Factors associated with timing of initiation of physical therapy in patients with acute lung injury

Objectives: Early initiation of physical therapy (PT) in mechanically ventilated patients is associated with improved outcomes. However, PT is frequently delayed until after extubation or discharge from the intensive care unit (ICU). We evaluated factors associated with the timing of initiation of PT in patients with acute lung injury (ALI) admitted to ICUs without an emphasis on early rehabilitation. Design: A secondary analysis of a prospective cohort study was conducted. Settings: The study was conducted in 11 ICUs in 3 teaching hospitals. Patients: A total of 503 patients with ALI were included in the study. Interventions: No interventions were used in this study. Measurements and Main Results: Thirty-four percent of patients ever received PT. In multivariable analysis, factors associated with later PT were a higher Sequential Organ Failure Assessment score (hazard ratio, 0.89; 95% confidence interval, 0.85-0.93), higher fraction of inspired oxygen (0.97, 0.96-0.98), mechanical ventilation (0.31, 0.16-0.59), coma (0.32, 0.20-0.51), delirium (0.72, 0.50-1.03), and continuous sedation (with daily sedation interruption: 0.49, 0.30-0.81; without daily sedation interruption: 0.59, 0.39-0.89). Factors associated with earlier PT were an admitting diagnosis of trauma (3.31, 1.74-6.31) and hospital study site (2.84, 1.89-4.26). Conclusions: In 11 ICUs without emphasis on early rehabilitation, patients with ALI frequently received no PT. Severity of illness, mental status, sedation practices, and hospital site were significant barriers to initiating PT. Understanding these barriers may be important when introducing early ICU physical rehabilitation.