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Sabrina Eggmann is a PhD physiotherapist with 17 years of experience. She shares with us how her team utilized their years of expertise in early mobility to preserve their practices for COVID19 patients in Switzerland.

 

Episode Transcription

Kali Dayton 0:48
There’s been a lot of online discussion about whether or not early mobility during mechanical ventilation is safe, feasible and beneficial. If you’ve been listening to this podcast you already know, of course it is. I love hearing about the expertise and experiences from people all around the world. I’m excited to have Sabrina Eggman on now to share her team’s COVID experiences in Switzerland, check out her latest article in The Lancet journal that discusses the need to have better classification of, quote, “adverse events” unquote during early mobility.

I’ll add the link to this and her studies in the show notes. Remember, every episode has a transcription and usually citations. So check them out on the website. Sabrina, welcome to the podcast. I’m so excited to have you on. Can you introduce yourself to the listeners?

Sabrina Eggmann 1:34
Thank you very much for the invitation. Hello, everyone. I’m Sabrina Ekman. I’m a physiotherapist in Switzerland. I work in a university hospital, we have about 30 intensive care beds, and 40 Step down beds. We treat everything from their logical patients to cardiac patients, to medicine patients, so we have a mixed unit. And they’ve been a physiotherapist there for the last 17 years. I also do research and did my PhD on early rehabilitation in the ICU so we can retrain these patients.

Kali Dayton 2:12
Research is where we really became connected. I recently saw a post from you about one of your recent publications. Can you share that with us?

Sabrina Eggmann 2:20
Yes, a master’s student of mine. She analyzed the data, our data, how early patients sat on the edge of bed during the COVID 19 pandemic in Switzerland. And this has just recently been published in the physical therapy journal. And yeah, I think we will discuss it much more.

Kali Dayton 2:44
Yeah, let’s get into it. How did you conduct the study?

Sabrina Eggmann 2:47
So it was a retrospective, observational study. And we included all patients that the COVID-19 confirmed and also with COVID-19 Play Monia. So the really, really sick patients. They also needed to be in our ICU for at least 72 days. This was so that we can compare them to earlier data that we already have to see if being mobilized

Kali Dayton 3:13
in the ICU for 72 days, or 72. Oh, sorry.

Sabrina Eggmann 3:19
Yeah, hours of 72 hours? Yes. And they didn’t have to be mechanically ventilated. So we just had to have a ploy ammonia. Yes. And that made it to our unit. And then we collect all this data routinely. So we had a look at our data management systems. And we pulled all these data out and analyze them accordingly.

Kali Dayton 3:48
And what did you find?

Sabrina Eggmann 3:51
Well, we included 168 patients, most were excluded because they refused general consent, and also some that weren’t ventilated for 72 hours, otherwise, the data would have been even better. So we included 168 patients, and we found that they sat at the median time of four days.

So that was pretty good. But we also found some differences between moderate ARDS and the severe ARDS. So those with severe ARDS, they set them substantially later. This was seven days in and the others with moderate they were 2.5 days. But all patients median was four days. So that’s pretty early for COVID-19.

Kali Dayton 4:42
No absolutely. Yeah. There was a lot of fear about mobilizing these patients. And yet fairly early on. You were mobilized and I worked in a waken walking COVID ICU and most patients were awake, and at least setting up oftentimes walking 2448 hours was after intubation, the sooner we did it, the less likely they were probably to develop severe ARDS. I mean, that’s my own observation.

But there were obviously there were severe areas patients in that high acuity COVID ICU, but not everyone is prone and paralyzed. I mean, they were they were the exception. Otherwise, they were awakened walking. And this isn’t because they that I see received lower acuity of patients.

I was working tele critical care, I was part of the transfer unit, we were just sending anyone that had an open bed, any patient from all over the region. So it was really interesting to see the role mobility played and level of severity that these patients developed. But what what else did you find? What did you measure any outcomes on those patients?

