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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

doi: 10.1097/CCM.0000000000000149
Clinical Investigations

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.

1Nursing Research, Nursing and Patient Service, University Hospital of Schleswig-Holstein, Campus Kiel, Germany.

2Outcomes After Critical Illness and Surgery (OACIS) Group, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.

3Critical Care Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD.

4Faculty of Nursing Science, University of Witten-Herdecke, Witten, Germany.

5Department of Anaesthesiology and Operative Intensive Care Medicine, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.

6Department of Physiotherapy, University Hospital of Gießen and Marburg GmbH, Marburg, Germany.

7Work and Life Educational Association, Göttingen, Germany.

8Department of Continuing Education of Critical Care Nursing, District Hospital of Reutlingen, Reutlingen, Germany.

9Department of Anaesthesiology and Intensive Care Medicine, Alb Fils Kliniken GmbH, Klinik am Eichert, Göppingen, Germany.

10Department of Anaesthesiology, Emergency and Intensive Care Medicine, University Hospital of Göttingen, Göttingen, Germany.

11Department of Anaesthesia and Intensive Care Medicine, Zentralklinik Bad Berka, Bad Berka, Germany.

12Department of Medicine, University Hospital Tübingen, Tübingen, Germany.

13Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD.

* See also p. 1308.

Mr. Nydahl lectured for Hill-Rom and received support for article research from The German Interdisciplinary Association of Critical Care Medicine, which had no role in designing and conducting the study, data collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the article. Mr. Kaltwasser consulted for Kimberly-Clark Health Care (KCC) and Hollister; lectured for Hollister, KCC, and Smith Medical; received support for article preparation from Hollister; and received support for article research from German Interdisciplinary Association of Critical Care Medicine Mr. Schuchhardt lectured for and received support for the development of educational presentations from the company providing material for management of chronic wounds. Dr. Needham’s institution received grant support (National Institutes of Health peer-reviewed grants). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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