title: Effect of early mobilization on sedation practices in the neurosciences intensive care unit: a preimplementation and postimplementation evaluation.
abstract: BACKGROUND
  The use of sedation and analgesia protocols, daily interruption of sedation, and early mobilization (EM) have been shown to decrease duration of mechanical ventilation and hospital length of stay (LOS).
  
  
  METHODS
  A retrospective chart review was conducted during a 6-month premobilization (pre-EM) and 6-month postmobilization (post-EM) period. Patients older than 18 years who were admitted to the neurosciences intensive care unit (ICU) and mechanically ventilated for at least 24 hours without documentation of withdrawal of life support or brain death were included.
  
  
  RESULTS
  Thirty-one pre-EM and 37 post-EM patients were included. Baseline demographics were similar with the exception of more ischemic stroke patients in the pre-EM group (P < .05). In the pre-EM and post-EM groups, patients received similar cumulative doses of propofol, dexmedetomidine, and benzodiazepines but higher median (interquartile range) doses of opioids (50.0 [13.8-165.0] vs 173.3 [41.2-463.2] μg of fentanyl equivalents [P < .05]) in the post-EM group. Neurosciences ICU LOS was 10 (6-19) and 13 (8-18) days, respectively (P = .188).
  
  
  CONCLUSIONS
  After implementation of an EM program, an increase in opioid use and no significant change in other sedatives were observed. Despite an increase in the amount of physical therapy and occupational therapy provided to patients, there was no change in hospital and ICU LOS or duration of mechanical ventilation.
authors.affiliation: NewYork-Presbyterian Hospital, New York, NY.
authors.forename: Robert
authors.initials: R
authors.lastname: Witcher
authors.affiliation: NewYork-Presbyterian Hospital, New York, NY.
authors.forename: Lauren
authors.initials: L
authors.lastname: Stoerger
authors.affiliation: NewYork-Presbyterian Hospital, New York, NY.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Dzierba
authors.affiliation: NewYork-Presbyterian Hospital, New York, NY.
authors.forename: Amy
authors.initials: A
authors.lastname: Silverstein
authors.affiliation: Weill Cornell Medical Center, New York, NY.
authors.forename: Axel
authors.initials: A
authors.lastname: Rosengart
authors.affiliation: Columbia University Medical Center, New York, NY.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brodie
authors.affiliation: NewYork-Presbyterian Hospital, New York, NY. Electronic address: kab9098@nyp.org.
authors.forename: Karen
authors.initials: K
authors.lastname: Berger
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002985:Clinical Protocols; D016292:Procedural Sedation / Q000379:methods*; D004434:Early Ambulation; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009488:Neurosciences; D015742:Propofol / Q000008:administration & dosage; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D015742:Propofol
keywords: Analgesia; Critical care; Early mobilization; Neurologic injury; Neurosurgery; Sedation