Sabrina Eggmann 5:50
No, unfortunately, we didn’t. Because it was retrospective study, we could only collect the data that we routinely measure and enter into our data system and structurally enter. So not free text. And we mostly enter free text outcomes as free text that was difficult. So this we could not really analyze, but we had a quite a low mortality actually, overall in our hospitals. I just need to check that in the article. So I do not say anything wrong. I think it was about 25. 77% survived. ICU. So that was quite high.

Kali Dayton 6:37
And your team already had a good baseline culture of early mobility, correct?

Sabrina Eggmann 6:42
Yes, yes. Because the trial we did in 2012, we started actually, we already did a trial on early mobilization also bed cycling. And since then, we have quite a good culture. And actually, our data was even better than before, even though they were much sicker, with high so for scores and higher Apache scores.

Kali Dayton 6:44
That’s remarkable. And yeah, throughout the pandemic, mobility really fell to the wayside for most ICUs. It seems especially those that didn’t have a strong mobility culture at baseline. And the reason was said to be because these patients were so sick, we could not mobilize them. Why do you think your team was able to mobilize patients so much sooner than the rest of the ICU community, even though we were all trading COVID patients? Yeah,

Sabrina Eggmann 7:34
I guess we already had the experience. And they were realistic that I can confirm that they were really a challenge to mobilize. And one thing that we had to take a space or special care was like to go very slow. So for example, you had to take much longer to set say the patient on the edge of the bed, for example, we we turned them to the side, and then we waited for about 5, 10 minutes, until they got back their briefing, their oxygenation was back on like we wanted it. And then we just lifted the head of the bed slowly.

And then again, we had to wait five to 10 minutes. And only then did we set them on the edge of the bed. So you sometimes you need a 20 minute until they sat. So it really took a long time. And a lot of breaks. Yeah, but I guess the culture helped. And that was really Yeah,

Kali Dayton 8:33
I don’t think I’ve touched a lot of that on the podcast. I think that’s something I’ve intuitively done and witnessed and that we can walk in ICU because that I see as a medical surgical ICU, we’ve always had a lot of interstitial lung disease patients, a lot of areas patients. And for a long time, we’ve mobilized patients with high ventilator settings. So I don’t think I’ve appreciated the skill set of what you just described, how you work someone through, I mean, I think now that I’m training teams, I appreciate that there’s a lot of fear.

So whenever you see oxygen saturations drop, or work or breathing increase, or the heart rate go up. There’s an inclination to just stop, cancel everything and maybe discuss this tomorrow.

Sabrina Eggmann 9:16
Yeah, and go back and Yeah, exactly. Yeah, I think it really needs a high skill set. Sometimes maybe just, Oh, yeah. You mobilize to your fame. It’s easy, and everyone can do it. But I do. I honestly do not believe that. And the COVID pandemic also showed how difficult it was to mobilize these patients. I mean, it was just not it wasn’t just to turn I mean, it was to turn slowly.

And then you could do respiratory exercises, for example, in the new position. You could teach them how to breathe even on the ventilator. You could just hold them their hands, and yeah, and the scale to go just up slowly and really try that they have a good position and no When you can go further. I think that was really challenging. And they tell us that we already did this for a long time.

Kali Dayton 10:08
And how did you know? How would you describe? Alex? I don’t know how to describe it when when a patient is recovering, maybe their oxygenation has dropped a little bit. And you’re taking a pause? How would you describe knowing like having that hope or that faith that there’s a good chance they will be able to recover and continue to advance in their mobility?

Sabrina Eggmann 10:30
Well, we knew a bit how the COVID patients reacted, because they, interestingly, they all reacted the same, you just had to go very slow, or that was our experience. And so we knew that we met, if we go slow, that we can achieve it with time, we just saw that. And, well, I guess we needed a bit of time until we found that out. But we in our study, we included all the data. So from the first wave until the third, I think, which was a bit more than one and a half year.

