Prolonged bed rest in critically ill patients contributes to many negative outcomes including ventilator-associated pneumonia, pressure injuries, thromboembolic disease, insulin resistance, and orthostasis. Numerous studies have shown that early mobilization minimizes these consequences, but various safety concerns of clinicians have limited this practice.
Cooper and colleagues explored early mobility practices with orally intubated patients who met early out-of-bed (OOB) criteria. They found
Average time for patients ready to be OOB was 42 hours after oral intubation.
Although only patients who met the hemodynamic and respiratory criteria for early mobility were included, none were mobilized.
Nurses reported numerous situations prohibiting OOB such as active medical concern, undergoing procedures, mechanical ventilation weaning, and awaiting extubation.
Barriers included worrying that the patient might fall or be harmed, competing demands with care of other patients, and lack of help from other staff.
The authors recommend that...