Role of early progressive mobilization protocol on outcomes of mechanically ventilated patients with pneumonia

Abstract

Introduction Mobilization targets include upgrading respiratory function by improving ventilation/perfusion matching, increasing lung capacity, improving secretion clearance, reducing the hazards of immobility, improving levels of consciousness, improving functional independence, improving cardiovascular status, and improving psychological well-being. Objectives The aim of the study was to determine the effect of early mobilization of mechanically ventilated patients with pneumonia on morbidity (facilitating weaning, hospital stay, incidence of muscle weakness, and incidence of delirium) and mortality. Patients and methods This comparative randomized single-blinded study enrolled 70 adult mechanically ventilated patients of both sexes having pneumonia. They were categorized into two groups according to applying the mobilization protocol: mobilization group and control group. Before starting the protocol, the participants were subjected to history taking, complete physical examination, neurological examination (Glasgow Coma Scale and muscle power), full laboratory and radiological investigations. Initiation of stepwise progressive mobilization protocol after 24 h of intubation was done, and respiratory and hemodynamic stability were assessed. Results The first group (mobilization group) included 35 patients, in whom mobilization protocol was applied, and second group (control group) included 35 patients, in whom no protocol was applied. The mobilization group showed less ventilator days, ICU stay, and hospital stay. Moreover, they showed improvement in the static compliance, hypoxic index, and Sequential Organ Failure Assessment score (SOFA score) values in comparison between the first and last day of the study in each group. They showed less incidence of delirium and less mortality at days 7 and 28 in comparison with the control group. Conclusions The mobilization intervention is a feasible and safe intervention and offers improvement in multiple outcomes for patients with pneumonia such as reduction of the duration of mechanical ventilation, ICU stay, hospital stay, delirium, and mortality and improvement of muscle power and lung compliance.