Yeah, so But then in the second wave, where we had a lot more patients than in the first wave, we already had the experience, we already knew how to do it. And because there was a much higher workload, but we knew that we can do it already, from the first wave where we had a bit more time, even though we were very close to Italy, we had more time to get to know these patients.

Kali Dayton 11:31
And I didn’t know how to capture that. It may be in the research the value of that kind of experience, to say I have mobilized previous COVID patients. So when I’m in this moment with this COVID patient, or with any patient in general, but especially when it’s acting a little nuanced, I know that this is how they likely will respond, I know that it is safe and beneficial to sit at the side of the bed, even when they are so sick. How do you think we get the rest of the ICU community to develop that skill set?

Sabrina Eggmann 12:04
That’s I guess that’s really difficult. I think it is that that’s the culture, right? The culture, we need to teach everyone and I guess it is talking about it, it is also sharing experiences. Like, for example, we go to an international unit and see how they do it and exchange experiences, or how do you do this and talk about it. Conferences, of course, as well. But I don’t think we can really well. I am not sure if we can research it really.

Kali Dayton 12:39
Right. Like, yeah, how do you really give them personal experience through the research?

Sabrina Eggmann 12:43
Yeah, I think I would study I mean, it shows a bit that that we have, we have good numbers. So we hypothesized, of course. Why is it by two, we have the good numbers. And then of course, one reason is because we have the culture. So it probably supports the culture. Because there were a lot of hurry data out there after more than 10 or 20 days, even sitting on sitting for the first time.

Kali Dayton 13:08
So you saw it. So you your team already knew the sooner we set them, the better their outcomes will be.

Sabrina Eggmann 13:14
yes, or they already know how to do it also, and that they can do it even though it’s challenging. We did mobilize with ECMO as well, though, we found that ECMO was a significant barrier, as well as Hey, so So first course,

Kali Dayton 13:30
and because how they responded to the mobility or because of that, maybe the personnel required.

Sabrina Eggmann 13:37
I think rather because they were really, really unstable. Our unit is not awake and bulking. I see you as you guys, but Well, it is a unit that stops sedation early and has light sedation protocols, and we evoke patients, but I wouldn’t say that we beat the with, we can do it with everyone and not everyone is awake so.

So of course, some were heavily sedated and also on neuromuscular blockers. So they couldn’t walk we had very, very in stable patients also, I initially I was actually surprised as the number was this good because some patients were just so sick, just the physio entered the room, they crashed sometimes.

Kali Dayton 14:27
Now, the COVID was its own beast. But I think there’s so much value in saying we have this subset of COVID patients that this didn’t acuity of COVID patients, but we’re not going to project that into all patients. You may think that as a culture. Dr. Needham mentioned that it was a recent study from Johns Hopkins looking at one of their more advanced units. And it showed that they were able they two were able to preserve their culture during COVID.

So we hypothesized that the units that had a good baseline cold Sure, we’re able to continue to provide this approach during COVID. But we haven’t captured in the research, but likely the units that did not have a strong foundation, were not able to bring in early mobility during COVID. concerns.

Sabrina Eggmann 15:19
I think that’s, that’s true. Yeah. But for us what also helps certainly that, but this was also established, it belongs to the culture, every patient is screened by a physio every day. And we managed to do that during the pandemic, because physios started working in two shifts. So we still manage to see physiotherapy started on day one for all patients in our study.

So again, I think that was another thing it was, it was a culture before already, but we had to improve or increase shifts, and increase our working hours during COVID. But it was something that was established before and belong to the culture. But that was certainly helpful.

Kali Dayton 16:04
And that’s pretty much opposite of what a lot of teams did, maybe from what I’ve heard in the United States. Your workload increased, your patients got sicker, you were in a crisis, and so you readjusted physio to compensate for that. But what happened a lot of units is that all of these things changed. And this decision was made a lot of units to take out physical and occupational therapists.

