The Association Between Early Mobilization Intervention and the Development of Pressure Injuries in the Intensive Care Unit

Abstract

Critically ill patients in ICU settings have a higher rate of PIs than other patients. These patients are at increased risk due to severe physiological instability and immobility. Immobility is one of the major risk factors of PI development. Mobilizing patients out of bed could be one way of preventing the development of PIs. This dissertation studied the association between PI development and mobilizing patients out of bed within the first seven days of ICU admission. Three chapters provided a comprehensive exploration of the association between EM and PI development. Chapter 2 presented detailed background information about EM, as well as a meta-analysis of the effects of EM on critically ill patients. The meta-analysis showed that mobilizing critically ill patients reduces their ICU and hospital LOS. Moreover, the EM group experienced better QoL six months after discharge. There were no significant effects of EM on mechanical ventilator days, the number of ventilator free days, vasopressors, sedation, delirium, or patient physical function. Chapter 3 provided a systematic review of the PI risk factors in critically ill patients in ICU settings , reviewed the pathophysiology of PI development, There is limited evidence concerning the association between EM interventions and PI development, so this chapter presented a conceptual framework exploring how EM could mitigate PI development. The framework introduced conceptual links between EM and PI development using Braden and Bergstrom’s conceptual scheme and demonstrates that immobility, shear, and friction are factors that can be mediated directly when ICU patients are mobilized out of bed. Finally, Chapter 4 reported a study that examined the relationship between EM and PI development in ICU patients. The study was comprised of a retrospective chart review of PI and EM events. Two sub-study designs, which did not and did control for other PI risk factors, were used to examine this association. The first phase used a cohort design that compared PI events before EM, during EM, and during hospital expansion. This phase found that there was no significant increase in PI events between these three periods. The second phase used a case control design that compared PI patients (cases) to non-PI patients (controls). When comparing the characteristics of the cases to the controls, we found that the cases had a significantly higher risk of PI development, higher APACHE II scores, a higher use of hemodialysis, a higher use of MV, and lower hemoglobin levels compared to the control group. The univariate logistic regression revealed that the following risk factors were significant predictors of PI development: total Braden score, Braden subscale scores (sensory,, activity, moisture, and friction), hemoglobin level, APACHE II score, hemodialysis, MV usage, EM received within 72 hours and EM received within seven days, , dangling, sitting, standing, ambulating, and EM sessions count. The multivariate logistic regression included two models. Model one used EM within 72 hours and model two used EM within 7 days as the main risk factors in the second block of the logistic analysis. Model one showed four significant variables: total Braden score, Braden moisture, Braden friction, and receiving EM within 72 hours. Model two revealed five significant risk factors: Braden score, Braden moisture, Braden friction, BMI, and receiving EM within 7 days. There is a gap in the knowledge about the relationship between PI and EM. The systematic review and studies presented as a part of this dissertation expand the body of science and our knowledge of this relationship and the additional benefit of EM.