Point Prevalence Study of Mobilization Practices for Acute Respiratory Failure Patients in the United States

Abstract

Objective Early mobility in mechanically ventilated patients is safe, feasible, and may improve functional outcomes. We sought to determine the prevalence and character of mobility for intensive care unit (ICU) patients with acute respiratory failure in US ICUs. Design Two-day multicenter point prevalence study Patients Adult patients (≥ 18 years old) with acute respiratory failure requiring mechanical ventilation in 17 US hospitals and 42 ICUs. Interventions We defined therapist-provided mobility as the proportion of patient-days with any physical (PT) or occupational therapy (OT) provided mobility event. Hierarchical regression models were used to identify predictors of out of bed mobility. Measurements and Main Results Hospitals contributed 770 patient-days of data. Patients received mechanical ventilation on 73% of the patient-days mostly (n=432, 56%) ventilated via an endotracheal tube. The prevalence of PT/OT-provided mobility was 32% (247/770), with a significantly higher proportion of non-mechanically ventilated patients receiving PT/OT (48% vs. 26%, p=<0.001). Patients on mechanical ventilation achieved out of bed mobility on 16% (n=90) of the total patient-days. PT/OT involvement in mobility events was strongly associated with progression to out of bed mobility (OR 29.1, CI 15.1 – 56.3, p≤0.001). Presence of an endotracheal tube and delirium were negatively associated with out of bed mobility. Conclusions In a cohort of hospitals caring for acute respiratory failure patients, PT/OT-provided mobility was infrequent. PT/OT involvement in mobility was strongly predictive of achieving greater mobility levels in patients with respiratory failure. Mechanical ventilation via an endotracheal tube and delirium are important predictors of mobility progression.

Worldwide Survey of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment” (ABCDEF) Bundle

“…(30, 31) A recent point-prevalence study across 42 United States ICUs reported 32% of adult patients with acute respiratory failure (and 26% of ventilated patients) received physical/occupational therapy. (32)An Indian survey reported higher mobilization levels(86% at the bed side, 70% to a wheel chair and 67% limited ambulation). (29)Our results suggest a discordance in intent and resources for mobilization.…”

Muscle wasting and function after muscle activation and early protocol‐based physiotherapy: an explorative trial

“…Further, the nature of the intervention prevented blinding of the treating physician, which must be respected as a bias. Current real word practice regarding mobilization is as previously shown not meeting guideline recommendations . We considered it would nevertheless be unethical to perform anything less than protocol‐based physiotherapy, which is our clinical standard, in the control group.…”

Patient early mobilization: A Malaysia's study of nursing practices

“…PM in this study referred to PM that was done on mechanically ventilated patient. PM was usually done by nurses for mechanically ventilated patient such as positioning patient from supine to left lateral, right lateral and prone or lifting patient with and sit patient up with bed on fowler or high fowler positions, perform suctioning with physiotherapist and Systemic reviews had shown early mobilization improved outcomes of mechanically ventilated patient [1,14] and decreases mechanical ventilation associate weakness [15]. The benefits of early mobilization include reduction in length of stay in ICU and hospital as well as improvements in strength and functional status [16,17].…”