Early mobilization of trauma patients in the Intensive Care Unit
Background: Prolonged immobility has detrimental consequences for critically ill patients admitted to the intensive care unit (ICU). Previous work has shown that early mobilization of ICU patients is a safe, feasible and effective strategy to improve outcomes; however, few of these studies focused on trauma ICU patients. Our objective was to assess the impact of implementing an ICU early mobilization protocol (EMP) on trauma outcomes.
Methods: We conducted a retrospective cohort study of adult trauma patients (>18 years old) admitted to ICU at a level 1 trauma center over a 2-year period prior to and following EMP implementation, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared outcomes (mortality, length of stay [LOS], requirement for mechanical ventilation) between patients admitted during pre-EMP and post-EMP periods, and assessed for factors associated with outcomes using binary logistic regression and generalized linear models.
Results: Overall, 526 patients were included in the analysis (292 pre-EMP, 234 post-EMP). Ages ranged from 18 to 92 years (mean 49.0 ± 20.4 years) and 74.3% were male. The post-EMP group had lower ICU mortality (21.6% vs. 12.8%; p=0.009) and in-hospital mortality (25.3% vs. 17.5%; p = 0.031). After controlling for confounders, patients in the post-EMP group were less likely to die in the ICU (OR = 0.40, 95% CI 0.21- 0.76, p=0.005) or in-hospital (OR = 0.52, 95% CI 0.30-0.91; p= 0.021). In-hospital LOS, ICU LOS, and number of ventilator days were similar between the two groups.
Conclusions: Trauma patients admitted to ICU during the post-EMP period had decreased odds of ICU mortality and in-hospital mortality. This is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol.