Abstract
Background:
The effects of early mobilization in ICU patients is an important topic.
Methods:
Retrospective study with data collected from January 2013 to December 2014, in the Hospital Universitario do Oeste do Parana (HUOP-Unioeste), Cascavel-Parana, Brazil. This study was approved by the Ethics Research Committee from the Western Parana State University (Unioeste), protocol number 436.770/2013. Early Mobilization (EM) was considered when performed within 48 hours after ICU admission. Patients who performed mobilization after this period were classified as Late Mobilization (LM). Both EM and LM patients were allocated into three groups: Passive Group (PG), Active-Assisted Group (AAG), and Active Group (AG) according to the level of consciousness, verified through the GCS and the muscle strength with the Medical Research Council (MRC). Patients were treated according to a protocol twice a day, seven days a week, including holidays, until their discharge from the ICU. Variables with normal distribution were compared using the Student's T-Test, and the non-normally distributed variables were compared using the Wilcoxon and Mann Whitney tests. All analyzes were performed at 5% significance.
Results:
The sample had 617 patients. From those 617 patients, 126 were in the MT group and 491 were in the MP group. On admission, patients were allocated to the PG (n = 471), AAG (n = 42) and AG (n = 104) groups, and at their discharge from ICU, the PG was 275, AAG 124, and AG 218. The MV time and ICU stay were significantly lower in all EM groups when compared to LM. The time of sedation and hospitalization was significantly lower in PG and AG groups of EM when compared to LM. At the time of their discharge from the ICU, patients who performed EM had a relatively better level of consciousness compared to LM, but only PG had a significantly better level of consciousness in EM compared to LM (P=0.01). Other results are shown in the Table 1.
Conclusions:
Early mobilization showed benefits related to the reduction of sedation time, MV time, length of stay in the ICU and hospital, which minimized functional losses, proving to be feasible and beneficial for critical patients.
Table 1. Compared variables between Groups of Early and Late Mobilization
Variables
PG (EM)(n=360)
PG (LM)(n=111)
p-value
AAG (EM)(n=36)
AAG (LM)(n=6)
p-value
AG (EM)(n=95)
AG (LM)(n=9)
p-value
Admission Cause (%)
Trauma without TBI
10
16
-
9
17
-
10
44
-
Trauma with TBI
30
23
-
11
33
-
-
11
-
Non-Neurological clinical patients
27
32
-
33
33
-
26
-
-
Neurological clinical patients
21
16
-
22
17
-
18
-
-
PO elective surgery
4
7
-
14
-
-
29
11
-
PO urgency surgery
8
6
-
11
-
-
17
34
-
Age (yrs)
50 ± 19
47 ± 17
0.20
55.0±17.9
46.6±8.1
0.40
51.6±16.3
47.6±17.2
0.47
Male (%)
66
70
0.48
56
67
0.61
64
89
0.13
APACHE II
24.7 ±6.6
24.8±6.4
0.86
17.0±7.3
25±8
0.02
17.9±7.2
20.6±6.9
0.25
SOFA
12.7±4.3
13.6±4.4
0.03
8.5±3.3
11.1±2.7
0.08
8.3±4.3
10.6±4.1
0.12
GCS 1st day
4.7±3.1
5.2±3.4
0.29
13.7±1.8
14±2
0.65
14.1±4.5
14±2
0.78
Discharge GCS
11.5±3.1
10.3±3.4
0.01
14.5±1.0
13.2±2.0
0.13
14.8±0.4
13.2±2.0
0.18
RASS 1st day
-4.1±1.6
-3.5±2.0
0.0009
-0.2±0.5
-0.8±0.4
0.03
-0.4±1.2
-0.6±0.5
0.01
Discharge RASS
-0.7±1.3
-1.0±1.7
0.54
-0.0±0.2
0.0
-
0.0
0.0
-
MV time (hours)
222.2±202.5
308.2±202
<0.0001
67±116.5
164,7±80
0.009
13.8±20.3
55.1±48.5
0.01
ICU length of stay (days)
13±10.4
17.6±9.9
<0.0001
5.9±6.3
10.1±2.7
0.004
3.6±2.2
6.1±2.9
0.01
Hospital length of stay (days)
28.7±23
33.0±21.6
0.006
23.4±20
28.3±11.6
0.12
20.0±21.0
28.3±11.9
0.01
Total sedation time (hours)
118.7±140.7
196.3±150.4
<0.0001
62.4±60.6
90.6±57.7
0.36
1.1±9.3
2±1.1
0.03
ICU death (%)
18
25
0.08
8
0
0.46
1
0
0.75
Hospital death (%)
26
29
0.61
11
17
0.69
3
0
0.58
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