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Klein, Kate; Mulkey, Malissa; Bena, James; Albert, Nancy
Critical Care Medicine: December 2013
doi: 10.1097/01.ccm.0000439196.54340.93
Oral Abstract Session: Brain Injury, Repair, and Recovery: PDF Only

Introduction: In previous research, when ICU patients received early mobilization, it was safe and feasible, and associated with improved clinical and cost outcomes. However, there is only one pre-post investigation of the impact of early mobilization on outcomes in critically ill adults with acute neurological injury. Methods: Prospective, 2-group, pre-post comparative design. All patients with acute neurological injury admitted to a 22-bed neurological ICU (NICU) were included. Staff nurses collected highest mobility level for up to13 days of ICU care in pre- and post-intervention (Pre-I and Post-I) groups. Each study period lasted 4 months and there was a 4 month intervention implementation period that included nurse education, encouragement and assistance in mobilizing patients into chairs. Patient characteristics and clinical outcomes were collected from medical records and administrative databases. At/after ICU discharge, depression, anxiety and hostility data were collected using subscales of the Brief Symptom Inventory. Analyses included comparative statistics and multivariable modeling after controlling for patient characteristics that differed between groups. Results: In 637 NICU patients (260 pre-I and 377 post-I), demographics were similar between groups. Post-I patients were less likely to have a walking aid, more likely to have a walking barrier history, and less likely to require mechanical ventilation in the NICU (all p<=0.006). Post-I, highest mobility level increased (p<0.001), bloodstream infection rate (p=0.015) and hospital acquired pressure ulcer rate (p=0.026) decreased; anxiety scores were lower (p=0.029) and depression scores trended toward being lower (p=0.055). In multivariate analyses, post-I patients were more mobile, had shorter mean NICU and hospital length of stay (all p<0.001); and trended to be discharged home (p=0.063) and have less anxiety (p=0.088), compared to pre-I patients; however, there were no between-group differences in mortality, deep-vein thrombosis, or other clinical outcomes studied. Conclusions: A NICU early mobility protocol increased mobility, reduced both ICU and hospital LOS, and trended to increase discharge to home. A nurse-driven early mobility protocol was feasible in many patients, was safe, and improved some clinical outcomes.

(C) 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins