TIME TO THE FIRST EDGE-OF-BED MOBILISATION IN CRITICALLY ILL ADULTS WITH COVID-19 PNEUMONIA: A RETROSPECTIVE OBSERVATIONAL STUDY

S. Eggmann¹, N. Pecorelli^1,2, M.-M. Jeitziner^3,4, Y.-A. Que³, A.S. Messmer³

¹Inselspital, Bern University Hospital, Department of Physiotherapy, Bern, Switzerland, ²Bern University of Applied Sciences, Department of Health Professions, Bern, Switzerland, ³Inselspital, Bern University Hospital, University of Bern, Department of Intensive Care Medicine, Bern, Switzerland, ⁴University of Basel, Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, Basel, Switzerland

Background: Early mobilisation is recommended as soon as critically ill adults achieve cardiorespiratory stability. Sitting on the edge-of-bed (EOB) is thereby an important milestone to regain functional independence. However, early mobilisation remains underused and implementation rates dropped during the COVID-19 pandemic.

Purpose: The aim of this analysis was to investigate the time to the first EOB mobilisation (time-to-EOB) after intensive care unit (ICU) admission in critically ill adults with confirmed COVID-19 pneumonia. We hypothesized that patients with ‘severe’ COVID-19 pneumonia (PaO₂/FiO₂ ratio ≤100mmHg) were mobilised substantially later than patients with ‘moderate’ COVID-19 pneumonia (PaO₂/FiO₂ ratio >100mmHg). We further explored the association of pre-specified explanatory variables with time-to-EOB.

Methods: This retrospective observational study was conducted from March 2020 to May 2021 in a mixed, tertiary ICU where physiotherapy and early mobilisation are standard care. Eligible participants had a laboratory confirmed COVID-19 pneumonia and a prolonged ICU stay (≥72h). Routine data was extracted from electronic databases and included baseline characteristics, ICU treatments, physiotherapy (time to first session, total sessions, duration per session) and mobility level. We used Kaplan-Meier log-rank analysis without censoring to estimate real time-to-EOB and with censoring to account for non-mobilized patients. Association of time-to-EOB with the pre-specified explanatory variables was determined with multiple linear regression. Variables (SOFA, Body-Mass-Index, Charlson Comorbidity Index, PaO₂/FiO₂, proning, ECMO-use, intubation) were chosen on current evidence and restricted to seven to avoid overfitting.

Results: We recruited 168 participants (26% female, 96% intubated) with a mean age of 63±12 years, a median Sequential Organ Failure Assessment (SOFA) of 11 [IQR 9-14] upon admission and an ICU stay of 10 days [IQR 5-18]. Physiotherapy started within a median of 1.0 days (95%-CI 0.9 to 1.2) with a median session duration of 25 minutes [IQR 20-30] and 10 sessions [IQR 6-19] per patient. 107 (64%) patients sat at least once on the EOB with a median time-to-EOB of 3.9 days [95%-CI 2.3 to 5.5]. In patients with ‘severe’ COVID-19 pneumonia (n=48 [53%]), time-to-EOB was significantly longer than in patients with “moderate” COVID-19 pneumonia (n= 59 [77%]) with 7.2 days [95%-CI 5.7 to 8.8] versus 2.5 days [95%-CI 1.8 to 3.5], p=0.014. Censored, median time-to-EOB was 8.8 days [95%-CI 6.4 to 11.1] for all, 3.9 days [95%-CI 1.6 to 6.2] in the ‘moderate’, and 12.7 days [95%-CI 11.1 to 14.4] in the ‘severe’ group (p<0.001). A delayed time-to-EOB was independently associated with SOFA scoring (0.32 days [95%-CI 0.05 to 0.59], p=0.019) and ECMO-use (13.7 days [95%-CI 10.1 to 17.4], p<0.001).

Conclusions: These real-world results demonstrate that a timely EOB mobilisation within 4 days is achievable in the majority of critically ill adults with COVID-19 pneumonia despite resource-intensive pandemic-peaks. Disease severity and ECMO-use delayed mobilisation, potentially prolonging functional recovery and warranting targeted interventions.

Implications: Our data supports the importance of established physiotherapy programmes in ICUs. Nevertheless, physiotherapists should be cautious in patients with COVID-19 and low PaO₂/FiO₂at ICU admission and adapt therapy sessions accordingly. Further studies are needed to evaluate the benefit of individualised rehabilitation programmes in critically ill patients with COVID-19.

Funding acknowledgements: None

Keywords:
Early ambulation
Early mobilization
COVID-19

Topics:
Critical care
COVID-19
Cardiorespiratory

Did this work require ethics approval? Yes

Institution: Inselspital, Bern University Hospital, Bern, Switzerland

Committee: Ethics Committee of Bern, Switzerland

Ethics number: ID 2021-00613 (approved on April 19, 2021)