Abstract Rationale Mobilization within the first 72 hours of admission or intubation has the potential to prevent disability in ICU survivors. Without this early timing, rehabilitation studies fail to demonstrate clinical efficacy. Early mobilization (EM) is severely underperformed in practice, especially in patients who are endotracheally intubated. While many barriers to any ICU rehabilitation exist, we aimed determine factors associated with delays in therapy in a larger cohort to elucidate ways to improve time to first mobilization. Methods Charts were reviewed of consecutive adult patients admitted to the medical ICU at the University of Chicago from 1/2022 to 9/2023. Patients were excluded if admitted for cardiac arrest, died within 72 hours, were intubated 24 hours, bedbound or nonfunctional at baseline, or admitted from a facility. Data collected included patient related factors such as comorbidity burden, illness severity, and demographics were collected. The primary outcome was delayed out-of-bed activity defined as therapy 72 hours after intubation or no therapy at all. Logistic regression modeling with backward elimination multivariable regression was performed and model fit was assessed using a likelihood ratio test to identify specific factors associated with delayed therapy. Results 329 patients were included in the analysis. 94/329 (28%) were mobilized within 72 hours of intubation. The median duration of mechanical ventilation in patients who received EM was 1.3 days as compared with 4.6 days for those who had delayed or no therapy (p 0.001). Hospital length of stay was shorter for patients who received EM compared to those who had delayed or no therapy (10.9 vs 17 days; p = 0.0004). A greater proportion of patients with EM were discharged home than patients who experienced delays (55% vs28%; p 0.001). White race (OR 0.48, p0.02), ventilatory failure (OR 0.41, p 0.008), and PT order within 72 hours of intubation (OR 0.18, p = 0.002) decreased odds of delay while sepsis increased odds of delay (OR 1.91, p = 0.016). Conclusions This larger dataset corroborates that rates of mobilization within 72 hours are poor amongst critically ill patients mechanically ventilated patients. Structural factors such as timing of PT orders and patient factors such as severity of illness, and race can contribute to delays. More investigations are needed to further elucidate other intervenable factors to improve time to mobilization. This abstract is funded by: NIH/NHLBI K23 HL148387
Smith et al. (2026) studied this question.