Variables associated with mobility levels in critically ill patients: A cohort study.

Autor: Raurell-Torredà M; Department of Fundamental and Medical Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain., Arias-Rivera S; Department of Nursing Management, University Hospital of Getafe, Madrid, Spain.; Research Department, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain., Martí JD; Cardiovascular Surgery Intensive Care Department, Instituto Clínico Cardiovascular, Clinic University Hospital, Barcelona, Spain., Frade-Mera MJ; Critical Care Department, 12 Octubre University Hospital, Madrid, Spain.; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain., Zaragoza-García I; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.; Research department (Invecuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Centro de Actividades Ambulatorias, Madrid, Spain., Gallart E; Critical Care Department, Vall Hebron University Hospital, Barcelona, Spain., Velasco-Sanz TR; Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.; Critical Care Department, San Carlos University Hospital, Madrid, Spain., San José-Arribas A; Department of Nursing, Escola Universitaria d'Infermeria Sant Pau (Hospital de la Santa Creu i Sant Pau), Barcelona, Spain., Blazquez-Martínez E; Critical Care Department, Bellvitge University Hospital, Barcelona, Spain.
Jazyk: angličtina
Zdroj: Nursing in critical care [Nurs Crit Care] 2022 Jul; Vol. 27 (4), pp. 546-557. Date of Electronic Publication: 2021 May 18.
DOI: 10.1111/nicc.12639
Abstrakt: Background: Early mobilization in the intensive care unit (ICU) helps improve patients' functional status at discharge. However, many barriers hinder this practice.
Aim and Objectives: To identify mobility levels acquired by critically ill patients and their variables.
Design: A multi-centre cohort study was conducted in adult patients receiving invasive mechanical ventilation for at least 48 hours.
Methods: The primary outcome was level of mobility according to the ICU mobility scale. The secondary outcome was human resource availability and existence of ABCDEF bundle guidelines. A logistic regression was performed, based on days 3 to 5 of the ICU stay and significant association with active mobility.
Results: Six hundred and forty-two patients were included from 80 ICUs. Active moving in and out of bed was found on 9.9% of patient-days from day 8 of the ICU stay. Bed exercises, or passive transfers, and immobility were observed on 45.6% and 42.2% of patient-days, respectively. Patients achieving active mobility (189/642, 29.4%) were in ICUs with more physiotherapist hours. Active mobility was more likely with a 1:4 nurse-patient ratio (odds ratio [OR] 3.7 95% confidence interval [CI] [1.2-11.2]), high MRC sum-score (OR 1.05 95% CI [1.04-1.06]) and presence of delirium (OR 1.01 95% CI [1.00-1.02]). By contrast, active mobility was hindered by higher BMI (OR 0.92 95% CI [0.88-0.97]), a 1:3 nurse-patient ratio (OR 0.54 95% CI [0.32-0.93]), or a shift-dependent nurse-patient ratio (OR 0.27 95% CI [0.12-0.62]).
Conclusions: Immobility and passive mobilization were prevalent. A high MRC sum-score and presence of delirium are protective factors of mobilization. A 1:4 nurse-patient ratio shows a stronger association with active mobility than a 1:3 ratio.
Relevance to Clinical Practice: Severity-criteria-based nurse-patient ratios hinder mobilization. Active mobilization may be enhanced by using nursing-intervention-based ratios, increasing physiotherapist hours, and achieving wider application of the ABCDEF bundle, resulting in more awake, cooperative patients.
(© 2021 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)
Databáze: MEDLINE
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