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Critical Care Medicine:
doi: 10.1097/CCM.0000000000000149
Clinical Investigations

Early Mobilization of Mechanically Ventilated Patients: A 1-Day Point-Prevalence Study in Germany*

Nydahl, Peter RN, BScN1; Ruhl, A. Parker MD2,3; Bartoszek, Gabriele MSc4; Dubb, Rolf BSc, CCRN5; Filipovic, Silke BSc6; Flohr, Hans-Jürgen RN, CCRN7; Kaltwasser, Arnold BSc, CCRN8; Mende, Hendrik MD9; Rothaug, Oliver BSc, CCRN10; Schuchhardt, Danny RN11; Schwabbauer, Norbert12; M. Needham, Dale FCA, MD, PhD2,13

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Abstract

Objectives:

There is growing evidence to support early mobilization of adult mechanically ventilated patients in ICUs. However, there is little knowledge regarding early mobilization in routine ICU practice. Hence, the interdisciplinary German ICU Network for Early Mobilization undertook a 1-day point-prevalence survey across Germany.

Design:

One-day point-prevalence study.

Setting:

One hundred sixteen ICUs in Germany in 2011.

Patients:

All adult mechanically ventilated patients.

Interventions:

None.

Measurements and Main Results:

For a 24-hour period, data were abstracted on hospital and ICU characteristics, the level of patient mobilization and associated barriers, and complications occurring during mobilization. One hundred sixteen participating ICUs provided data for 783 patients. Overall, 185 patients (24%) were mobilized out of bed (i.e., sitting on the edge of the bed or higher level of mobilization). Among patients with an endotracheal tube, tracheostomy, and noninvasive ventilation, 8%, 39%, and 53% were mobilized out of bed, respectively (p < 0.001 for difference between three groups). The most common perceived barriers to mobilizing patients out of bed were cardiovascular instability (17%) and deep sedation (15%). Mobilization out of bed versus remaining in bed was not associated with a higher frequency of complications, with no falls or extubations occurring in those mobilized out of bed.

Conclusions:

In this 1-day point-prevalence study conducted across Germany, only 24% of all mechanically ventilated patients and only 8% of patients with an endotracheal tube were mobilized out of bed as part of routine care. Addressing modifiable barriers for mobilization, such as deep sedation, will be important to increase mobilization in German ICUs.

Copyright © 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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