Barriers to implementing expert safety recommendations for early mobilisation in intensive care unit during mechanical ventilation: A prospective observational study

Abstract

Background: Early mobilisation in the intensive care unit (ICU) has been consistently reported as feasible and safe with minimal adverse events; however, invasive mechanical ventilation patients are rarely actively mobilised. An expert consensus group developed and published recommendations using a traffic light system on safety criteria to promote active mobilisation of invasive mechanical ventilation patients.

Objectives: The aim of this study was to determine whether, in clinical practice, the safety consensus recommendations resulted in (1) increased early mobilisation in patients assessed as appropriate to mobilise based on the risk classification and (2) early mobilisation without adverse events.

Methods: A prospective observational study of 100 patients requiring invasive mechanical ventilation (IMV) for greater than 24 h admitted to the ICU at The Alfred Hospital. Patients were assessed daily (Monday to Friday) to determine their ability to perform early mobilisation.

Results: Data were collected on 100 patients, resulting in 280 physiotherapy-patient interactions during IMV. Of the 100 patients, five patients actively mobilised out of bed during IMV. No adverse event occurred during active physiotherapy-patient interactions. There were 15 physiotherapy-patient interactions that had a low risk of an adverse event, and on nine (60.0%) of these physiotherapy-patient interactions, patients were actively mobilised out of bed with the main reported barrier being time constraints. Of 208 physiotherapy-patient interactions where there were significant potential risks of an adverse event identified for mobilising, active out of bed mobilisation did not occur, with sedation being reported as the main barrier in 170 (82%) patients.

Conclusions: The translation of expert consensus recommendations for early mobilisation into clinical practice was poor. Clinicians were safe and conservative in the implementation of early mobilisation during IMV.

Keywords: Barriers to mobilisation; Early mobilisation; Invasive mechanical ventilation; Physiotherapy.