Sabrina Eggmann 16:30
Yeah, because it was too dangerous. Right? That ain’t happened in Europe, I think as well. Yeah. Which

Kali Dayton 16:35
and then you guys said, “Wait, wait, wait, let’s think about this”. Y

Sabrina Eggmann 16:38
Yeah, Especially us. Exactly. We were there quite at the beginning, actually. And we set two goals. He said one goal is going to help prone. And also to ensure that the positioning is well done that we do not have pressure sores and everything. So please use assisted with groaning but that’s the second goal and offer on the Eco standing was rehabilitation, because if you do not get the flow going, they will, the hospital will, no one will leave the hospital anymore. And so

Kali Dayton 17:12
A lot of hospitals quickly saw it. They said, “Yeah, we have some survivors, but we don’t know what to do with them. And now all the rehab centers are either closed or full from our past survivors. If you’ve been listening to this podcast, you’re likely convinced that sedation and mobility practices in the ICU need to change. The ICU community is facing incredible difficulty with a trauma from the pandemic, staffing crisis and burnout. We cannot afford to continue practices that result in poor patient outcomes, more time in the ICU, higher health care costs and greater workload for the ICU team. Yet the prospect of changing decades of beliefs, practices and culture across all disciplines of the ICU is a daunting task. How does this transformation start? It can begin with a consultation with me to discuss your team’s current practices, barriers and to formulate a plan to help your ICU become an awake and walking ICU. I help teams master the ABCDE F mental through education, consulting, simulation, training and bedside support. Let’s work together to move your team into the future of evidence based ICU care. Click the link in the show notes of this episode to find out more. And we don’t know how to get them out of here.

Sabrina Eggmann 18:30
Yes. And so this was really a metrical to also to get new space in the ICU. So it’s really as soon as they will sit up and then they already left the ICU. So maybe you saw in the article, we didn’t do a lot of standing and walking. But this was also because of our very high flow. We really patients set up and they leave the unit that goes to really

Kali Dayton 18:55
get them off the ventilator and you’d get them out to rehabilitate, yes. Or

Sabrina Eggmann 18:59
in the acute care hospital or transfer to another hospital.

Kali Dayton 19:03
Do you know how often you had tricky ostomies

Sabrina Eggmann 19:07
we had a lot of crappy ostomies actually, I just see it here. In our sample it was 1/3

Kali Dayton 19:14
Okay. So do you have a culture of doing tracheostomy sooner? Pretty

Sabrina Eggmann 19:18
soon I think compared to the yes it is sooner? Yes.

Kali Dayton 19:22
Okay. And there. I mean, there were studies coming out during COVID Showing that earlier tracheostomy resulted in better outcomes. But my thought is that that’s likely because when we do tracheostomy we then take off sedation and mobilize patients. That’s true as well. Yeah, that was better they have a tracheostomy, or is that in discontinuing sedation sooner and mobilizing sooner? And the the myth that that a tracheotomy makes it safer and more feasible in others nothing to support that

Sabrina Eggmann 19:57
in our unit is also a bit And I guess they’re still the barrier. I guess it is mostly nurses. But I don’t want to charge too much but of the tubes still being uncomfortable and just like, they really care for patients and they do not want them hurt. So it’s still the feeling that the tube is worse for patients, though, be mobilized patients with tubes. It’s not that but we mobilize more easily with tracheostomy, of course. But the culture is really 10 days, you get a chalky. ostomy. Okay. Yeah. Yeah, sometimes ever even too stable to get a tracheotomy. I remember some that were,

Kali Dayton 20:42
well, that can absolutely happen. Yeah, with those severe severe COVID patients that really struggle for a long time. And this way can walk in ICU, they could. And they said, looking back in the pandemic, they could probably count on maybe one hand, how many tracheostomy they had, and they had hundreds and hundreds and COVID patients. But that was because they kept them pretty mobile and strong throughout the time and rarely sedated them that there were times that they did have to be sedated. But they quickly rehabilitated them. So it’s just interesting to see how each team practices differently. And those barriers are very similar, you know, the belief that the tracheostomy is more comfortable. And they’re I mean, I’m sure it is. I’m sure it is.

