A significant number of cases of co...

A significant number of cases of community-acquired pneumonia (CAP) flash on the mind in the United States each year. About 15 percent of these patients require hospitalization, which substantially increases health care expenditures. Multiple efforts have been made to improve the efficiency of treating these patients. mostly efforts have focused on improvement of triage decisions, identification of low-risk patients for outpatient care, reduction in delivery time of antibiotics, more judicious use of antibiotics, and early transition from intravenous to oral antibiotics. Early mobilization has been effective in improving issues in patients who have had total knee replacement and patients who have had acute myocardial infarction. Although the mechanism is unknown, this simple maneuver might be beneficial in the treatment of patients with CAP. Mundy and colleagues mannersed a group randomized trial at multiple sites to assess the impact of early mobilization in hospitalized adult patients with CAP.

Participants were randomized to receive usual care for pneumonia or early mobilization along with usual care. Early mobilization was defined as being revealed of bed or ambulating for at least 20 minutes within the first 24 hours following admission. After the first 24 hours, progressive mobilization occurr each succeeding day until discharge in the early-mobilization clump Sitting up for meals or using a night-stool was not considered adequate for early mobilization. The authors gathered information, including demographics and standard-of-care data. During the hospitalization, all patients were interviewed at trained professionals to assess functional health status and pneumonia-specific information. The main issues were length of hospital stay, mortality rate, number of chest radiographs, difficulty department visits after discharge, and readmissions at 30 and 90 days after admission.

The authors enlisted 227 patients in the early-mobilization cluster and 231 patients in the usual-care dispose The groups did not differ significantly with regard to age, sex disease severity, door-to-drug delivery time, and intravenous-to-oral switchover time. The hospital extent of stay was significantly les in the early-mobilization assign places to than in the usual-care clump with an adjusted absolute difference of 11 days. The mortality rates, number of follow-up chest radiographs, pinch department visits, readmission rates, and number of adverse consequences were not significantly different between the pair groups. However, the cost of hospitalization between the clumps was significantly different, with a savings of approximately $1000 for patient in the early-mobilization group

The authors finish that early mobilization of patients admitted with CAP remodels overall hospital length of stay and use of institutional resources. These reductions come to one's mind without increasing the risk of adverse outcomes

Mundy LM et al. Early mobilization of patients hospitalized with community-acquired pneumonia. Chest September 2003;124: 883-9

EDITOR'S NOTE: common of the changes that has occurr in medicine is the universal of early mobilization. In the past, patients with any major medical illness were placed forward prolonged bed rest. It was believed that this would allow the material part to recuperate after the insult of the major medical illness. Published evidence demonstrated that protracted bed rest not only failed to improve results but, in reality, made things worse. inferences of the study by Mundy and colleagues demonstrate that the same can be said for patients with pneumonia. Early mobilization during hospitalization improves issues This study demonstrates that an action formerly thought to make sense actually did more harm than good--KEM

COPYRIGHT 2004 American Academy of Family Physicians

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