• Chris Winkelman, Abdus Sattar, Hasina Momotaz, Kimberly D Johnson, Peter Morris, James R Rowbottom, John Daryl Thornton, Sheryl Feeney, and Alan Levine.
• 1 Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA.
• Biol Res Nurs. 2018 Oct 1; 20 (5): 522-530.

ObjectiveInvestigate the feasibility of a nurse-led mobility protocol and compare the effects of once- versus twice-daily episodes of early therapeutic mobility (ETM) and low- versus moderate-intensity ETM on serum biomarkers of inflammation and selected outcomes in critically ill adults.DesignRandomized interventional study with repeated measures and blinded assessment of outcomes.SettingFour adult intensive care units (ICUs) in two academic medical centers.SubjectsFifty-four patients with > 48 hr of mechanical ventilation (MV).InterventionPatients were assigned to once- or twice-daily ETM via sealed envelope randomization at enrollment. Intensity of (in-bed vs. out-of-bed) ETM was administered according to protocolized patient assessment.MeasurementsInterleukins 6, 10, 8, 15, and tumor necrosis factor-α were collected from serum before and after ETM; change scores were used in the analyses. Manual muscle and handgrip strength, delirium onset, duration of MV, and ICU length of stay (LOS) were evaluated as patient outcomes.Main ResultsHypotheses regarding the inflammatory biomarkers were not supported based on confidence intervals. Twice-daily intervention was associated with reduced ICU LOS. Moderate-intensity (out-of-bed) ETM was associated with greater manual muscle test scores and handgrip strength and reduced occurrence of delirium.ConclusionFindings from this study suggest that nurses can provide twice-daily mobility interventions that include sitting on the edge of the bed once patients have a stable status without altering a pro-inflammatory serum biomarker profile.

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