Alberto Sibilla1, Peter Nydahl2, Nicola Greco1, Giuseppe Mungo1, Natalie Ott1, Ines Unger1, Spencer Rezek1, Sarah Gemperle3, Dale M Needham4, Sapna R Kudchadkar5. 1. Kantonsspital Winterthur, Institute for Physiotherapy, Winterthur, Switzerland. 2. Nursing Research, University Hospital of Schleswig-Holstein, Schleswig-Holstein, Germany. 3. Intensive Care Unit, Kantonsspital Winterthur, Winterthur, Switzerland. 4. Outcomes after Critical Illness and Surgery (OACIS) Group, Pulmonary and Critical Care Medicine, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 5. Outcomes after Critical Illness and Surgery (OACIS) Group, Anesthesiology and Critical Care Medicine, Pediatrics and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Abstract
PURPOSE: Growing evidence suggests that early mobilization benefits intensive care unit (ICU) patients. However, national practices and the culture of individual ICUs influence mobilization activities. MATERIALS AND METHODS: In a 1-day, Swiss point prevalence study conducted in 35 ICUs (representing 45% of all ICUs), the highest level of mobilization for mechanically ventilated patients was characterized using the validated ICU Mobility Scale, along with data collection for potential safety events and mobilization barriers. RESULTS: Among 161 mechanically ventilated patients, a total of 33% (n = 53) had active mobilization, with walking achieved by only 2% (n = 4). More severe organ failure was associated with lower mobilization (respiratory Sequential Organ Failure Assessment score: P = .037, cardiac: P = .008, neurology: P < .001). Barriers to mobilization were reported in 71% (n = 115), with deep sedation significantly higher among patients receiving passive versus active mobilization (14% vs 0%, P = .005). Potential safety events occurred in 20% (n = 33) of patients without significant differences between passive and active mobilization. Availability of physiotherapists and appropriate equipment were not reported barriers. CONCLUSION: Mobilization during mechanical ventilation occurred infrequently with greater organ failure associated with lower mobilization. Addressing the identified modifiable barriers via structured efforts to achieve multidisciplinary culture change is essential to decrease the common use of bed rest in Swiss ICUs.
PURPOSE: Growing evidence suggests that early mobilization benefits intensive care unit (ICU) patients. However, national practices and the culture of individual ICUs influence mobilization activities. MATERIALS AND METHODS: In a 1-day, Swiss point prevalence study conducted in 35 ICUs (representing 45% of all ICUs), the highest level of mobilization for mechanically ventilated patients was characterized using the validated ICU Mobility Scale, along with data collection for potential safety events and mobilization barriers. RESULTS: Among 161 mechanically ventilated patients, a total of 33% (n = 53) had active mobilization, with walking achieved by only 2% (n = 4). More severe organ failure was associated with lower mobilization (respiratory Sequential Organ Failure Assessment score: P = .037, cardiac: P = .008, neurology: P < .001). Barriers to mobilization were reported in 71% (n = 115), with deep sedation significantly higher among patients receiving passive versus active mobilization (14% vs 0%, P = .005). Potential safety events occurred in 20% (n = 33) of patients without significant differences between passive and active mobilization. Availability of physiotherapists and appropriate equipment were not reported barriers. CONCLUSION: Mobilization during mechanical ventilation occurred infrequently with greater organ failure associated with lower mobilization. Addressing the identified modifiable barriers via structured efforts to achieve multidisciplinary culture change is essential to decrease the common use of bed rest in Swiss ICUs.
Entities:
Keywords:
critical care; early mobilization; intensive care unit; mechanical ventilation; physical therapy; rehabilitation
Authors: Daniel L Young; Jason Seltzer; Mary Glover; Caroline Outten; Annette Lavezza; Earl Mantheiy; Ann M Parker; Dale M Needham Journal: Am J Crit Care Date: 2018-05 Impact factor: 2.228
Authors: Ann M Parker; Narges Akhlaghi; Albahi M Malik; Lisa Aronson Friedman; Earl Mantheiy; Kelsey Albert; Mary Glover; Sherry Dong; Annette Lavezza; Jason Seltzer; Dale M Needham Journal: Aust Crit Care Date: 2021-06-18 Impact factor: 3.265