Complications related to early mobilization of mechanically ventilated patients on Intensive Care Units.

Abstract

To compare international literature on the detection of complications associated with early mobilization of mechanically ventilated patients in intensive care units (ICUs). Early mobilization of mechanically ventilated ICU patients is considered to be a more beneficial approach to treatment in intensive care; however, it remains unclear how safe this approach is and what complications to expect. A systematic literature research in English and German was conducted in June 2013 in the databases Pubmed, CINAHL, Cochrane library and MedPilot without limiting by year of publication. References of the included studies were screened and supplemented by manual search. Inclusion criteria were studies about mechanically ventilated adult patients on ICU, who were mobilized and reported complications. Excluded were studies that (a) did not differentiate between non-ventilated and ventilated patients, (b) did not report complications and (c) focused on in-bed mobilization. Of 952 titles, 16 articles fit the criteria including 3 reviews and 13 clinical trials. The percentage of complications in clinical trials ranged between 0% and 16%. In total, 453 patients were mobilized 3613 times (up to walking with ventilation) with a complication mean rate of 3·9% (n = 144) using the inherent safety limits. No fall, cardiac arrest, or death was reported. Most complications were pulmonary, followed by haemodynamic ones. Serious complications that led to further consequences were observed in 0·3% (n = 10) of all mobilizations. The clinical studies have been carried out in trained, interdisciplinary teams with most of them using adapted algorithms for safety. Despite a low complication rate, a frame for safety during early mobilization including team training and adapted criteria is recommended.