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

Abstract

Background Mobilization of critically ill patients is safe and may improve functional outcomes. However, the prevalence of mobilization activities of ICU patients in Brazil is unknown. Methods A one-day point prevalence prospective study with a 24-hour follow-up period was conducted in Brazil. Demographic data, ICU characteristics, prevalence of mobilization activities, level of patients' mobilization, and main reasons for not mobilizing patients were collected for all adult patients with more than 24hs of ICU stay in the 26 participating ICUs. Mobilization activity was defined as any exercise performed during ICU stay. Results In total, 358 patients were included in this study. Mobilization activities were performed in 87.4% of patients. Patients received mobilization activities while under invasive mechanical ventilation (44.1%), noninvasive ventilation (11.7%), or without any ventilatory support (44.2%). Passive exercises were more frequently performed [46.5% in all patients; 82.3% in mechanically ventilated patients]. Mobilization activities included in-bed exercise regimen (72.2%). Out-of-bed mobility was reported in 39.9% of mobilized patients, and in 16.3% of patients under invasive mechanical ventilation. The presence of an institutional early mobility protocol was associated with early mobilization (OR, 3.19; 95% CI, 1.23 to 8.22; p = 0.016), and with out-of-bed exercise (OR, 5.80; 95% CI, 1.33 to 25.30; p = 0.02).

Effectiveness, Safety, and Barriers to Early Mobilization in the Intensive Care Unit

“…Even then, early mobilization is not practiced commonly. Studies on the practice of early mobilization in different countries are mentioned in Table 9 [ 65 , 69 – 75 ].…”

Nurses’ Perceptions of Barriers to Out-of-Bed Activities Among Patients Receiving Mechanical Ventilation

“…31 Authors of recent studies have reported that the presence of an endotracheal tube with mechanical ventilation was negatively associated with a patient being engaged in OOB activities. 26,[38][39][40][41] Results of 3 critical care unit 1-day point-prevalence studies showed that patients receiving mechanical ventilation never 40 or very rarely were mobilized with OOB activities. 26,38 Timenetsky et al 26 reported that only 16% of 158 patients receiving mechanical ventilation in 26 ICUs had engaged in OOB activities.…”

“…22,23 These barriers can be conceptualized as patient condition barriers, nurse and health care team barriers, and environment-of-care barriers. Prominent patient condition barriers are obesity, 24 agitation, 25 delirium, 23 excessive sedation, 26 distressing symptoms (pain, fatigue, and dyspnea), 27 lack of motivation, [23][24][25]27 and unstable vital signs. 25,26 Use of invasive monitoring devices, endotracheal intubation, and use of vascular access devices 23,24 have all been cited by clinicians as patient-related reasons for not mobilizing their patients.…”

“…24,28 Factors within the environment of care contribute to a lack of early mobility practices. Barriers occur when the unit does not have a mobility protocol, 24,26 staffing is inadequate, 6,27 physical therapists are not available, 26 the unit lacks assistive devices and equipment, 6,24,26,27 and clinicians fail to enter mobility orders. 25 Current evidence indicates that extensive barriers to mobilizing critically ill patients stem from several sources.…”

Mobility and clinical outcome of patients admitted to an intensive care unit

“…Another recent prevalence study investigated 26 Brazilian ICUs and showed that 87.4% of the population underwent some type of mobilization. However, passive activities restricted to the bed predominated, particularly in patients on mechanical ventilation [30].…”