Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic

Abstract

Background Mobilization and acute rehabilitation are essential in the intensive care unit (ICU), with substantial evidence supporting their benefits. This study aimed to characterize ICU mobilization practices during the COVID-19 pandemic for patients with and without COVID-19. Methods This was a secondary analysis of an international point prevalence study. All ICUs across the world were eligible to participate and were required to enroll all patients in each ICU on the survey date, 27 January 2021. The primary outcome was the achievement of mobilization at the level of sitting over the edge of the bed. Independent factors associated with mobilization, including COVID-19 infection, were analyzed by multivariable analysis. Results A total of 135 ICUs in 33 countries participated, for inclusion of 1229 patients. Among patients who were not receiving mechanical ventilation (MV), those with COVID-19 infection were mobilized more than those without COVID-19 (60% vs. 34%, p < 0.001). Among patients who were receiving MV, mobilization was low in both groups (7% vs. 9%, p = .56). These findings were consistent irrespective of ICU length of stay. Multivariable analysis showed that COVID-19 infection was associated with achievement of mobilization in patients without (adjusted odds ratio [aOR] = 4.48, 95% confidence interval [CI] = 2.71-7.42) and with MV (aOR = 2.13, 95% CI = 1.00-4.51). Factors that prevented mobilization were prone positioning in patients without MV and continuous use of neuromuscular blockade and sedation agents in patients with MV, whereas facilitating factors were the presence of targets/goals in both groups. Conclusion Mobilization rates for ICU patients across the globe are severely low, with the greatest immobility observed in mechanically ventilated patients. Although COVID-19 is not an independent barrier to the mobilization of patients with or without MV, this study has highlighted the current lack of mobility practice for all ICU patients during the COVID-19 pandemic. (299 words)

Physical function and mental health trajectories in COVID-19 patients following invasive mechanical ventilation: a prospective observational study

“…The results presented here have important implications both for clinical practice and for the design of future clinical studies of severe COVID-19. Although early rehabilitation for COVID-19 in the ICU has been reported to be both safe and feasible [7,34,35], early rehabilitation may be delayed in the ICU for a number of reasons, all of which are exacerbated by sta ng shortages and infection control, overwhelmed hospital capacity, and the obesity status and severity of respiratory failure of patients. In the present study, prolonged IMV was signi cantly associated with longer time to rst mobilization and LOS in the ICU, suggesting that new interventions, such as electrical muscle stimulation therapy, should be implemented in the ICU to prevent functional decline in patients with severe COVID-19 [36].…”

Intensive care unit-acquired weakness: A review from molecular mechanisms to its impact in COVID-2019

“…In addition, another aspect to consider and that could have important negative effects on the subsequent functional recovery of ICU and COVID-19 patients is the lack of mobilization during hospitalization. In this regard, a study by Liu et al (2022) 141 conducted with data from 135 ICUs, with a total of 1,229 patients in 33 countries around the world, showed that more than 90% of patients with MV (positive or negative for COVID-19) during the pandemic, remained completely immobile most of the time. These results are worrying considering the enormous number of sequelae that these patients can have and, without a doubt, it is essential to change the therapeutic approach to one where mobility is a fundamental element of the rehabilitation.…”

“…These results are worrying considering the enormous number of sequelae that these patients can have and, without a doubt, it is essential to change the therapeutic approach to one where mobility is a fundamental element of the rehabilitation. 141 Regarding post-ICU rehabilitation in COVID-19 patients, given the limited information, more research is needed. 139,142 Patients with physical function sequelae of ICU-AW and COVID-19 need physical therapy to reverse the disability associated with cardiopulmonary dysfunction and muscle atrophy.…”

“…These results are worrying considering the enormous number of sequelae that these patients can have and, without a doubt, it is essential to change the therapeutic approach to one where mobility is a fundamental element of the rehabilitation. 141 …”

COVID-19 and Dialysis: What’s Past Is Prologue

“…Not only did patients with COVID-19 experience lengthy admissions in 2020, many also had prolonged periods of ventilator dependence and associated immobility. 10 Due to high comorbidity burden, most patients receiving maintenance dialysis require greater time and support to recover from a prolonged admission; in the meantime, hospital-acquired frailty increases their vulnerability to future illness and complications, 11 even after recovery from COVID-19 itself.…”