Effect of a new early mobilization protocol for mechanically ventilated patients: a before-and-after study

Shota Fukushima, Emiko Nakataki, Hayato Mori
Purpose:

 The purpose of this study was to evaluate the effectiveness of a newly developed early mobilization protocol in our ICU. This protocol, designed through collaboration among intensivists, nurses, and physical therapists, includes explicit criteria for initiation, cessation, and management of adverse events. 

Methods:

 This single-center before-and-after study included patients aged 18 years or older who required invasive mechanical ventilation for more than 48 hours. Exclusion criteria were as follows: (1) inability to walk prior to admission, (2) ventilator dependence prior to admission, (3) requirement for extracorporeal life support, (4) dementia or other psychiatric disorders, (5) COVID-19, (6) receiving palliative care, and (7) readmission to the ICU. The protocol was piloted between July and September 2021, and its effectiveness was evaluated by comparing patient outcomes between the pre-group (October 2020 to June 2021) and the post-group (October 2021 to June 2022). The primary outcome was the proportion of patients achieving early mobilization, defined as sitting upright within three days of ICU admission. Secondary outcomes were the time from ICU admission to initiation of rehabilitation, sitting upright, and beginning transfers.

Results:

 The study included 23 patients in the pre-group and 25 in the post-group, with no substantial differences in baseline characteristics. The proportion of patients achieving early mobilization was higher in the post-group, at 36.0% (9/25) compared to 8.7% (2/23) in the pre-group. The time to start rehabilitation was shorter in the post-group: a median of 1 day [Interquartile range (IQR): 1–2 days] compared to 4 days [IQR: 3–6 days] in the pre-group. The time to sit upright was also shorter in the post-group, 4 days [IQR: 3–6 days] compared to 7 days [IQR: 5–9 days] in the pre-group. Similarly, the time to begin transfers was 5 days [IQR: 4–7 days] in the post-group, compared to 11 days [IQR: 9–16 days] in the pre-group.

Conclusion(s):

 The implementation of the new early mobilization protocol improved the mobilization outcomes for mechanically ventilated patients.

Implications:

 These findings suggest that structured early mobilization protocols may enhance patient recovery and could potentially serve as a framework for improving early rehabilitation in other ICUs.

Funding acknowledgements:
No funding was provided for this study.
Keywords:
Early mobilization
Intensive care
New protocol
Primary topic:
Critical care
Second topic:
Other
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
Tokushima Central Hospital Ethics Review Committee
Provide the ethics approval number:
22-25
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

Back to the listing