51
|
Mima K, Baba H. Outcomes of patients with frailty and metastatic cancer admitted to the intensive care unit. THE LANCET. HEALTHY LONGEVITY 2023; 4:e655-e656. [PMID: 38042156 DOI: 10.1016/s2666-7568(23)00240-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 12/04/2023] Open
Affiliation(s)
- Kosuke Mima
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan.
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto 860-8556, Japan
| |
Collapse
|
52
|
Watanabe S, Liu K, Kozu R, Yasumura D, Yamauchi K, Katsukawa H, Suzuki K, Koike T, Morita Y. Association Between Mobilization Level And Activity of Daily Living Independence in Critically Ill Patients. Ann Rehabil Med 2023; 47:519-527. [PMID: 37990499 PMCID: PMC10767217 DOI: 10.5535/arm.23056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/11/2023] [Accepted: 10/13/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To examine the association between the mobilization level during intensive care unit (ICU) admission and independence in activity of daily living (ADL), defined as Barthel Index (BI)≥70. METHODS This was a post-hoc analysis of the EMPICS study involving nine hospitals. Consecutive patients who spend >48 hours in the ICU were eligible for inclusion. Mobilization was performed at each hospital according to the shared protocol and the highest ICU mobility score (IMS) during the ICU stay, baseline characteristics, and BI at hospital discharge. Multiple logistic regression analysis, adjusted for baseline characteristics, was used to deter-mine the association between the highest IMS (using the receiver operating characteristic [ROC]) and ADL. RESULTS Of the 203 patients, 143 were assigned to the ADL independence group and 60 to the ADL dependence group. The highest IMS score was significantly higher in the ADL independence group than in the dependence group and was a predictor of ADL independence at hospital discharge (odds ratio, 1.22; 95% confidence interval, 1.07-1.38; adjusted p=0.002). The ROC cutoff value for the highest IMS was 6 (specificity, 0.67; sensitivity, 0.70; area under the curve, 0.69). CONCLUSION These results indicate that, in patients who were in the ICU for more than 48 hours, that patients with good function in the ICU also exhibit good function upon discharge. However, prospective, multicenter trials are needed to confirm this conclusion.
Collapse
Affiliation(s)
- Shinichi Watanabe
- Department of Rehabilitation, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, Gifu, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
| | - Ryo Kozu
- Department of Cardiopulmonary Rehabilitation Science, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Daisetsu Yasumura
- Department of Rehabilitation, Naha City Hospital, Naha, Japan
- Department of Healthcare Administration, The University of Kyushu, Fukuoka, Japan
| | - Kota Yamauchi
- Department of rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | | | - Keisuke Suzuki
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, Gifu, Japan
| | - Takayasu Koike
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, Gifu, Japan
| | - Yasunari Morita
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| |
Collapse
|
53
|
Lorenz M, Fuest K, Ulm B, Grunow JJ, Warner L, Bald A, Arsene V, Verfuß M, Daum N, Blobner M, Schaller SJ. The optimal dose of mobilisation therapy in the ICU: a prospective cohort study. J Intensive Care 2023; 11:56. [PMID: 37986100 PMCID: PMC10658796 DOI: 10.1186/s40560-023-00703-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND This study aimed to assess the impact of duration of early mobilisation on survivors of critical illness. The hypothesis was that interventions lasting over 40 min, as per the German guideline, positively affect the functional status at ICU discharge. METHODS Prospective single-centre cohort study conducted in two ICUs in Germany. In 684 critically ill patients surviving an ICU stay > 24 h, out-of-bed mobilisation of more than 40 min was evaluated. RESULTS Daily mobilisation ≥ 40 min was identified as an independent predictor of an improved functional status upon ICU discharge. This effect on the primary outcome measure, change of Mobility-Barthel until ICU discharge, was observed in three different models for baseline patient characteristics (average treatment effect (ATE), all three models p < 0.001). When mobilisation parameters like level of mobilisation, were included in the analysis, the average treatment effect disappeared [ATE 1.0 (95% CI - 0.4 to 2.4), p = 0.16]. CONCLUSIONS A mobilisation duration of more than 40 min positively impacts functional outcomes at ICU discharge. However, the maximum level achieved during ICU stay was the most crucial factor regarding adequate dosage, as higher duration did not show an additional benefit in patients with already high mobilisation levels. TRIAL REGISTRATION Prospective Registry of Mobilization-, Routine- and Outcome Data of Intensive Care Patients (MOBDB), NCT03666286. Registered 11 September 2018-retrospectively registered, https://classic. CLINICALTRIALS gov/ct2/show/NCT03666286 .
