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Early Mobilization in the ICU: A 1-Day Point-Prevalence Study in Brazil
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A6026 - Early Mobilization in the ICU: A 1-Day Point-Prevalence Study in Brazil
Author Block: K. Timenetsky, D. Carnieli-Cazati, T. D. Corréa, A. Serpa Neto, R. C. F. Chaves, M. S. Cesar De Assuncao, R. A. C. Eid, e-MOTION Study group; Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
RATIONALE: Early mobilization of critically ill patients is safe and may improve functional outcomes. However, the prevalence of early mobilization of intensive care unit (ICU) patients in Brazil is unknown.
METHODS: A one-day, prospective, point prevalence study with a 24-hour follow-up period conducted on June 29, 2017 in Brazil. Demographic data, ICU characteristics, prevalence of early mobilization, level of patients’ mobilization and main reasons for not mobilizing patients were collected for all adult patients with ICU stay longer than 24h in the 25 participating ICUs. Early mobilization was defined as any exercise performed during the ICU stay (from passive to resistive exercise; in-bed or out-of-bed). Local ethical committee approval at each participating center was expedited or waived owing to the purely observational nature of this study.
RESULTS: In total, 367 patients were included in this study. The mean (SD) age was 64 (19) years and 53% of patients were male. Median (IQR) length of ICU stay prior study inclusion was 6 (3-13) days. Early mobilization was performed in 87.2% (320/367) of patients. Patients received early mobilization while on invasive mechanical ventilation (42.5%), noninvasive ventilation (11.9%) or without any ventilatory support (45.6%). Early mobilization activities encompassed in bed exercise regimen (n=222; 69.4%), passive movement to chair (n=16; 5.0%), sitting over the edge of bed (n=55; 17.2%), standing up at the bedside (n=40; 12.5%), transferring from bed to chair (n=35; 10.9%), marching on spot (n=6; 1.9%), walking with the assistance of 2 or more people (n=13; 4.0%), walking with assistance of one physiotherapist (n=25; 7.8%), walking without assistance with gait aid (n=5; 1.6%) and walking without assistance or gait aid (n=19; 5.9%). Out-of-bed mobility was reported in 66.8% (214/320) of mobilized patients and in 9.5% (13/136) of patients on invasive mechanical ventilation. Absence of early mobilization protocol (3.3%), unavailability of physiotherapists (2.2%) and hemodynamic instability (1.6%) were the most frequently reported reasons for not mobilizing patients. Complications related to early mobilization were reported in 8.4% (27/320) of patients, mainly respiratory distress (59%) and hemodynamic instability (22%).
CONCLUSION: Early mobilization in critically ill patients in Brazil was highly prevalent. The impact of early mobilization of critically ill patients on outcomes in Brazil needs to be further addressed.
Author Block: K. Timenetsky, D. Carnieli-Cazati, T. D. Corréa, A. Serpa Neto, R. C. F. Chaves, M. S. Cesar De Assuncao, R. A. C. Eid, e-MOTION Study group; Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
RATIONALE: Early mobilization of critically ill patients is safe and may improve functional outcomes. However, the prevalence of early mobilization of intensive care unit (ICU) patients in Brazil is unknown.
METHODS: A one-day, prospective, point prevalence study with a 24-hour follow-up period conducted on June 29, 2017 in Brazil. Demographic data, ICU characteristics, prevalence of early mobilization, level of patients’ mobilization and main reasons for not mobilizing patients were collected for all adult patients with ICU stay longer than 24h in the 25 participating ICUs. Early mobilization was defined as any exercise performed during the ICU stay (from passive to resistive exercise; in-bed or out-of-bed). Local ethical committee approval at each participating center was expedited or waived owing to the purely observational nature of this study.
RESULTS: In total, 367 patients were included in this study. The mean (SD) age was 64 (19) years and 53% of patients were male. Median (IQR) length of ICU stay prior study inclusion was 6 (3-13) days. Early mobilization was performed in 87.2% (320/367) of patients. Patients received early mobilization while on invasive mechanical ventilation (42.5%), noninvasive ventilation (11.9%) or without any ventilatory support (45.6%). Early mobilization activities encompassed in bed exercise regimen (n=222; 69.4%), passive movement to chair (n=16; 5.0%), sitting over the edge of bed (n=55; 17.2%), standing up at the bedside (n=40; 12.5%), transferring from bed to chair (n=35; 10.9%), marching on spot (n=6; 1.9%), walking with the assistance of 2 or more people (n=13; 4.0%), walking with assistance of one physiotherapist (n=25; 7.8%), walking without assistance with gait aid (n=5; 1.6%) and walking without assistance or gait aid (n=19; 5.9%). Out-of-bed mobility was reported in 66.8% (214/320) of mobilized patients and in 9.5% (13/136) of patients on invasive mechanical ventilation. Absence of early mobilization protocol (3.3%), unavailability of physiotherapists (2.2%) and hemodynamic instability (1.6%) were the most frequently reported reasons for not mobilizing patients. Complications related to early mobilization were reported in 8.4% (27/320) of patients, mainly respiratory distress (59%) and hemodynamic instability (22%).
CONCLUSION: Early mobilization in critically ill patients in Brazil was highly prevalent. The impact of early mobilization of critically ill patients on outcomes in Brazil needs to be further addressed.
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