Early Mobilization Reduces Duration of Mechanical Ventilation and Intensive Care Unit Stay in Patients With Acute Respiratory Failure

• Published in: Archives of physical medicine and rehabilitation Vol. 98; no. 5; pp. 931 - 939
• Main Authors: Lai, Chih-Cheng, MD, Chou, Willy, MD, Chan, Khee-Siang, PhD, Cheng, Kuo-Chen, MD, Yuan, Kuo-Shu, PhD, Chao, Chien-Ming, MD, Chen, Chin-Ming, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2017
• Subjects: Acute Disease; Aged; Aged, 80 and over; Body Weights and Measures; Comorbidity; Early Ambulation - statistics & numerical data; Early mobilization; Female; Humans; Intensive care units; Intensive Care Units - statistics & numerical data; Length of Stay - statistics & numerical data; Male; Mechanical ventilation; Middle Aged; Physical Medicine and Rehabilitation; Rehabilitation; Respiration, Artificial - statistics & numerical data; Respiratory Insufficiency - rehabilitation; Retrospective Studies; Severity of Illness Index; Time Factors; Ventilator Weaning - statistics & numerical data; OR; CI; MV; odds ratio; APACHE II; Early mobilization; Intensive care units; Therapeutic Intervention Scoring System; TISS; Acute Physiology and Chronic Health Evaluation II; Glasgow Coma Scale; GCS; confidence interval; ICU; intensive care unit; Rehabilitation; Mechanical ventilation
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2016.11.007

Abstract Objective To evaluate the effects of a quality improvement program to introduce early mobilization on the outcomes of patients with mechanical ventilation (MV) in the intensive care unit (ICU). Design A retrospective observational study. Setting Nineteen-bed ICU at a medical center. Participants Adults patients with MV (N=153) admitted to a medical ICU. Interventions A multidisciplinary team (critical care nurse, nursing assistant, respiratory therapist, physical therapist, patient's family) initiated the protocol within 72 hours of MV when patients become hemodynamically stable. We did early mobilization twice daily, 5d/wk during family visits (30min each time), and cooperated with family, if possible. Main Outcome Measures MV duration, rate of successful weaning, and length of ICU and hospital stay. Results We enrolled 63 patients in the before protocol group and 90 in the after protocol group. The 2 groups were well matched in age, sex, body height, body weight, body mass index, disease severity, cause of intubation, number of comorbidities, and most underlying diseases. After protocol group patients had shorter MV durations (4.7d vs 7.5d; P <.001) and ICU stays (6.9d vs 9.9d; P =.001) than did before protocol group patients. Early mobilization was negatively associated with the duration of MV (β=−.269; P <.002; 95% confidence interval [CI], −4.767 to −1.072), and the risk of MV for ≥7 days was lower in patients who underwent early mobilization (odds ratio, .082; 95% CI, .021–.311). Conclusions The introduction of early mobilization for patients with MV in the ICU shortened MV durations and ICU stays. A multidisciplinary team that includes the patient's family can work together to improve the patient's clinical outcomes.