Collapse
Affiliation(s)
- Marco Lorenz
- Technical University of Munich, School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Kristina Fuest
- Technical University of Munich, School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany
| | - Bernhard Ulm
- Technical University of Munich, School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany
- University Hospital Ulm, Faculty of Medicine, Department of Anesthesiology and Intensive Care Medicine, Ulm, Germany
| | - Julius J Grunow
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Linus Warner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Annika Bald
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Vanessa Arsene
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Michael Verfuß
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Nils Daum
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Manfred Blobner
- Technical University of Munich, School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany
- University Hospital Ulm, Faculty of Medicine, Department of Anesthesiology and Intensive Care Medicine, Ulm, Germany
| | - Stefan J Schaller
- Technical University of Munich, School of Medicine and Health, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany.
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany.
| |
Collapse
|
54
|
Kloss P, Lindholz M, Milnik A, Azoulay E, Cecconi M, Citerio G, De Corte T, Duska F, Galarza L, Greco M, Girbes ARJ, Kesecioglu J, Mellinghoff J, Ostermann M, Pellegrini M, Teboul JL, De Waele J, Wong A, Schaller SJ. Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study. Ann Intensive Care 2023; 13:112. [PMID: 37962748 PMCID: PMC10645963 DOI: 10.1186/s13613-023-01201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 10/05/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. METHODS This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. RESULTS Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI - 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI - 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. CONCLUSIONS Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).
Collapse
Affiliation(s)
- Philipp Kloss
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Maximilian Lindholz
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany
| | - Annette Milnik
- Research Platform Molecular and Cognitive Neurosciences (MCN), Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Elie Azoulay
- Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, Paris University, Paris, France
- Université de Paris, Paris, France
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Department Neuroscience, Neurointensive Care, IRCCS Fondazione San Gerardo dei Tintori, Monza, Italy
| | - Thomas De Corte
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Frantisek Duska
- Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University, Prague, Czech Republic
- FNKV University Hospital in Prague, Prague, Czech Republic
| | - Laura Galarza
- Intensive Care Unit, Hospital General Universitario de Castellón, Castellón de La Plana, Spain
| | - Massimiliano Greco
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - Armand R J Girbes
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Sciences (ACS), Amsterdam Infection and Immunity Institute (AI&II), UMC, Location VUmc, VU Amsterdam, Amsterdam, The Netherlands
| | - Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, UK
| | - Mariangela Pellegrini
- Intensive Care Unit, AnOpIVA, Akademiska Sjukhuset, Uppsala, Sweden
- Hedenstierna Laboratory, Department of Surgical Science, Uppsala University, Uppsala, Sweden
| | - Jean-Louis Teboul
- Service de Médecine Intensive-Réanimation, Hôpital Bicêtre, AP-HP Université Paris-Saclay, Inserm UMR S_999, Le Kremlin-Bicêtre, France
| | - Jan De Waele
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK
| | - Stefan J Schaller
- Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CCM/CVK), Berlin, Germany.
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care Medicine, Munich, Bavaria, Germany.
| |
Collapse
|
55
|
Tonna JE, Bailey M, Abrams D, Brodie D, Hodgson CL. Predictors of early mobilization in patients requiring VV ECMO for greater than 7 days: An international cohort study. Heart Lung 2023; 62:57-63. [PMID: 37311360 PMCID: PMC10592536 DOI: 10.1016/j.hrtlng.2023.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite the demonstrated benefits of rehabilitation, active physical therapy and early mobilization are not universally performed during critical illness, especially among patients receiving extracorporeal membrane oxygenation (ECMO), with variation among sites. OBJECTIVE What factors are predictive of physical mobility during venovenous (VV) ECMO support? METHODS We performed an observational analysis of an international cohort using data from the Extracorporeal Life Support Organization (ELSO) Registry. We analyzed adults (≥18 years) supported with VV ECMO who survived for at least 7 days. Our primary outcome was early mobilization (ICU Mobility Scale score >0) at day 7 of ECMO support. Hierarchical multivariable logistic regression models were utilized to identify factors independently associated with early mobilization at day 7 of ECMO. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI). RESULTS Among 8,160 unique VV ECMO patients, factors independently associated with early mobilization included cannulation for transplantation (aOR 2.86 [95% CI 2.08-3.92]; p<0.001), avoidance of mechanical ventilation (aOR 0.51 [95% CI 0.41-0.64]; p<0.0001), higher center level patient volume (6-20 patients annually: aOR 1.49 [95% CI 1 to 2.23] and >20 patients annually: aOR 2 [95% CI: 1.37 to 2.93]; p<0.0001 for group), and cannulation with a dual-lumen cannula (aOR 1.25 [95% CI 1.08-1.42]; p = 0.0018). Early mobilization was associated with a lower probability of death (29 vs 48%; p<0.0001). CONCLUSIONS Higher levels of early mobilization on ECMO were associated modifiable and non-modifiable patient characteristics, including cannulation with a dual-lumen cannula, and with high center level patient volume.
