120 A Survey of Burn Care Professionals to Characterize Patterns of Early Mobility in ICU Burn Patients

Abstract

Abstract Introduction Early mobility in intensive care unit (ICU) patients has been demonstrated effective in improving functional status, range of motion, preventing complications, and decreasing length of stay. There is limited data regarding the early mobilization of burn ICU patients. The purpose of this study was to survey burn care providers to better understand their experience with early mobilization and explore perceived barriers and contraindications. Methods An internet-based 21-item survey was distributed to burn professionals at North American burn centers and units. Descriptive statistics were performed. Results There were a total of 63 respondents. Most respondents were physical therapists (33%), occupational therapists (33%), or nurses (25%), with >5 years of burn care experience (71%). Early mobility was characterized as both in bed and out of bed activities within 24 hours of ICU admission, up to any time during the course of mechanical ventilation or ICU stay. The majority of respondents (54%) indicated they mobilize patients on ventilators in bed and out of bed, while there was an even split on whether or not patients on vasopressor support were mobilized. Of those respondents (46%) who use the Richmond Agitation-Sedation Scale (RASS) to guide mobility, 14% mobilize patients with a RASS of -4 or -5 and 41% mobilize patients with a RASS of -3 to -2. The highest appropriate score for mobilization was +1 to +2 (76%). Hgb/Hct, line presence, ventilator mode, mental status, and vital signs were viewed as precautions to discuss with the medical team, rather than a contraindication to mobility. Respiratory rate < 6 and presence of ECMO were the areas of most concern, with the majority respondents indicating they would likely hold mobility. Most respondents indicated that they would mobilize any burn ICU patients after discussion with the medical team if necessary. The majority of respondents (72%) indicated that they did not have an early mobilization protocol for burn ICU patients. Conclusions There is a paucity of evidence available for early mobility in burn ICU patients. This survey demonstrates a lack of consensus regarding what constitutes early mobility and when patients should be mobilized. A multi-center observational trial is needed to inform the development of an evidence-based mobility protocol.