Early mobilization practices of mechanically ventilated patients: a 1-day point-prevalence study in southern Brazil

Abstract

OBJECTIVES:To assess early mobilization practices of mechanically ventilated patients in southern Brazilian intensive care units (ICUs) and to identify barriers associated with early mobilization and possible complications.METHODS:A prospective, observational, multicenter, 1-day point-prevalence study was conducted across 11 ICUs and included all mechanically ventilated adult patients. Hospital and ICU characteristics and patients' demographic data, the highest level of mobilization achieved in the 24 hours prior to the survey and related barriers, and complications that occurred during mobilization were collected in the hospital and the ICU.RESULTS:A total of 140 patients were included with a mean age of 57±17 years. The median and interquartile range was 7 (3-17) days for the length of ICU stay to the day of the survey and 7 (3-16) days for the duration of mechanical ventilation (MV). The 8-level mobilization scale was classified into two categories: 126 patients (90%) remained in bed (level 1–3) and 14 (10%) were mobilized out of bed (level 4–8). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 2%, 23%, and 50% were mobilized out of bed, respectively (p<0.001 for differences among the three groups). Weakness (20%), cardiovascular instability (19%), and sedation (18%) were the most commonly observed barriers to achieving a higher level of mobilization. No complications were reported.CONCLUSIONS:In southern Brazilian ICUs, the prevalence of patient mobilization was low, with only 10% of all mechanically ventilated patients and only 2% of patients with an endotracheal tube mobilized out of bed as part of routine care.

Mobilization practices in the ICU: A nationwide 1-day point- prevalence study in Brazil

“…The vast majority of patients receiving mechanical ventilation included in our study received passive mobilization. Our results, in the mechanically ventilated patients, are in agreement with the results reported in a recent study performed in 11 ICUs located in southern Brazil [18]. Nevertheless, the prevalence of mobilization in mechanically ventilated patients found in our study was higher than the prevalence between 32 to 45% reported by other authors [15][16][17][18].…”

“…In their study, non-mechanically ventilated patients were more likely to receive mobilization than mechanically ventilated patients, and approximately one third of mobilized patients received only passive activities [17]. A study performed in 11 Southern Brazilian ICUs reported a prevalence of 85% of mobilization activities in mechanically ventilated patients [18]. Nevertheless, this study evaluated only mechanically ventilated patients, and it reflects a regional pattern rather than a nationwide practice [18].…”

“…A study performed in 11 Southern Brazilian ICUs reported a prevalence of 85% of mobilization activities in mechanically ventilated patients [18]. Nevertheless, this study evaluated only mechanically ventilated patients, and it reflects a regional pattern rather than a nationwide practice [18]. Therefore, we aimed to evaluate the prevalence of mobilization activities of critically ill patients in Brazilian ICUs through a nationwide one-day point prevalence study.…”

“…It improves, if applied early, independent physical status at hospital discharge [12,13], decreases the duration of mechanical ventilation [12], the number of days in delirium [12,13] and hospital length of stay [13], enhances recovery of functional exercise capacity [14], self-perceived functional status and muscle force at hospital discharge [14]. Nevertheless, recent studies have reported a low prevalence of mobilization activities in critically ill patients [15][16][17][18]. Moreover, mobilization is often limited to in-bed exercise [15][16][17][18].…”

“…Nevertheless, recent studies have reported a low prevalence of mobilization activities in critically ill patients [15][16][17][18]. Moreover, mobilization is often limited to in-bed exercise [15][16][17][18]. For instance, Jolley and colleagues reported a 65% prevalence of mobilization activities in 42 ICUs in the United States of America [17].…”