Current situation of rehabilitation before the implementation of a program of early mobilization in a polyvalent ICU

Abstract

Survivors of critical illness frequently experience muscle weakness and relevant functional impairment after intensive care unit (ICU) discharge. This study aimed to evaluate currently mobilization practice in ICU patients with more than 72 hours of mechanical ventilation (MV). Unicenter prospective observational study from September 2016 to July 2017. We enrolled patients under MV longer than 12 h and measure the baseline functional level, ICU-acquired weakness (ICUAW) and functional status at hospital discharge. We recorded the mobilization related adverse events. We recruited 30 patients (63 ± 12 years; 70% men), mean acute physiology and chronic health evaluation II (APACHE II) 16 ± 5. Mean time of ICU stay and hospital stay were 23 and 32 days respectively. Mean time to ask for rehabilitation evaluation was 8 ± 4 days after ICU admission and finally rehabilitation began 10 ± 5 days after admission to the ICU. Eleven (37%) patients were mobilized with an endotracheal tube and 19 (63%) with endotracheal tube initially and after with tracheostomy tube. Strength was assessed at ICU discharge and 23 patients (80%) had ICU-acquired weakness [Medical research Council Manual Muscle Test Sum Score (MRC-SS) score 48 < 60]. The functional level obtained during sessions was sitting at the edge of the bed ( n = 24, 80%), standing at the bedside ( n = 10, 33%) and walking ( n = 5, 17%). Not adverse effects during rehabilitation therapy were reported. ICU and hospital mortality were 27% and 33%, respectively. The myopathic patients discharged from the ICU had higher mortality at day 90 ( P = 0.002). Early mobilization was uncommon in our ICU. Most of our patients discharged from the ICU had developed ICU-acquired weakness with higher mortality at day-90 in most severe myopathic ones. Implementation of an early mobilization program is urgent and requires a cultural change.