Collapse
Affiliation(s)
- Joseph E Tonna
- Division of Cardiothoracic Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT, United States of America; Department of Emergency Medicine, University of Utah Health, Salt Lake City, UT, United States of America.
| | - Michael Bailey
- Australian and New Zealand Intensive Care-Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Darryl Abrams
- Department of Medicine, Columbia University College of Physicians & Surgeons, United States of America; Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians & Surgeons, United States of America; Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, NY, United States of America
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care-Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Physiotherapy, The Alfred, Melbourne, Australia; The George Institute for Global Health, Sydney, Australia; Department of Critical Care, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
56
|
Brockman A, Krupp A, Bach C, Mu J, Vasilevskis EE, Tan A, Mion LC, Balas MC. Clinicians' perceptions on implementation strategies used to facilitate ABCDEF bundle adoption: A multicenter survey. Heart Lung 2023; 62:108-115. [PMID: 37399777 PMCID: PMC10592449 DOI: 10.1016/j.hrtlng.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Intensive care unit (ICU) clinicians struggle to routinely implement the ICU Liberation bundle (ABCDEF bundle). As a result, critically ill patients experience increased risk of morbidity and mortality. Despite extensive research related to the barriers and facilitators of bundle use, little is known regarding which implementation strategies are used to facilitate its adoption and sustainability. OBJECTIVES To identify implementation strategies used to increase adoption of the ABCDEF bundle and how those strategies are perceived by end-users (i.e., ICU clinicians) related to their helpfulness, acceptability, feasibility, and cost. METHODS We conducted a national, cross-sectional survey of ICU clinicians from the 68 ICU sites that previously participated in the Society of Critical Care Medicine's ICU Liberation Collaborative. The survey was structured using the 73 Expert Recommendations for Implementing Change (ERIC) implementation strategies. Surveys were delivered electronically to site contacts. RESULTS Nineteen ICUs (28%) returned completed surveys. Sites used 63 of the 73 ERIC implementation strategies, with frequent use of strategies that may be readily available to clinicians (e.g., providing educational meetings or ongoing training), but less use of strategies that require changes to well-established organizational systems (e.g., alter incentive allowance structure). Overall, sites described the ERIC strategies used in their implementation process to be moderately helpful (mean score >3<4 on a 5-point Likert scale), somewhat acceptable and feasible (mean score >2<3), and either not-at-all or somewhat costly (mean scores >1<3). CONCLUSIONS Our results show a potential over-reliance on accessible strategies and the possible benefit of unused ERIC strategies related to changing infrastructure and utilizing financial strategies.
Collapse
Affiliation(s)
- Audrey Brockman
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH. 43210. USA.
| | - Anna Krupp
- The University of Iowa College of Nursing, 50 Newton Rd, CNB 480, Iowa City, IA. 52246. USA
| | - Christina Bach
- University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, Omaha, NE. 68198-5330. USA
| | - Jinjian Mu
- The Ohio State University College of Nursing, Center for Research and Health Analytics 1585 Neil Avenue, Columbus, OH. 43210. USA
| | - Eduard E Vasilevskis
- Center for Clinical Quality and Implementation Science, Section of Hospital Medicine, Department of Medicine, Vanderbilt University Medical Center, 2525 West End, Suite 450, Nashville, TN 37027. USA
| | - Alai Tan
- The Ohio State University College of Nursing, Center for Research and Health Analytics 1585 Neil Avenue, Columbus, OH. 43210. USA
| | - Lorraine C Mion
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH. 43210. USA
| | - Michele C Balas
- University of Nebraska Medical Center College of Nursing, 985330 Nebraska Medical Center, Omaha, NE. 68198-5330. USA
| |
Collapse
|
57
|
Pérez Lucendo A, Piñeiro Otero P, Matía Almudévar P, Alcántara Carmona S, López López E, Ramasco Rueda F. Individualised analgesia, sedation, delirium and comfort management strategies in the ICU: a narrative review. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:509-535. [PMID: 37742996 DOI: 10.1016/j.redare.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023]
Abstract
This group is a product of the collaboration agreement signed by SOMIAMA (Sociedad de Medicina Intensiva de Madrid) and SAR MADRID (Sociedad de Anestesiología, Reanimación y Terapéutica del Dolor de Madrid) under which the organisations agreed to create joint working groups to improve critical patient care. Pain, discomfort, agitation, and delirium cause suffering, delay discharge, and can lead to serious complications in patients admitted to medical and surgical critical care units and post-anaesthesia care units. The main objectives in this type of unit include: Ensuring the comfort of patients suffering or recovering from a critical illness.Avoiding complications associated with the measures, particularly pharmacological, taken to ensure that comfort.