Sabrina Eggmann 21:27
There are other problems after of course,

Kali Dayton 21:30
yeah, right. Yeah. Well, yeah, I

Sabrina Eggmann 21:32
guess. So. You have probably problems with the larynx,

Kali Dayton 21:36
the larynx, you have stenosis, you have bleeding. I mean, there’s a high there’s like a 13% complication rate just in the hospital. And I can’t remember what percentage of readmissions are from those tracheostomy. So they come with a price. But we don’t think about that in the moment, when we are really trying to be compassionate and say, I don’t want to take sedation off, I don’t want to disrupt their comfortable sleep.

Sabrina Eggmann 22:01
Well, I can surely say that the sedation is not a cause for the tracheostomy in our unit. So really, it is weaning. weaning doesn’t advanced out ones as quickly, then it occurs to me is discussed, though it is not a question of sedation or mobilization. So the tube is not a barrier for

Kali Dayton 22:25
that. Absolutely.

Yeah. To your team. From day one, you guys are deeply part of that discussion, saying, How are we the second you intubate someone, you’re there discussing? How are we going to get them excavated? Yes, and

Sabrina Eggmann 22:38
I guess if the if the physio is on the unit already on day one, you always remind them to have recovery in mind. So they look at you and they already think, Oh, I just intubated kind of mobilize, but they I think it is the process behind it. So they see you and they are Yeah, the physio is also there is we need to think about recovery. I think that helps.

Kali Dayton 23:02
Oh, absolutely, yes, because there’s so much going on during critical illness, and really, nurses and lot of physicians, the main focus in is in the moment to keep them alive for that moment, to focus on the certain organ failures and certain problems that are going on, but someone needs to be there saying, okay, while you’re thinking about that, let’s step out. And I suggest that we look at the big picture. And I’m here to guide that. So the fact that that’s physiotherapist in your unit is really powerful. And to do that so promptly. It shows in your data, that it changes outcomes and or changes practices, which we know changes outcomes.

What else?

What do you envision for the rest of the ICO community?

Sabrina Eggmann 23:45
Well, I think I really wish us good timber, because I think it was also the timber very much because it was not just the physios that mobilized, they had a medical doctor, in fact, the chief physician helped me mobilize a patient to standing because no one else else was available. So that was really the teamwork. And I think if we all work together, we can achieve much more and and improve the quality of life also at the latest data of our patients. I’m pretty sure it will improve outcomes. So yes, I wish everyone teamwork, I guess.

Kali Dayton 24:29
I love it and what basis absolutely this cannot happen otherwise, and I love it. Christiane purvey says she’s in Texas, and she’s a well known physical therapist that has pioneered walking patients on ventilators for decades. And she says that mobility is everyone’s job.

Sabrina Eggmann 24:46
Exactly. Absolutely. I mean, as a physio I could kind of go there. I mean, this patient I remember him so well. He wanted to stand up people still ventilated on ECMO actually and And, well, this patient, we sat with him on the edge of the bed and he wanted to stand up and do some steps on place. And the chief physician came by and we needed a hand and he was just there and helped us. Yeah, that I think that’s teamwork. And he also felt responsible to achieve this. I

Kali Dayton 25:21
love that. Heidi Engel brings it has residents follow her. As part of her their training, they have to do a shift, or I don’t know how many shifts with her. And they are just floored. They say I don’t, I had no idea that this is what you did. I didn’t know how much you knew or how much you did for patients. And then they developed that skill set, and they get excited about those practices. That’s nice. And what better way to lead that didn’t say, if you need help, I’m here. Yes, I guess teamwork

Sabrina Eggmann 25:51
does improve if you also know what the auditors do. And if you assist. We actually since COVID, the COVID pandemic, we have now medical students who assist in the shifts, and they also assist with setting up and mobilization. And this is our future. So I’m really hopeful that they also bring something to their practice, because they they assist with nurses and physios. And they, I’m hopeful that this will also improve teamwork. Oh, that’s

