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. Physiologic instability and deep sedation are the most cited barriers to EM delivery in clinician surveys. However, to what extent deep sedation impedes eligibility for EM among physiologically stable patients remains unknown. Methods We used data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) dataset transformed to Common Longitudinal ICU data Format (CLIF) to identify adults (≥18 years) who received MV for ≥4 hours, excluding those with tracheostomy. Within the first 72 hours of MV, we classified hourly eligibility for mobilization as green (low-risk), yellow (intermediate-risk), or red (high-risk) based on hemodynamic and respiratory thresholds for out-of-bed activity in the consensus safety guidelines and being off continuous paralytics. We assigned a patient-day as green, yellow, or red based on best criteria met for ≥4 hours in a 24-hour period within the first 72 hours after MV initiation and calculated the proportion of patient-days in each tier. We then added sedation thresholds from consensus guidelines (RASS ≥-1 and ≤ +1 for green, ≤-2 or + 2 for yellow, and ≥ +3 for red) and re-classified risk for each patient-day. Results We identified 32,009 ICU encounters of mechanically ventilated adults Age, Mean (SD): 64.1 (16) years; 61.1% female, ICU Length of stay, Median (IQR): 3.4 (1.8,7.7) days. Figure 1 presents the proportion of patient-days meeting green, yellow, or red criteria for at least 4 hours in a 24-hour period applying (i) the hemodynamic and respiratory criteria, and (ii) adding sedation criteria using RASS scores, in the first 72 hours after MV initiation. After adding sedation criteria, 41.4% of patient-days classified as green based on hemodynamic and respiratory thresholds changed to yellow or red, dropping the proportion of patient-days in green from 25.7% to 15.0%. The proportion of patient-days in the yellow risk tier increased from 63.7% to 74.5% while no substantial increases were noted in the red category. Conclusion Addition of sedation criteria resulted in a decrease in the proportion of patients eligible for EM compared to using hemodynamic and respiratory criteria alone, highlighting the role of sedation as a modifiable barrier to EM eligibility. Our findings suggest that decreasing medication-induced sedation can increase opportunities for early mobilization for mechanically ventilated patients. This abstract is funded by: National Institute on Aging
Jain et al. (Fri,) studied this question.