Five-Year Retrospective Analysis of a Vented Mobility Algorithm in the Burn ICU

Abstract

Early mobilization with mechanically ventilated patients has received significant attention within recent literature; however, limited research has focused specifically on the burn population. The purpose of this single-center, retrospective analysis was to review the use of a burn critical care mobility algorithm, to determine the safety and feasibility of a burn vented mobility program, share limitations preventing mobility progression at our facility, and discuss unique challenges to vented mobility with intubated burn patients. A retrospective review was completed for all intubated burn center admissions between January 2015 and December 2019. Burn therapy notes were then reviewed for data collection, during the intubation period, using stages of the mobility algorithm. In the 5-year period following initial implementation, the vented mobility algorithm was utilized on 127 patients with an average TBSA of 22.8%. No adverse events occurred. Stage 1 (range of motion) was completed with 100% of patients (n = 127). Chair mode of bed, stage 2a, was utilized in 39.4% (n = 50) of patients, while 15.8% (n = 20) of patients were dependently transferred to the cardiac chair in stage 2b. Stage 3 (sitting on the edge of the bed) was completed with 25% (n = 32) of patients, with 11% (n = 14) progressing to stage 5 (standing), and 3.9% (n = 5) actively transferring to a chair. In the 5 years, only 4.7% (n = 6) reached stage 6 (ambulation). The most common treatment limitations were medical complications (33%) and line placement (21%). Early mobilization during mechanical ventilation is safe and feasible within the burn population, despite challenges, including airway stability, sedation, and line limitations.