Fatores determinantes da mobilização precoce em pacientes neurocríticos adultos em unidade de terapia intensiva: estudo retrospectivo observacional

Abstract

Early mobilization reduces complications related to immobility in intensive care units (ICUs); however, its implementation in neurocritical patients remains inconsistent and poorly characterized in real-world settings. This study identifies barriers to early mobilization in adult neurocritical patients admitted to the ICU and evaluates the compliance of documented justifications for non-mobilization with the institutional protocol. This is a retrospective, single-center observational study including adult neurocritical patients admitted to an ICU. The analyzed outcomes include daily mobilization status, reasons for non-mobilization categorized as clinical, organizational, and structural barriers, and the compliance of clinical justifications with the institutional Standard Operating Procedure (SOP). Among 163 patients, corresponding to 1,798 patient-days, 64.7% of ICU days occurred without mobilization. Clinical barriers predominated (82.6%), particularly general clinical and hemodynamic criteria, whereas organizational and structural barriers accounted for 16.6% and 0.6%, respectively. Of the 1,164 justifications for non-mobilization, 66.4% were compliant with the SOP, a proportion significantly higher than expected by chance (exact binomial test, p < 0.001; 95% CI, 63.6%–69.1%). A relevant proportion of justifications was not included in the protocol, indicating possible gaps between formal guidelines and bedside practice. Early mobilization in neurocritical ICU patients is predominantly limited by clinical restrictions, reflecting the complexity of this population; however, organizational factors and protocol gaps also contribute to this scenario. Periodic protocol review and continuous interprofessional education may improve alignment between guidelines and practice, promoting safer and more consistent implementation of early mobilization.