Collapse
Affiliation(s)
- A Pérez Lucendo
- Servicio de Medicina Intensiva, Hospital Universitario de La Princesa, Madrid, Spain.
| | - P Piñeiro Otero
- Servicio de Anestesiología y Reanimación, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - P Matía Almudévar
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - S Alcántara Carmona
- Servicio de Medicina Intensiva, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - E López López
- Servicio de Anestesiología y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - F Ramasco Rueda
- Servicio de Anestesiología y Reanimación, Hospital Universitario de La Princesa, Madrid, Spain
| |
Collapse
|
58
|
Edelstein J, Messenger L, Kinney AR, Graham JE, Malcolm MP. Predicting Receipt and Types of Occupational Therapy Services for Patients with Arousal Deficits in the Neuro Critical Care Unit. Occup Ther Health Care 2023; 37:445-460. [PMID: 35200095 DOI: 10.1080/07380577.2022.2041781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/08/2022] [Indexed: 10/19/2022]
Abstract
Occupational therapy has been identified as a required service in the neuro critical care unit (NCCU), however who receives occupational therapy services and what services they receive are not well understood. We sought to determine if arousal deficits impacted patients' likelihood to receive an occupational therapy evaluation or specific types of occupational therapy interventions in the NCCU. When compared to patients without arousal deficits, patients who were experiencing agitation or light sedation, but not deep sedation, were more likely to receive occupational therapy interventions in the therapeutic activities category. Arousal deficits were not associated with receipt of occupational therapy services or occupational therapy interventions in the self-care or therapeutic exercise categories. Determining predictors of occupational therapy services will help ensure the timely delivery of services by improving the allocation of resources and identifying potential gaps in care.
Collapse
Affiliation(s)
- Jessica Edelstein
- Department of Occupational Therapy, Colorado State University, CO, USA
| | - Lindsey Messenger
- Department of Occupational Therapy, Colorado State University, CO, USA
| | - Adam R Kinney
- Rocky Mountain Mental Illness Research, Education and Clinical Center, Department of Veterans Affairs, Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - James E Graham
- Department of Occupational Therapy, Colorado State University, CO, USA
| | - Matt P Malcolm
- Department of Occupational Therapy, Colorado State University, CO, USA
- Colorado School of Public Health, Colorado State, CO, USA
| |
Collapse
|
59
|
Broadley T, Higgins A, Hodgson C. Physical rehabilitation, mobilization and patient-centred outcomes: what is new? Curr Opin Crit Care 2023; 29:505-512. [PMID: 37641507 DOI: 10.1097/mcc.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW Physical rehabilitation and mobilization interventions aim to reduce the incidence of intensive care unit (ICU)-acquired weakness and subsequently reduce morbidity in critically ill patients. This chapter will explore the evidence for physical rehabilitation and mobilization with an emphasis on patient-centred outcomes selected in randomized controlled trials. This is particularly pertinent at a time when clinicians are deciding how to implement physical rehabilitation and mobilization into the treatment of critically ill patients. RECENT FINDINGS Multiple trials of physical rehabilitation and mobilization were published in 2022 and 2023 with conflicting results. Analysing the complexities of physical rehabilitation research provides an insight into these results and will aid in the interpretation of trials of physical rehabilitation and mobilization. SUMMARY Patient-centred outcomes are often utilized in physical rehabilitation and mobilization research, but this does not automatically correspond to an increase in research quality. Improving consistency in trials of physical rehabilitation will aid in the interpretation and translation of physical rehabilitation research.
