Point Prevalence Study of Mobilization Practices for Acute... : Critical Care Medicine (original) (raw)

Clinical Investigations

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

Jolley, Sarah Elizabeth MD, MSc1; Moss, Marc MD2; Needham, Dale M. MD, PhD3; Caldwell, Ellen MS4; Morris, Peter E. MD5; Miller, Russell R. MD, MPH6; Ringwood, Nancy RN, BSN7; Anders, Megan MD8; Koo, Karen K. MD9; Gundel, Stephanie E. RD, CD4; Parry, Selina M. PhD10; Hough, Catherine L. MD, MSc4

1Section of Pulmonary and Critical Care Medicine, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA.

2Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Colorado, Boulder, CO.

3Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.

4Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA.

5Division of Pulmonary and Critical Care Medicine, Department of Medicine, Wake Forest University, Winston-Salem, NC.

6Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Hospital/University of Utah, Salt Lake City, UT.

7Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.

8Department of Anesthesiology, University of Maryland, College Park, MD.

9Swedish Medical Center, Seattle, WA.

10Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia.

Drs. Jolley, Moss, Needham, Morris, Miller, Koo, and Hough contributed to study concept and design, data acquisition and interpretation, and study conduct. Dr. Jolley wrote the first version of the article. Drs. Ringwood, Anders, Gundel, and Parry contributed to data acquisition and study conduct. Ms. Caldwell performed the data analysis and contributed to data interpretation. All authors contributed to revision of the article, and all authors approved the final article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by grant 1 U54 GM104940 from the National Institute of General Medical Sciences of the National Institutes of Health which funds the Louisiana Clinical and Translational Science Center (to Dr. Jolley). Dr. Jolley, Dr. Moss, Dr. Needham, Ms. Caldwell, Dr. Morris, Dr. Miller, Dr. Ringwood, Dr. Koo, Dr. Gundel, Dr. Parry, and Dr. Hough on this study received funding for this work (NIH/non-industry). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Dr. Jolley received funding from Lyric Pharmaceuticals, received support for article research from the National Institutes of Health (NIH), and disclosed travel for protocol development meeting for Lyric Pharmaceuticals for work unrelated to this article. Dr. Moss received support for article research from the NIH. Dr. Needham received support for article research from the NIH. His institution received funding from the National Heart, Lung, and Blood Institute (NHLBI). Dr. Ringwood received support for article research from the NIH. Her institution received funding from the NHLBI. Dr. Anders disclosed other support. Dr. Hough received support for article research from the NIH. Her institution received funding from the NIH NHLBI. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

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 ICU patients with acute respiratory failure in U.S. ICUs.

Design:

Two-day cross-sectional point prevalence study.

Setting:

Forty-two ICUs across 17 Acute Respiratory Distress Syndrome Network hospitals.

Patients:

Adult patients (≥ 18 yr old) with acute respiratory failure requiring mechanical ventilation.

Interventions:

We defined therapist-provided mobility as the proportion of patient-days with any physical or occupational therapy–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 physical therapy/occupational therapy–provided mobility was 32% (247/770), with a significantly higher proportion of nonmechanically ventilated patients receiving physical therapy/occupational therapy (48% vs 26%; p ≤ 0.001). Patients on mechanical ventilation achieved out-of-bed mobility on 16% (n = 90) of the total patient-days. Physical therapy/occupational therapy involvement in mobility events was strongly associated with progression to out-of-bed mobility (odds ratio, 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, physical therapy/occupational therapy–provided mobility was infrequent. Physical therapy/occupational therapy 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.