Mobilization and Rehabilitation Practice in ICUs During the COVID-19 Pandemic

Abstract

Background: Mobilization and acute rehabilitation are essential in the intensive care unit (ICU), with substantial evidence supporting their benefits. This study aimed to characterize ICU mobilization practices during the COVID-19 pandemic for patients with and without COVID-19.

Methods: This was a secondary analysis of an international point prevalence study. All ICUs across the world were eligible to participate and were required to enroll all patients in each ICU on the survey date, 27 January 2021. The primary outcome was the achievement of mobilization at the level of sitting over the edge of the bed. Independent factors associated with mobilization, including COVID-19 infection, were analyzed by multivariable analysis.

Results: A total of 135 ICUs in 33 countries participated, for inclusion of 1229 patients. Among patients who were not receiving mechanical ventilation (MV), those with COVID-19 infection were mobilized more than those without COVID-19 (60% vs. 34%, p < 0.001). Among patients who were receiving MV, mobilization was low in both groups (7% vs. 9%, p = .56). These findings were consistent irrespective of ICU length of stay. Multivariable analysis showed that COVID-19 infection was associated with achievement of mobilization in patients without (adjusted odds ratio [aOR] = 4.48, 95% confidence interval [CI] = 2.71-7.42) and with MV (aOR = 2.13, 95% CI = 1.00-4.51). Factors that prevented mobilization were prone positioning in patients without MV and continuous use of neuromuscular blockade and sedation agents in patients with MV, whereas facilitating factors were the presence of targets/goals in both groups.

Conclusion: Mobilization rates for ICU patients across the globe are severely low, with the greatest immobility observed in mechanically ventilated patients. Although COVID-19 is not an independent barrier to the mobilization of patients with or without MV, this study has highlighted the current lack of mobility practice for all ICU patients during the COVID-19 pandemic.(299 words).

Keywords: COVID-19; ICU; barrier; mechanical ventilation; mobilization; rehabilitation.

Figure 1.

Rehabilitation level achieved is not dependent on ICU length of stay. Rehabilitation intensity is shown by ICU length of stay and presented as percentage (A) and median ICU Mobility Scale score (B). For both panels, left bar is COVID-19 and right bar is non-COVID-19. The ICU Mobility Scale is as follows: 0: nothing (lying in bed, passive exercise); 1: sitting in bed, exercises in bed; 2: passively moved to chair (no standing); 3: sitting over edge of bed; 4: standing; 5: transferring bed to chair; 6: marching in place (at bedside); 7: walking with assistance of two or more people; 8: walking with assistance of one person; 9: walking independently with a gait aid; 10: walking independently without a gait aid (Hodgson C et al Heart and Lung 2014; 43:19-24). In this study, mobilization was defined as a rehabilitation level of 3 or more on the ICU Mobility Scale.