Collapse
Affiliation(s)
- Tessa Broadley
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre
- Alfred Health, Melbourne
| | - Alisa Higgins
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre
- The George Institute for Global Health, Sydney
| | - Carol Hodgson
- Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre
- Alfred Health, Melbourne
- The George Institute for Global Health, Sydney
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
60
|
Jones JRA, Karahalios A, Puthucheary ZA, Berry MJ, Files DC, Griffith DM, McDonald LA, Morris PE, Moss M, Nordon-Craft A, Walsh T, Berney S, Denehy L. Responsiveness of Critically Ill Adults With Multimorbidity to Rehabilitation Interventions: A Patient-Level Meta-Analysis Using Individual Pooled Data From Four Randomized Trials. Crit Care Med 2023; 51:1373-1385. [PMID: 37246922 DOI: 10.1097/ccm.0000000000005936] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore if patient characteristics (pre-existing comorbidity, age, sex, and illness severity) modify the effect of physical rehabilitation (intervention vs control) for the coprimary outcomes health-related quality of life (HRQoL) and objective physical performance using pooled individual patient data from randomized controlled trials (RCTs). DATA SOURCES Data of individual patients from four critical care physical rehabilitation RCTs. STUDY SELECTION Eligible trials were identified from a published systematic review. DATA EXTRACTION Data sharing agreements were executed permitting transfer of anonymized data of individual patients from four trials to form one large, combined dataset. The pooled trial data were analyzed with linear mixed models fitted with fixed effects for treatment group, time, and trial. DATA SYNTHESIS Four trials contributed data resulting in a combined total of 810 patients (intervention n = 403, control n = 407). After receiving trial rehabilitation interventions, patients with two or more comorbidities had HRQoL scores that were significantly higher and exceeded the minimal important difference at 3 and 6 months compared with the similarly comorbid control group (based on the Physical Component Summary score (Wald test p = 0.041). Patients with one or no comorbidities who received intervention had no HRQoL outcome differences at 3 and 6 months when compared with similarly comorbid control patients. No patient characteristic modified the physical performance outcome in patients who received physical rehabilitation. CONCLUSIONS The identification of a target group with two or more comorbidities who derived benefits from the trial interventions is an important finding and provides direction for future investigations into the effect of rehabilitation. The multimorbid post-ICU population may be a select population for future prospective investigations into the effect of physical rehabilitation.
Collapse
Affiliation(s)
- Jennifer R A Jones
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
- Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
- Institute of Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Amalia Karahalios
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Zudin A Puthucheary
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England, United Kingdom
- Adult Critical Care Unit, Royal London Hospital, Barts Health NHS Trust, London, England, United Kingdom
| | - Michael J Berry
- Department of Health and Exercise Science, Wake Forest University, Winston Salem, NC
| | - D Clark Files
- Pulmonary, Critical Care, Allergy and Immunologic Disease, Wake Forest University, Winston-Salem, NC
- Wake Forest Critical Illness Injury and Recovery Research Center, Wake Forest University, Winston Salem, NC
| | - David M Griffith
- Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
- Royal Infirmary of Edinburgh, NHS (National Health Service) Lothian, Edinburgh, Scotland, United Kingdom
| | - Luke A McDonald
- Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Peter E Morris
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Marc Moss
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Amy Nordon-Craft
- Physical Therapy Program, University of Colorado School of Medicine, Aurora, CO
| | - Timothy Walsh
- Deanery of Molecular, Genetic and Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom
- Anaesthetics, Critical Care, and Pain Medicine, School of Clinical Sciences, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Sue Berney
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
- Physiotherapy Department, Division of Allied Health, Austin Health, Heidelberg, Victoria, Australia
| | - Linda Denehy
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
- Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
- Allied Health, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| |
Collapse
|
61
|
Lehmkuhl L, Dreyer P, Laerkner E, Tanghus Olsen H, Jespersen E, Juel Rothmann M. Getting the body back on track - Understanding the phenomenon of mobilisation when conscious and mechanically ventilated patients are mobilised in the intensive care unit. Intensive Crit Care Nurs 2023; 78:103450. [PMID: 37172466 DOI: 10.1016/j.iccn.2023.103450] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To gain an in-depth understanding of the phenomenon of mobilisation when conscious and mechanically ventilated patients are mobilised in the intensive care unit. DESIGN A qualitative study with a phenomenological-hermeneutic approach. Data were generated in three intensive care units from September 2019 to March 2020. Participant observations of twelve conscious mechanically ventilated patients, thirty-five nurses and four physiotherapists were performed. Furthermore, seven semi-structured patient interviews were conducted, both on the ward and after discharge. FINDINGS Mobilisation during mechanical ventilation in the intensive care unit followed a trajectory from a failing body to a growing sense of independence in getting the body back on track. Three themes were revealed: 'Challenging to move a failing body', 'Ambiguity of both resistance and willingness in the process of strengthen the body', and 'An ongoing effort in getting the body back on track'. CONCLUSIONS Mobilisation when conscious and mechanically ventilated included support of the living body by physical prompts and ongoing bodily guidance. Resistance and willingness regarding mobilisation were found to be a way of coping with bodily reactions of comfort or discomfort, embedded in a need to feel bodily control. The trajectory of mobilisation promoted a sense of agency, as mobilisation activities at different stages during the intensive care unit stay supported the patients in becoming more active collaborators in getting the body back on track. IMPLICATIONS FOR CLINICAL PRACTICE Ongoing bodily guidance provided by healthcare professionals can promote bodily control and support conscious and mechanically ventilated patients in active participation in mobilisation. Furthermore, understanding the ambiguity of patients' reactions caused by loss of bodily control provides a potential to prepare mechanically ventilated patients for and assist them with mobilisation. In particular, the first mobilisation in the intensive care unit seems to influence the success of future mobilisation, as the body remembers negative experiences.
