Improved outcomes for patients on mechanical ventilation may be achieved with early
mobilization (EM). However, it is not clear how widely this strategy is adopted into
routine intensive care unit (ICU) practice in Saudi Arabia.
This study was conducted to describe the present practices and challenges to providing
EM for mechanically ventilated patients, which may drive dissemination and implementation
We approached 205 ICUs across Saudi Arabia using a validated tool to assess ICU characteristics,
the practices of EM for mechanically ventilated patients, and the barriers to providing
We approached 205 ICU persons in charge and achieved a 65% response rate (133 ICUs).
The prevalence of EM for mechanically ventilated patients was 47% (63 ICUs). A total
of 85 (64%) of the respondents reported having no previous training in EM. The absence
of a written protocol was reported by 55% of the ICU practitioners in charge, 36%
started EM within 2 to 5 days of critical illness, and 35% reported that performing
EM for mechanically ventilated patients was totally dependent on physicians’ orders.
Forty-seven percent of the ICUs that practised EM had at least one coordinator or
person in charge of facilitating EM. The highest level of EM with mechanically ventilated
patients was 35/63 (55%) with patients remaining in-bed and 28/63 (45%) with patient
getting out of bed. A majority of the respondents (39, 64%) performed EM once daily
for an interval period of more than 15 min. Previous training in EM and years of experience
of the ICU person in charge were significant factors that promoted EM for mechanically
ventilated ICU patients (OR: 7.6 (3.37–17.26); p < 0.001 and OR: 1.07 (1.01–1.14), p = 0.004, respectively). Existing protocols increased the odds of starting EM within
2 to 5 days of critical illness by six-fold (OR: 6.03 (1.79–20.30); p = 0.004). No written guidelines/protocols available for EM, medical instability,
and limited staff were the most common hospital-, patient- and health care provider-related
barriers to EM in the ICUs, respectively.
The prevalence of EM for mechanically ventilated patients across Saudi Arabia was
47%, although only 36% of the ICU staff had previous training in EM. Targeting modifiable
barriers to EM, including a lack of training, guidelines and protocols, and staffing,
will help to promote EM in Saudi Arabian ICUs.