Early mobilisation in intensive care units in Australia and Scotland: a prospective, observational cohort study examining mobilisation practises and barriers

Abstract

Introduction: Mobilisation of patients in the intensive care unit (ICU) is an area of growing research. Currently, there is little data on baseline mobilisation practises and the barriers to them for patients of all admission diagnoses.

Methods: The objectives of the study were to (1) quantify and benchmark baseline levels of mobilisation in Australian and Scottish ICUs, (2) compare mobilisation practises between Australian and Scottish ICUs and (3) identify barriers to mobilisation in Australian and Scottish ICUs. We conducted a prospective, observational, cohort study with a 4-week inception period. Patients were censored for follow-up upon ICU discharge or after 28 days, whichever occurred first. Patients were included if they were >18 years of age, admitted to an ICU and received mechanical ventilation in the ICU.

Results: Ten tertiary ICUs in Australia and nine in Scotland participated in the study. The Australian cohort had a large proportion of patients admitted for cardiothoracic surgery (43.3%), whereas the Scottish cohort had none. Therefore, comparison analysis was done after exclusion of patients admitted for cardiothoracic surgery. In total, 60.2% of the 347 patients across 10 Australian ICUs and 40.1% of the 167 patients across 9 Scottish ICUs mobilised during their ICU stay (p < 0.001). Patients in the Australian cohort were more likely to mobilise than patients in the Scottish cohort (hazard ratio 1.83, 95% confidence interval 1.38-2.42). However, the percentage of episodes of mobilisation where patients were receiving mechanical ventilation was higher in the Scottish cohort (41.1% vs 16.3%, p < 0.001). Sedation was the most commonly reported barrier to mobilisation in both the Australian and Scottish cohorts. Physiological instability and the presence of an endotracheal tube were also frequently reported barriers.

Conclusions: This is the first study to benchmark baseline practise of early mobilisation internationally, and it demonstrates variation in early mobilisation practises between Australia and Scotland.

Fig. 1

Time to mobilisation for Australian and Scottish cohorts, excluding cardiothoracic surgery patients

Fig. 2

a Mobilisation status on each day of intensive care unit (ICU) admission for patients in the Australian cohort (n =347). b Mobilisation status on each day of ICU admission for patients in the Scottish cohort (n =167). ETT endotracheal tube, MV mechanical ventilation, trache tracheostomy

Fig. 3

Discharge destination for Australian and Scottish patients who mobilised and those who did not mobilise. ICU intensive care unit

Fig. 4

Reported barriers to mobilisation for each occasion of service in the Australian and Scottish cohorts. CNS central nervous system, CVS cardiovascular system, ETT endotracheal tube