Collapse
Affiliation(s)
- Lene Lehmkuhl
- Department of Anaesthesiology and Intensive Care, OUH Svendborg Hospital, Baagøes Alle 15, 5700 Svendborg, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark.
| | - Pia Dreyer
- Department of Public Health, Aarhus University, Bartholin's Alle 2, 8000 Aarhus C, Denmark; Department of Intensive Care, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Eva Laerkner
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Anaesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Hanne Tanghus Olsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense C, Denmark.
| | - Eva Jespersen
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Department of Oncology, Odense University Hospital, Kløvervænget 8D, 5000 Odense C, Denmark.
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 5000 Odense C, Denmark; Steno Diabetes Center Odense, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark; Centre for Innovative Medical Technology, Odense University Hospital, Kløvervænget 8C, 5000 Odense, Denmark; Department of Endocrinology, Odense University Hospital, J. B. Winsløws Vej 9a, 5000 Odense, Denmark.
| |
Collapse
|
62
|
Schellenberg CM, Lindholz M, Grunow JJ, Boie S, Bald A, Warner LO, Ulm B, Milnik A, Zickler D, Angermair S, Reißhauer A, Witzenrath M, Menk M, Balzer F, Ocker T, Weber-Carstens S, Schaller SJ. Mobilisation practices during the SARS-CoV-2 pandemic: A retrospective analysis (MobiCOVID). Anaesth Crit Care Pain Med 2023; 42:101255. [PMID: 37257753 PMCID: PMC10226277 DOI: 10.1016/j.accpm.2023.101255] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Corona Virus Disease 2019 (COVID-19) patients display risk factors for intensive care unit acquired weakness (ICUAW). The pandemic increased existing barriers to mobilisation. This study aimed to compare mobilisation practices in COVID-19 and non-COVID-19 patients. METHODS This retrospective cohort study was conducted at Charité-Universitätsmedizin Berlin, Germany, including adult patients admitted to one of 16 ICUs between March 2018, and November 2021. The effect of COVID-19 on mobilisation level and frequency, early mobilisation (EM) and time to active sitting position (ASP) was analysed. Subgroup analysis on COVID-19 patients and the ICU type influencing mobilisation practices was performed. Mobilisation entries were converted into the ICU mobility scale (IMS) using supervised machine learning. The groups were matched using 1:1 propensity score matching. RESULTS A total of 12,462 patients were included, receiving 59,415 mobilisations. After matching 611 COVID-19 and non-COVID-19 patients were analysed. They displayed no significant difference in mobilisation frequency (0.4 vs. 0.3, p = 0.7), maximum IMS (3 vs. 3; p = 0.17), EM (43.2% vs. 37.8%; p = 0.06) or time to ASP (HR 0.95; 95% CI: 0.82, 1.09; p = 0.44). Subgroup analysis showed that patients in surge ICUs, i.e., temporarily created ICUs for COVID-19 patients during the pandemic, more commonly received EM (53.9% vs. 39.8%; p = 0.03) and reached higher maximum IMS (4 vs. 3; p = 0.03) without difference in mobilisation frequency (0.5 vs. 0.3; p = 0.32) or time to ASP (HR 1.15; 95% CI: 0.85, 1.56; p = 0.36). CONCLUSION COVID-19 did not hinder mobilisation. Those treated in surge ICUs were more likely to receive EM and reached higher mobilisation levels.
Collapse
Affiliation(s)
- Clara M Schellenberg
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Berlin, Germany
| | - Maximilian Lindholz
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Berlin, Germany
| | - Julius J Grunow
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Berlin, Germany
| | - Sebastian Boie
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Annika Bald
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Berlin, Germany
| | - Linus O Warner
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Berlin, Germany
| | - Bernhard Ulm
- Technical University of Munich, School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany; Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University Hospital Ulm, Ulm, Germany
| | - Annette Milnik
- Research Platform Molecular and Cognitive Neurosciences (MCN), Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Daniel Zickler
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Nephrology and Medical Intensive Care, Berlin, Germany
| | - Stefan Angermair
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine (CBF), Berlin, Germany
| | - Anett Reißhauer
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rehabilitation Medicine, Berlin, Germany
| | - Martin Witzenrath
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Pulmonary Medicine and Critical Care, Berlin, Germany; German Center for Lung Research (DZL), Berlin, Germany
| | - Mario Menk
- Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Felix Balzer
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Thomas Ocker
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Berlin, Germany; Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Steffen Weber-Carstens
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Berlin, Germany
| | - Stefan J Schaller
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine | CCM | CVK, Berlin, Germany; Technical University of Munich, School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany.
