Traumatic injury remains a leading cause of death and disability globally, though mortality has decreased due to advances in surgery and centralised trauma care. Consequently, long-term outcomes like social reintegration have gained importance.
Early mobilisation and rehabilitation in the ICU are known to improve physical function, reduce ICU and hospital stays, and lower ICU-acquired weakness, but most research includes few trauma patients, who often have complex injuries, making early mobilisation challenging.
Multidisciplinary team-based early mobilisation and rehabilitation protocols (EMRPs) tailored for trauma patients may reduce mortality and complications, but existing studies have limitations in adjusting for confounders. While some trauma centres have dedicated trauma ICUs, many hospitals admit trauma and non-trauma patients to mixed ICUs. In such settings, a general EMRP applicable to all ICU patients could be practical, but its impact on key outcomes such as home discharge and physical function in trauma patients is unclear.
A new study aimed to evaluate whether implementing a general EMRP in the ICU affects home discharge rates, activities of daily living (ADLs) at discharge, length of ICU and hospital stay, and physical function in trauma patients and to compare mobilisation progress before and after EMRP implementation.
The study was conducted on adult trauma ICU patients with Injury Severity Scores ≥9 at a university hospital. Patients admitted before the implementation of EMRP (July 2021–June 2022) formed the pre-EMRP group, and those admitted after (July 2022–August 2023) formed the post-EMRP group. Outcomes between groups were compared using propensity score matching to control for confounders. The primary outcome was the rate of home discharge. Secondary outcomes included Barthel Index scores at hospital discharge, ICU and hospital length of stay, Functional Status Score at ICU discharge, and the cumulative rates of patients achieving specified ICU Mobility Scale levels within 28 days of ICU admission.
Among 552 trauma ICU patients, 254 were in the pre-EMRP phase and 298 in the post-EMRP phase. After matching, the post-EMRP group had a significantly higher home discharge rate (52.1% vs. 41.1%), better functional outcomes at hospital discharge, and shorter ICU stays. Additionally, patients in the post-EMRP group reached higher levels of mobility earlier, with increased hazard ratios for achieving ICU Mobility Scale levels ≥3, ≥4, and ≥7 compared to the pre-EMRP group. These findings suggest that improved physical function and activity facilitated by EMRP likely contributed to increased home discharge rates.
Unlike previous studies using trauma-specific EMRPs that showed no improvement in home discharge or ICU length of stay, this study’s rigorous adjustment for confounders and inclusion of an older patient population may explain its positive findings. The implementation of a general EMRP in a mixed ICU setting also demonstrated feasibility across a clinically heterogeneous trauma population with multiple injury types.
Key factors contributing to successful EMRP implementation included a multidisciplinary team approach, consistent interprofessional rounds, clear roles, screening processes, and staff education, all fostering an ICU culture supportive of early mobilisation without overburdening staff. The study also observed a reduction in complications related to immobility and muscle weakness, consistent with prior literature. Safety events during mobilisation were low and comparable pre- and post-EMRP, with no serious adverse events, indicating the protocol’s safety in trauma patients. However, pain-related events were common, highlighting the importance of optimal pain management.
Overall, the study found that implementing an EMRP within 48 hours of ICU admission significantly increased the rate of home discharge among trauma patients. EMRP also improved activities of daily living at hospital discharge and reduced ICU length of stay, suggesting that early mobilisation enhances physical function and supports earlier return home.
Source: Critical Care
Image Credit: iStock
