(1290) Moving the Mechanically Ventilated: Early Progressive Mobility in ICU

Introduction: Among mechanically ventilated patients, critical illness myopathy, polyneuropathy, and reduced pulmonary capacity are common complications. Research shows that reducing sedation and initiating early mobility improves outcomes and physical function up to 5 years. In our ICU, patients are assessed using the John Hopkins Activity and Mobility Promotion (JH-HLM) program. However, there has been insufficient improvement in JH-HLM scores from admission to discharge. This quality improvement (QI) project aimed to raise the JH-HLM score to 3 or above.

Methods: Patients on mechanical ventilation for over 24 hours were selected. A daily sedation vacation and mobility orders from the ICU team were implemented. The baseline JH-HLM score was recorded, and those meeting safety criteria were started on a designed mobility protocol. Tolerability for progression was assessed. The protocol began in February 2024, with post-implementation JH-HLM scores recorded on the day of ICU discharge. For one month, the percentage of patients showing score progression was calculated, and a monthly audit assessed ventilator-free days (VFDs) and ICU length of stay (LoS).

Results: In January 2024, among 15 ventilated patients who received mobility interventions, only 3 (20%) improved their scores. However, in February 2024, out of 20 who underwent mobility protocols, 8 (40%) demonstrated improvement, reflecting a two-fold increase in effectiveness (confidence interval of 0.797 to 3.033, p=0.095). The average LoS for patients with improved scores was 113.3 hours compared to 397.87 hours for those without improvement (p=0.026). Additionally, patients with improved scores had an average of 1.19 VFDs, while those without had 0.17 days (p=0.0039).

Conclusions: The average JH-HLM score improved from 2.67 to 3.96 after the intervention. Although 20% improvement in scores was statistically insignificant, likely due to a small sample size, patients with improved scores had shorter LoS and more VFDs, potentially lowering hospital costs and enhancing QoL. This project underscores the importance of mobility awareness, protocol implementation, reduced sedation, and interdisciplinary collaboration in achieving ICU mobility goals and supports the long-term sustainability of the project.