| |
Collapse
|
63
|
Hamazaki N, Kamiya K, Nozaki K, Koike T, Miida K, Yamashita M, Uchida S, Noda T, Maekawa E, Yamaoka-Tojo M, Matsunaga A, Arai M, Kitamura T, Ako J, Miyaji K. Trends and Outcomes of Early Rehabilitation in the Intensive Care Unit for Patients With Cardiovascular Disease: A Cohort Study With Propensity Score-Matched Analysis. Heart Lung Circ 2023; 32:1240-1249. [PMID: 37634967 DOI: 10.1016/j.hlc.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/21/2023] [Accepted: 05/24/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND The effectiveness of acute-phase cardiovascular rehabilitation (CR) in intensive care settings remains unclear in patients with cardiovascular disease (CVD). This study aimed to investigate the trends and outcomes of acute-phase CR in the intensive care unit (ICU) for patients with CVD, including in-hospital and long-term clinical outcomes. METHOD This retrospective cohort study reviewed a total of 1,948 consecutive patients who were admitted to a tertiary academic ICU for CVD treatment and underwent CR during hospitalisation. The endpoints of this study were the following: in-hospital outcomes: probabilities of walking independence and returning home; and long-term outcomes: clinical events 5 years following hospital discharge, including all-cause readmission or cardiovascular events. It evaluated the associations of CR implementation during ICU treatment (ICU-CR) with in-hospital and long-term outcomes using propensity score-matched analysis. RESULTS Among the participants, 1,092 received ICU-CR, the rate of which tended to increase with year trend (p for trend <0.001). After propensity score matching, 758 patients were included for analysis (pairs of n=379 ICU-CR and non-ICU-CR). ICU-CR was significantly associated with higher probabilities of walking independence (rate ratio, 2.04; 95% CI 1.77-2.36) and returning home (rate ratio, 1.22; 95% CI 1.05-1.41). These associations were consistently observed in subgroups aged >65 years, after surgery, emergency, and prolonged ICU stay. ICU-CR showed significantly lower incidences of all-cause (HR 0.71; 95% CI 0.56-0.89) and cardiovascular events (HR 0.69; 95% CI 0.50-0.95) than non-ICU-CR. CONCLUSIONS The implementation of acute-phase CR in ICU increased with year trend, and is considered beneficial to improving in-hospital and long-term outcomes in patients with CVD and various subgroups.
Collapse
Affiliation(s)
- Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan.
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Tomotaka Koike
- Department of Intensive Care, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Kazumasa Miida
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Shota Uchida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Takumi Noda
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Kanagawa, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Masayasu Arai
- Department of Anesthesiology, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| |
Collapse
|
64
|
Barth I, Beumeler LFE, Nahar-van Venrooij L, van Dijk O, Buter H, Boerma EC. The effect of protein provision and exercise therapy on patient-reported and clinical outcomes in intensive care unit survivors: A systematic review. J Hum Nutr Diet 2023; 36:1727-1740. [PMID: 37211649 DOI: 10.1111/jhn.13188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 05/18/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Intensive care unit (ICU) survivors deal with long-term health problems, which negatively affect their quality of life (QoL). Nutritional and exercise intervention could prevent the decline of muscle mass and physical functioning which occurs during critical illness. Despite the growing amount of research, robust evidence is lacking. METHODS For this systematic review, Embase, PubMed and Cochrane Central Register of Controlled Trials databases were searched. The effect of protein provision (PP) or combined protein and exercise therapy (CPE) during or after ICU admission on QoL, physical functioning, muscle health, protein/energy intake and mortality was assessed compared to standard care. RESULTS Four thousand nine hundred and fifty-seven records were identified. After screening, data were extracted for 15 articles (9 randomised controlled trials and 6 non-randomised studies). Two studies reported improvements in muscle mass, of which one found higher independency in activities of daily living. No significant effect was found on QoL. Overall, protein targets were seldom met and often below recommendations. CONCLUSION Evidence for the effect of PP or CPE on patient-reported outcomes in ICU survivors is limited due to study heterogeneity and lack of high-quality studies. Future research and clinical practice should focus on adequate protein delivery with exercise interventions to improve long-term outcomes.