Kali Dayton 26:23
brilliant, bringing the med students are you hearing that us all that model? No, that’s great experience, because they get to really be familiar with the lines and the tubes and have real patient interactions. I mean, besides bed bath, maybe like what’s more intimate than having to really be literally hands on with a patient. That’s true, and preserving their, their function, you know, the very basic skills, that’s it’s so you know, it’s just, it’s extremely intimate. And you really, you capture the humanity of those patients, and of the whole project that you’re working on there. So for physicians to be trained that way, that will be a huge impact on the future culture. Yes, and

Sabrina Eggmann 27:11
I also see a I mean, mobilization also brings humanity back, you know, you see the first time the patient again, is not just laying there not moving, not participating. And when patients set up again, they feel it more humane. And also you are more in contact. This one patient I just told you about. He was doing Sudoku on the edge of the bed. And like he couldn’t talk because he was still ventilated, but he was in contact with everyone. And that was also because we start to mobilize and I mean, that’s why the physician helps. Because if they if they see a human,

Kali Dayton 27:50
I love that. And I really think you’ve captured well, the culture of a unit that really prioritizes the patient, the patient as a person. And that’s something that does come with time and experience, I think we all have to appreciate when we have a really established culture of automatic, deep, prolonged sedation, no mobility, it takes a process of evolution to change that perspective.

And to develop that skill set. It’s really overwhelming and daunting for people initially, to take sedation off to avoid sedation then to mobilize them. But what you’ve described as a team that has done this for many years, so even when something new came along, like COVID-19. And it was scary, and it was hard and patients were sick, your culture and that skills, that expertise that your team had developed, still carried through and especially applied to COVID-19 patients.

Sabrina Eggmann 28:50
Yes, and it was really do because we were a team and we knew what each other skills was and how we can help each other. I actually just talked about something else about turning excitation of and because sometimes I think it’s even helpful if we what we do, sometimes we sit them up a bit in the in the bed, a little turn to this side, one and one foot already on the floor, and then we stop sedation only. So like that it really helps them when they when they wake up to be a bit in a sitting position. It’s actually quite an interesting approach that we sometimes also use them during COVID.

Kali Dayton 29:30
That is brilliant. Absolutely. When I really didn’t appreciate this until I played a patient in the scenario at a conference when I really got into character and just really embodied this scenario of being delirious and confused, being 30 degrees in the bed, even though I wasn’t delirious, right? And I wasn’t actually intubated. It felt so vulnerable and I knew these people around me I still have that’s a good one. And when they’re like towering over you and you’re at this really helpless position. It’s scary. And so I learned from some of my colleagues that have a lot of experience with tilt tables, these tilt beds, they’re having them tilted standing up, and then they take sedation off. And I said that it totally helps. So what you’re sharing it absolutely validates that. And so that’s going to be another tool in the box, right to say exactly,

Sabrina Eggmann 30:23
yeah, I didn’t even think that it’s vulnerability as well, but it fully, it fully applies, I think. Yeah. Yeah. Yeah. I levels.

Kali Dayton 30:34
Yeah. And you’re engaging with your environment. I have often experienced that when patients are agitated and they’re delirious. Sitting them up at the side of the bed is magic. Yeah, you should add it walking. They just, I mean, they can still be delirious, but the agitation improves, they, everyone’s reaffirming this to me, they start to make eye contact, follow commands. You’ve seen it.

But many of our teams are not trained that way. That’s the last thing they would ever do. They want the patient to be awake following commands before they get them up. Yes. But I think that is such a barrier and a disservice to the patient and our clinicians and like you’re taking away one of the biggest tools to get patients to that point, which is setting them up. So you’re so you would say the resident Ross like negative one, maybe negative to you get to that side of the bed, and then finalize that those last that last little leap, and the sedation.

