Point Prevalence Study of Mobilization Practices for Acute Respiratory Failure Patients in the United States.
OBJECTIVE
Early mobility in mechanically ventilated patients is safe, feasible, and may improve functional outcomes. We sought to determine the prevalence and character of mobility for ICU patients with acute respiratory failure in U.S. ICUs.


METHODS
Two-day cross-sectional point prevalence study.


METHODS
Forty-two ICUs across 17 Acute Respiratory Distress Syndrome Network hospitals.


METHODS
Adult patients (≥ 18 yr old) with acute respiratory failure requiring mechanical ventilation.


METHODS
We defined therapist-provided mobility as the proportion of patient-days with any physical or occupational therapy-provided mobility event. Hierarchical regression models were used to identify predictors of out-of-bed mobility.


RESULTS
Hospitals contributed 770 patient-days of data. Patients received mechanical ventilation on 73% of the patient-days mostly (n = 432; 56%) ventilated via an endotracheal tube. The prevalence of physical therapy/occupational therapy-provided mobility was 32% (247/770), with a significantly higher proportion of nonmechanically ventilated patients receiving physical therapy/occupational therapy (48% vs 26%; p ≤ 0.001). Patients on mechanical ventilation achieved out-of-bed mobility on 16% (n = 90) of the total patient-days. Physical therapy/occupational therapy involvement in mobility events was strongly associated with progression to out-of-bed mobility (odds ratio, 29.1; CI, 15.1-56.3; p ≤ 0.001). Presence of an endotracheal tube and delirium were negatively associated with out-of-bed mobility.


CONCLUSIONS
In a cohort of hospitals caring for acute respiratory failure patients, physical therapy/occupational therapy-provided mobility was infrequent. Physical therapy/occupational therapy involvement in mobility was strongly predictive of achieving greater mobility levels in patients with respiratory failure. Mechanical ventilation via an endotracheal tube and delirium are important predictors of mobility progression.
1Section of Pulmonary and Critical Care Medicine, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA. 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Colorado, Boulder, CO. 3Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD. 4Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA. 5Division of Pulmonary and Critical Care Medicine, Department of Medicine, Wake Forest University, Winston-Salem, NC. 6Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Hospital/University of Utah, Salt Lake City, UT. 7Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA. 8Department of Anesthesiology, University of Maryland, College Park, MD. 9Swedish Medical Center, Seattle, WA. 10Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia.
Sarah Elizabeth
SE
Jolley
Marc
M
Moss
Dale M
DM
Needham
Ellen
E
Caldwell
Peter E
PE
Morris
Russell R
RR
Miller
Nancy
N
Ringwood
Megan
M
Anders
Karen K
KK
Koo
Stephanie E
SE
Gundel
Selina M
SM
Parry
Catherine L
CL
Hough
D003430:Cross-Sectional Studies; D004434:Early Ambulation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data; D015995:Prevalence; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D014481:United States / Q000453:epidemiology
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