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. 2022 Jul;27(4):546-557.
doi: 10.1111/nicc.12639. Epub 2021 May 18.

Variables associated with mobility levels in critically ill patients: A cohort study

Marta Raurell-Torredà  1 , Susana Arias-Rivera  2   3 , Joan Daniel Martí  4 , María Jesús Frade-Mera  5   6 , Ignacio Zaragoza-García  6   7 , Elisabet Gallart  8 , Tamara Raquel Velasco-Sanz  6   9 , Alicia San José-Arribas  10 , Eva Blazquez-Martínez  11 ; MOviPre group
Affiliations

Variables associated with mobility levels in critically ill patients: A cohort study

Marta Raurell-Torredà et al. Nurs Crit Care. 2022 Jul.

Abstract

Background: Early mobilization in the intensive care unit (ICU) helps improve patients' functional status at discharge. However, many barriers hinder this practice.

Aim and objectives: To identify mobility levels acquired by critically ill patients and their variables.

Design: A multi-centre cohort study was conducted in adult patients receiving invasive mechanical ventilation for at least 48 hours.

Methods: The primary outcome was level of mobility according to the ICU mobility scale. The secondary outcome was human resource availability and existence of ABCDEF bundle guidelines. A logistic regression was performed, based on days 3 to 5 of the ICU stay and significant association with active mobility.

Results: Six hundred and forty-two patients were included from 80 ICUs. Active moving in and out of bed was found on 9.9% of patient-days from day 8 of the ICU stay. Bed exercises, or passive transfers, and immobility were observed on 45.6% and 42.2% of patient-days, respectively. Patients achieving active mobility (189/642, 29.4%) were in ICUs with more physiotherapist hours. Active mobility was more likely with a 1:4 nurse-patient ratio (odds ratio [OR] 3.7 95% confidence interval [CI] [1.2-11.2]), high MRC sum-score (OR 1.05 95% CI [1.04-1.06]) and presence of delirium (OR 1.01 95% CI [1.00-1.02]). By contrast, active mobility was hindered by higher BMI (OR 0.92 95% CI [0.88-0.97]), a 1:3 nurse-patient ratio (OR 0.54 95% CI [0.32-0.93]), or a shift-dependent nurse-patient ratio (OR 0.27 95% CI [0.12-0.62]).

Conclusions: Immobility and passive mobilization were prevalent. A high MRC sum-score and presence of delirium are protective factors of mobilization. A 1:4 nurse-patient ratio shows a stronger association with active mobility than a 1:3 ratio.

Relevance to clinical practice: Severity-criteria-based nurse-patient ratios hinder mobilization. Active mobilization may be enhanced by using nursing-intervention-based ratios, increasing physiotherapist hours, and achieving wider application of the ABCDEF bundle, resulting in more awake, cooperative patients.

Keywords: critical care nursing; early mobilization; mechanical ventilation; physical therapy; weakness.

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References

REFERENCES

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