Sabrina Eggmann 31:33
I’ve even extubated patient actually at the edge of the bed. You cannot do that with weak patients, but we have COPD, for example.

Kali Dayton 31:44
A lot of my exztubations have been in the chair. Yeah. Walk around the unit. They sit in the chair, and there’s no there’s no need to cross your fingers when you activate them.

Sabrina Eggmann 31:57
Patients often say they can breathe better when they say,

Kali Dayton 31:59
Oh, yep, you hear it all the time, too. Yeah.

Sabrina Eggmann 32:03
Well, it’s not out just after they start up, because usually it’s exhausting. But when they say it, and they’ve recaptured their breath, and many people can breathe better.

Kali Dayton 32:13
Absolutely. Have people write on clipboards, saying, “Can I get to the chair? Can I please get to the chair?” And it seems to be I mean, this is just my observation. I saw it a lot with patients with higher ventilator settings. One patient just a few months ago was working with a team and he was on a peep of 14 80%. And they were about to print and paralyze them. And we said hold on, let’s let’s get him up first and see how he does got him to the chair an hour later, he was down to a peep of 12 and 50%.

Sabrina Eggmann 32:43
Oh, wow. Just say that I’m still waiting, actually, for the studies that compare lung protective ventilation with non lung. I guess that’s your

Kali Dayton 32:54
Hear that, ARDS net? Do you hear that? We are all waiting. But really the area studies are from the 90s.

Sabrina Eggmann 33:02
Yes. And and lung protective ventilation seems plausible to me. But of course, now we have also brain protection, interventions like mobilization. So I guess we need to find out again, how we can do both, maybe?

Kali Dayton 33:20
Absolutely, those ARDS. This is a whole nother topic. But those ad artists studies were done comparing high volumes that we were doing in and high peeps that we were doing in the 90s to lower volumes. But all of those patients were sedated and I think usually paralyzed. Yes.

Sabrina Eggmann 33:37
And this, of course, in Europe, in lung protective ventilation is still very important. But I think we found a good pair or a cute, good measure during the COVID 19 pandemic in the first few days. It was really lung protective, protective ventilation. proning. But then after four days, they said so it I think it was quite a good balance to have both.

Kali Dayton 34:01
Yep. So it wasn’t just we can’t let them take any independent brands. We can’t let them exceed that volume ever. While they’re on the ventilator it was we’re going to follow some of this research. You know, it’s antiquated, but we’re going to keep this very controlled initially. And then we’re going to look at the big picture and make sure we take care of the rest of the body to Yes,

Sabrina Eggmann 34:20
and of course also our our doctors, they really looked at all the compliance parameters and how that was also always a very important then parameter to see how we can progress.

Kali Dayton 34:33
Well, I am really proud of your team. Thank you so much for publishing that research and just showing that it was possible and done to have patients mobilized fairly early on during the pandemic. Thank you for all that your team is doing and all that you do as a physiotherapist, you’re, as you can tell in your data you are saving lives.

Sabrina Eggmann 34:54
Thank you very much for inviting us and yeah, I’m also very happy with this team. Thank

Kali Dayton 35:00
you so much and congratulations, Switzerland.

Transcribed by https://otter.ai

 

Citations

Eggmann, S., Nydahl, P., Gosselink, R., & Bissett, B. (2024). We need to talk about adverse events during physical rehabilitation in critical care trials. EClinicalMedicine, 68, 102439.

Eggmann, S., Kindler, A., Perren, A., Ott, N., Johannes, F., Vollenweider, R., Balma, T., Bennett, C., Silva, I. N., & Jakob, S. M. (2021). Early Physical Therapist Interventions for Patients With COVID-19 in the Acute Care Hospital: A Case Report Series. Physical therapy, 101(1), pzaa194.

Eggmann, S., Verra, M. L., Luder, G., Takala, J., & Jakob, S. M. (2018). Effects of early, combined endurance and resistance training in mechanically ventilated, critically ill patients: A randomised controlled trial. PloS one, 13(11), e0207428.

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