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Abstract

Introduction: The use of sedation and analgesia protocols, daily interruption of sedation, and early mobilization (EM) have been shown to result in decreased duration of mechanical ventilation, hospital stay, and mortality. Methods: An IRB-approved, retrospective chart review was conducted during a 6-month pre-mobilization (pre-EM) period from January to June 2012 and 6-month post-mobilization (post-EM) period from January to June 2013. Patients over the age of 18 who were admitted to the NICU and mechanically ventilated for at least 24 hours were included. Use of sedatives and analgesics, NICU length of stay (LOS), NICU mortality, and number of physical PT and OT sessions were assessed. These variables were evaluated using median and interquartile range (IQR) and analyzed using Mann-Whitney U test with p-value of significance <0.05. Results: A total of 181 patients were screened, and 43 pre-EM and 41 post-EM patients were included. Baseline demographics were different between groups with more ischemic stroke patients in the pre-EM group (p<0.05). GCS scores were 7 (7,10) and 8 (5,11) in the pre- and post-EM groups (p=0.57). In the pre- and post-EM groups, patients received similar cumulative doses of propofol, dexmedetomidine, benzodiazepines, but higher median (IQR) doses of opioids [330 (100,1475) mcg of fentanyl equivalents vs 1853 (460,7057) mcg (p<0.05)] in the post-EM group. Continuous infusions were used in 76% vs 92% of the pre- and post-EM patients (p<0.05). NICU LOS was 9 (8,33) vs 12 (8,18) days (p=0.07). Mortality was 30.2% vs 9.7% between the pre- and post-EM groups (p<0.05). The number of PT and OT sessions was 1 (0,4) and 1 (0,3) vs 3 (1,6) and 3 (2,4) in the pre- and post-EM groups (p<0.05). Conclusions: An EM program in this NICU population demonstrated a significant increase in the number of PT and OT sessions despite the increased use of opioids and infusions. Decreased mortality was detected, but admitting diagnoses varied significantly between groups.