Abstract Background Early mobilization (EM) reduces functional dependence at discharge and long-term cognitive impairment; yet fewer than 20% of mechanically ventilated (MV) patients achieve out-of-bed activity. In US ICUs, EM is typically initiated by physical therapy (PT). Whether PT consults are delayed despite physiologic eligibility for EM is unknown. We aimed to describe the timing of PT consult orders relative to meeting safety thresholds for EM. Methods In this retrospective cohort study, we used the Medical Information Mart for Intensive Care IV (MIMIC-IV) dataset transformed to the Common Longitudinal ICU Format (CLIF) to identify adults (≥18 years) who received MV for ≥4 hours, excluding those with tracheostomy. Within the first 72 hours of MV, hourly eligibility for EM was defined as meeting hemodynamic and respiratory thresholds for out-of-bed activity per consensus safety guidelines and being off continuous paralytics. The primary outcome was time to PT consult order relative to MV initiation, characterized as “early” if placed within 48 hours of first eligibility. We also included orders within 24 hours prior to MV since they may lead to EM delivery. We estimated cumulative incidence of first eligibility for EM and PT consult order using Kaplan-Meier method and compared characteristics by early vs late/no PT. Results Among 32,009 MV ICU encounters Age, Mean (SD): 64.1 (16) years; 61.1% female, median time to first EM eligibility was 12 hours (IQR:5,16); with 96.3% of patients achieving eligibility within 48 hours. Overall, 15.2% received a PT consult order during ICU admission ICU Length of stay, Median (IQR): 3.4 (1.8,7.7) days; only 14.6% received early PT. Among those ever-receiving PT, median time from MV initiation to consult was 1 hour (IQR: -1, 5), clustering around intubation. In unadjusted analyses, patients who received early PT were older (Age, mean (SD): 65.9(14.7) vs 63.8(16.1) years), more frequently on vasopressors (64.4% vs 54.4%), and spent less time in deep sedation defined as RASS ≤-2 Median (IQR): 8 (3,17) vs 10 (3,20) hours in the first 24 hours. In-hospital mortality was lower among those who received early PT (10.4% vs 19.7%) compared to those receiving late or no PT. Conclusion Despite rapid achievement of eligibility, fewer than 1 in 5 mechanically ventilated patients received timely PT consultation; consults clustered around MV initiation rather than physiologic readiness. Interventions targeting recognition of EM eligibility by physicians may increase PT consult orders, enabling timely mobilization and consequently improve functional outcomes among mechanically ventilated adults. This abstract is funded by: Francis Family Foundation, John A Hartford Foundation, NIH/NIA R03 R03AG078942
Castejon et al. (Fri,) studied this question.