Eligibility for Early Mobilization in Mechanically Ventilated Adults: A Multicenter Study
Bhakti K Patel, Kaveri Chhikara, Snigdha Jain, Krysta Wolfe, Chad H Hochberg, Anna K Barker, Nicholas E Ingraham, Patrick G Lyons, Brenna Park-Egan, Catherine A Gao, Wan Ting Liao, Juan C Rojas, Kevin G Buell, Vaishvik Chaudhari, Alexander C Ortiz, Aartik Sarma, Andrew Willmore, Siva Bhavani, Navya Tippananapalya Ramesh, William F ParkerAbstract
Rationale
Early mobilization of mechanically ventilated patients within 72 hours of intubation is underutilized despite its known clinical benefits. The most cited barrier to implementation is physiologic instability.
Objectives
To quantify eligibility for early mobilization across established physiologic criteria in a multicenter cohort of mechanically ventilated adults and estimate the relative impact of structural and process implementation barriers.
Methods
Retrospective cohort of adults receiving invasive mechanical ventilation for ≥4 hours across nine CLIF Consortium health systems (2018–2024) and MIMIC-IV (2008–2022). Four physiologic eligibility criteria, from clinical trials (Chicago, TEAM) and consensus guidelines (Green, Yellow), were applied between 8am and 5pm within 72 hours of intubation. Random-effects meta-analysis compared eligibility across criteria and quantified the relative effect of two implementation barriers: weekday-only availability (structural) and 4-hour continuous eligibility (process).
Measurements and Main Results
Among 223,281 hospitalizations, 86.9–95.6% met eligibility for mobilization within 72 hours of intubation across all 4 criteria. Compared with Chicago trials criteria, eligibility was reduced under TEAM (SHR 0.782, 95% CI 0.746–0.820) and Green (SHR 0.631, 0.611–0.651) but not Yellow (SHR 0.990, 0.976–1.005). Restricting eligibility to weekdays (structural) or requiring continuous eligibility (process) each reduced eligibility by 26-39% across all four criteria (SHR range 0.61–0.74); imposing both barriers together reduced eligibility by 45-56% (SHR range 0.44-0.55).
Conclusions
Most mechanically ventilated adults met physiologic eligibility criteria for early mobilization within 72 hours of intubation. Structural and process barriers, such as staff availability on weekends and sustained eligibility for care coordination, reduced opportunity more potently than physiologic instability alone.