The effect of increased mobility on morbidity in the neurointensive care unit

Clinical article

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Object

The detrimental effects of immobility on intensive care unit (ICU) patients are well established. Limited studies involving medical ICUs have demonstrated the safety and benefit of mobility protocols. Currently no study has investigated the role of increased mobility in the neurointensive care unit population. This study was a single-institution prospective intervention trial to investigate the effectiveness of increased mobility among neurointensive care unit patients.

Methods

All patients admitted to the neurointensive care unit of a tertiary care center over a 16-month period (April 2010 through July 2011) were evaluated. The study consisted of a 10-month (8025 patient days) preintervention observation period followed by a 6-month (4455 patient days) postintervention period. The intervention was a comprehensive mobility initiative utilizing the Progressive Upright Mobility Protocol (PUMP) Plus.

Results

Implementation of the PUMP Plus increased mobility among neurointensive care unit patients by 300% (p < 0.0001). Initiation of this protocol also correlated with a reduction in neurointensive care unit length of stay (LOS; p < 0.004), hospital LOS (p < 0.004), hospital-acquired infections (p < 0.05), and ventilator-associated pneumonias (p < 0.001), and decreased the number of patient days in restraints (p < 0.05). Additionally, increased mobility did not lead to increases in adverse events as measured by falls or inadvertent line disconnections.

Conclusions

Among neurointensive care unit patients, increased mobility can be achieved quickly and safely with associated reductions in LOS and hospital-acquired infections using the PUMP Plus program.

Abbreviations used in this paper:ICU = intensive care unit; I-MOVE = Independent Mobility Validation Examination; LOS = length of stay; NHSN = National Health Safety Network; PUMP = Progressive Upright Mobility Protocol; SUF = Shands Hospital at the University of Florida; UTI = urinary tract infection; VAP = ventilator-associated pneumonia.

Article Information

Address correspondence to: J Mocco, M.D., M.S., University of Florida, P.O. Box 100265, Gainesville, Florida 32610. email: jmocco@neurosurgery.ufl.edu.

Please include this information when citing this paper: published online March 30, 2012; DOI: 10.3171/2012.2.JNS111881.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    The PUMP Plus algorithm. BP = blood pressure; CRRT = continuous renal replacement therapy; cont. = continuous; CXR = chest x-ray (radiograph); HOB = head of bed; HR = heart rate; HTN = hypertension; mgmt = management; O2Sat = oxygen saturation; PRN = as needed; pt = patient; q2hours = every 2 hours; Q shift = every 8 hour nursing shift; TBerg = Trendelenburg bed position; TID = three times/day; tPA = tissue plasminogen activator.

  • View in gallery

    Graph showing the change in the average number of recorded activities per day before and after implementation of the PUMP Plus program. *p < 0.05; ***p < 0.001; OOB = out of bed.

  • View in gallery

    Total number of culture-confirmed hospital-acquired infections over time. The dashed line indicates the start of the Mobility Initiative.

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