such as increased motivation, physical relief, or stress will be evaluated. In addition, this study will focus on whether current structures allow following the recommendation of mobilizing patients twice a day for at least 20 min. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05071248 . Date: 2021/10/21.

Spatial Modulation of Nonlinear Flexural Vibrations of Membrane Resonators.

We study the vibrational motion of mechanical resonators under strong drive in the strongly nonlinear regime. By imaging the vibrational state of rectangular silicon nitride membrane resonators and by analyzing the frequency response using optical interferometry, we show that, upon increasing the driving strength, the membrane adopts a peculiar deflection pattern formed by concentric rings superimposed onto the drum head shape of the fundamental mode. Such a circular symmetry cannot be described as a superposition of a small number of excited linear eigenmodes. Furthermore, different parts of the membrane vibrate at different multiples of the drive frequency, an observation that we denominate as "localization of overtones." We introduce a phenomenological model that is based on the coupling of a small number of effective nonlinear resonators, representing the different parts of the membrane, and that describes the experimental observations correctly.