Timing to out-of-bed mobilization and mobility levels of COVID-19 patients admitted to the ICU: Experiences in Brazilian clinical practice

ABSTRACT

Introduction

At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there was scarce data about clinical/functional conditions during hospitalization or after hospital discharge. Little was known about COVID-19 repercussions and how to do early mobilization in intensive care unit (ICU).

Objective

Identify the time to the initiation of out-of-bed mobilization and the levels of mobility (sitting over the edge of the bed, sitting in a chair, standing, and ambulating) reached by critically ill patients with COVID-19 during hospitalization and the factors that could impact early mobilization.

Methods

This was a retrospective observational study of patients with COVID-19 in the ICU.

Results

There were 157 surviving COVID-19 patients included in the study (median age: 61 years; median ICU length of stay: 12 days). The median time to initiate out-of-bed mobilization in the ICU was 6 days; between patients who received mechanical ventilation (MV) compared with those who did not, this time was 8 vs. 2.5 days (p < .001). Most patients who used MV were mobilized after extubation (79.6%). During ICU stays, 88.0% of all patients were mobilized out of bed, and 41.0% were able to ambulate either with assistance or independently. The time to initiate out-of-bed mobilization is associated with sedation time and MV time.

Conclusion

Despite the pandemic scenario, patients were quickly mobilized out of bed, and most of the patients achieved higher mobility levels in the ICU and at hospital discharge. Sedation time and MV time were associated with delays in initiating mobilization.

KEYWORDS:

• Coronavirus disease 2019
• early mobilization
• intensive care unit
• physiotherapy
• rehabilitation

Acknowledgments

We would like to thank the Hospital das Clinicas COVID-19 crisis committee for their support for this project. We would also like to thank Luciana Oliveira and Edson Prado Bomfim for the statistical consultancy.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.