Barriers to Mobility in the ICU: Insights from Severe COVID-19 and Implications for Improving Patient Outcomes

Objective To evaluate mobility outcomes of patients with severe COVID-19 during their intensive care unit (ICU) stay compared to non-COVID-19 critically ill counterparts and assess factors impacting mobility status. Design A retrospective, single-center case–control study. Setting This investigation was conducted at a large tertiary care center at the epicenter of the COVID-19 pandemic between April 2019 and July 2020 to capture a prepandemic baseline and the initial surge. Participants A total of 3275 ICU cases were analyzed. Analysis was conducted at the ICU visit level rather than the patient level. Eligible visits included adults ≥18 years. The COVID-19 cohort (COVID vs non-COVID) was defined by confirmed infection (polymerase chain reaction or equivalent testing). ICU visits with missing data were excluded and subsequently matched via coarsened exact matching. Interventions Not applicable. Main Outcome Measures Primary outcome measure was an ICU visit’s highest ICU mobility status (Immobile, Nonambulatory, Ambulatory) at any time during their stay. Secondary outcomes included age, sex, body mass index, APACHE-III score, Richmond Agitation Sedation Scale, patient expired, tracheostomy status, percutaneous endoscopic gastrostomy status, hospital length of stay, prone status, and physical therapy status. Results The COVID visits were overwhelmingly categorized as immobile, whereas non-COVID visits were more likely to be ambulatory. Multinomial regression showed that COVID patients were 60% less likely to be Nonambulatory and 93% less likely to be Ambulatory versus immobile. COVID-19 visits were also associated with higher final APACHE-III scores ( P =.001), longer hospital stays ( P <.001), increased sedation ( P <.001), fewer ICU physical therapy visits ( P =.001), and more frequent proning ( P <.001) compared to non-COVID visits. Conclusions Severe COVID-19 significantly affects ICU mobility, with COVID visits experiencing reduced mobility compared to non-COVID visits. These findings underscore the urgent need for innovative sedation protocols and ICU mobilization strategies to mitigate risks of ICU-acquired weakness, postintensive care syndrome, and other long-term disabilities. Addressing these challenges is critical to improving outcomes for all ICU patients facing barriers to traditional mobilization strategies and preparing for future pandemics.