TY - JOUR
T1 - Mobilization of Mechanically Ventilated Patients in Switzerland
AU - Sibilla, Alberto
AU - Nydahl, Peter
AU - Greco, Nicola
AU - Mungo, Giuseppe
AU - Ott, Natalie
AU - Unger, Ines
AU - Rezek, Spencer
AU - Gemperle, Sarah
AU - Needham, Dale M.
AU - Kudchadkar, Sapna R.
PY - 2020/1/1
Y1 - 2020/1/1
N2 - Purpose: Growing evidence suggests that early mobilization benefits intensive care unit (ICU) patients. However, national practices and the culture of individual ICUs influence mobilization activities. Materials and Methods: In a 1-day, Swiss point prevalence study conducted in 35 ICUs (representing 45% of all ICUs), the highest level of mobilization for mechanically ventilated patients was characterized using the validated ICU Mobility Scale, along with data collection for potential safety events and mobilization barriers. Results: Among 161 mechanically ventilated patients, a total of 33% (n = 53) had active mobilization, with walking achieved by only 2% (n = 4). More severe organ failure was associated with lower mobilization (respiratory Sequential Organ Failure Assessment score: P =.037, cardiac: P =.008, neurology: P <.001). Barriers to mobilization were reported in 71% (n = 115), with deep sedation significantly higher among patients receiving passive versus active mobilization (14% vs 0%, P =.005). Potential safety events occurred in 20% (n = 33) of patients without significant differences between passive and active mobilization. Availability of physiotherapists and appropriate equipment were not reported barriers. Conclusion: Mobilization during mechanical ventilation occurred infrequently with greater organ failure associated with lower mobilization. Addressing the identified modifiable barriers via structured efforts to achieve multidisciplinary culture change is essential to decrease the common use of bed rest in Swiss ICUs.
AB - Purpose: Growing evidence suggests that early mobilization benefits intensive care unit (ICU) patients. However, national practices and the culture of individual ICUs influence mobilization activities. Materials and Methods: In a 1-day, Swiss point prevalence study conducted in 35 ICUs (representing 45% of all ICUs), the highest level of mobilization for mechanically ventilated patients was characterized using the validated ICU Mobility Scale, along with data collection for potential safety events and mobilization barriers. Results: Among 161 mechanically ventilated patients, a total of 33% (n = 53) had active mobilization, with walking achieved by only 2% (n = 4). More severe organ failure was associated with lower mobilization (respiratory Sequential Organ Failure Assessment score: P =.037, cardiac: P =.008, neurology: P <.001). Barriers to mobilization were reported in 71% (n = 115), with deep sedation significantly higher among patients receiving passive versus active mobilization (14% vs 0%, P =.005). Potential safety events occurred in 20% (n = 33) of patients without significant differences between passive and active mobilization. Availability of physiotherapists and appropriate equipment were not reported barriers. Conclusion: Mobilization during mechanical ventilation occurred infrequently with greater organ failure associated with lower mobilization. Addressing the identified modifiable barriers via structured efforts to achieve multidisciplinary culture change is essential to decrease the common use of bed rest in Swiss ICUs.
KW - critical care
KW - early mobilization
KW - intensive care unit
KW - mechanical ventilation
KW - physical therapy
KW - rehabilitation
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U2 - 10.1177/0885066617728486
DO - 10.1177/0885066617728486
M3 - Article
C2 - 28847238
AN - SCOPUS:85041588195
VL - 35
SP - 55
EP - 62
JO - Journal of Intensive Care Medicine
JF - Journal of Intensive Care Medicine
SN - 0885-0666
IS - 1
ER -