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J Trauma Acute Care Surg. 2020 Jan 15. doi: 10.1097/TA.0000000000002588. [Epub ahead of print]

Impact of an early mobilization protocol on outcomes in trauma patients admitted to the intensive care unit: a retrospective pre-post study.

Author information

1
Faculty of Medicine, Dalhousie University, Halifax, NS, Canada, B3H 4R2.
2
Trauma Nova Scotia, Nova Scotia Health Authority, Room 1-026B Centennial Building, 1276 South Park Street, Halifax, NS, Canada, B3H 2Y9.
3
Departments of Critical Care and Emergency Medicine, Dalhousie University, Halifax, NS, Canada, B3H 4R2.

Abstract

BACKGROUND:

Prolonged immobility has detrimental consequences for critically ill patients admitted to the intensive care unit (ICU). Previous work has shown that early mobilization of ICU patients is a safe, feasible and effective strategy to improve outcomes; however, few of these studies focused on trauma ICU patients. Our objective was to assess the impact of implementing an ICU early mobilization protocol (EMP) on trauma outcomes.

METHODS:

We conducted a retrospective pre-post study of adult trauma patients (>18 years old) admitted to ICU at a level 1 trauma center over a 2-year period prior to and following EMP implementation, allowing for a 1-year transition period. Data were collected from the Nova Scotia Trauma Registry. We compared outcomes (mortality, length of stay [LOS], ventilator-free days) between patients admitted during pre-EMP and post-EMP periods, and assessed for factors associated with outcomes using binary logistic regression and generalized linear models.

RESULTS:

Overall, 526 patients were included in the analysis (292 pre-EMP, 234 post-EMP). Ages ranged from 18 to 92 years (mean 49.0 ± 20.4 years) and 74.3% were male. The post-EMP group had lower ICU mortality (21.6% vs. 12.8%; p=0.009) and in-hospital mortality (25.3% vs. 17.5%; p = 0.031). After controlling for confounders, patients in the post-EMP group were less likely to die in the ICU (OR = 0.43, 95% CI 0.24-0.79, p=0.006) or in-hospital (OR = 0.55, 95% CI 0.32-0.94, p= 0.03). In-hospital LOS, ICU LOS, ICU-free days, and number of ventilator-free days were similar between the two groups.

CONCLUSIONS:

Trauma patients admitted to ICU during the post-EMP period had decreased odds of ICU mortality and in-hospital mortality. This is the first study to demonstrate a significant reduction in trauma mortality following implementation of an ICU mobility protocol.Level III, therapeutic.

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