Collapse
Affiliation(s)
- Iris Barth
- Department of Dietetics, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Lise F E Beumeler
- Campus Fryslân, University of Groningen, Leeuwarden, The Netherlands
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Lenny Nahar-van Venrooij
- Department of Data Science and Epidemiology, University Medical Centre Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital, Hertogenbosch, The Netherlands
| | - Olga van Dijk
- Knowledge and Information Centre, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Hanneke Buter
- Department of Data Science and Epidemiology, University Medical Centre Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
- Department of Data Science and Epidemiology, University Medical Centre Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
65
|
Kurematsu K, Ikematsu Y. Quality of Life of Sepsis Survivors. Crit Care Med 2023; 51:1339-1349. [PMID: 37314395 DOI: 10.1097/ccm.0000000000005944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the differences between the quality of life for sepsis and nonsepsis survivors, factors affecting the quality of life for sepsis survivors, and their changes over time. DESIGN A prospective longitudinal study with a quantitative comparative design. SETTING A university hospital in the greater Tokyo area of Japan. PATIENTS The study included 41 and 40 patients in the sepsis and nonsepsis groups, respectively. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Health-related quality of life (HRQOL), independence in activities of daily living (ADL), stress levels, and spirituality were compared between the sepsis and nonsepsis groups at ICU discharge, hospital discharge, and 1 month after discharge. Comparison of HRQOL between the sepsis and nonsepsis groups showed significantly low HRQOL in the sepsis group compared with the nonsepsis group at ICU discharge and hospital discharge. Factors such as stress levels and spirituality affected the HRQOL in the nonsepsis group at ICU discharge. At discharge, stress and spirituality affected HRQOL in both the sepsis and nonsepsis groups. One month after discharge, ADL, stress, and spirituality affected HRQOL in both the sepsis and nonsepsis groups. In terms of changes over time, HRQOL at ICU discharge in the sepsis group was significantly lower than at discharge and 1 month after discharge. The two-way analyses of variance showed no interactions between the groups and time regarding HRQOL. CONCLUSIONS HRQOL of sepsis survivors was significantly lower than that of nonsepsis survivors. ADL and stress influenced HRQOL. The study suggests the importance of ADL training and stress alleviation during the ICU stay.
Collapse
Affiliation(s)
- Kumiko Kurematsu
- Department of Nursing, Nagoya University Graduate School of Medicine, Aichi, Japan
- Department of Nursing, Kitasato University Hospital, Kanagawa, Japan
| | | |
Collapse
|
66
|
Matsuoka A, Yoshihiro S, Shida H, Aikawa G, Fujinami Y, Kawamura Y, Nakanishi N, Shimizu M, Watanabe S, Sugimoto K, Taito S, Inoue S. Effects of Mobilization within 72 h of ICU Admission in Critically Ill Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2023; 12:5888. [PMID: 37762829 PMCID: PMC10531519 DOI: 10.3390/jcm12185888] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Previous systematic review and meta-analysis indicates that rehabilitation within a week of intensive care unit (ICU) admission benefits physical function in critically ill patients. This updated systematic review and meta-analysis aim to clarify effects of initiating rehabilitation within 72 h of ICU admission on long-term physical, cognitive, and mental health. We systematically searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for randomized controlled trials (RCTs) between April 2019 and November 2022 to add to the previous review. Two investigators independently selected and extracted data. Pooled effect estimates for muscle strength, cognitive function, mental health after discharge, and adverse events were calculated. Evidence certainty was assessed via Grading of Recommendations, Assessment, Development, and Evaluations. Eleven RCTs were included in the meta-analysis. Early rehabilitation may improve muscle strength (three trials; standard mean difference [SMD], 0.16; 95% confidence interval [CI], -0.04-0.36) and cognitive function (two trials; SMD, 0.54; 95% CI, -0.13-1.20). Contrastingly, early mobilization showed limited impact on mental health or adverse events. In summary, initiating rehabilitation for critically ill patients within 72 h may improve physical and cognitive function to prevent post-intensive care syndrome without increasing adverse events. The effect on mental function remains uncertain.
Collapse
Affiliation(s)
- Ayaka Matsuoka
- Department of Emergency and Critical Care Medicine, Saga University, 5-1-1 Nabeshima, Saga City 849-8501, Japan;
| | - Shodai Yoshihiro
- Department of Pharmacy, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi 722-8508, Japan;
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan;
| | - Haruka Shida
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2 Kasumigaseki, Chiyodaku, Tokyo 100-0013, Japan;
| | - Gen Aikawa
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi 319-1295, Japan;
| | - Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Central City Hospital, 439 Kakogawacho Honmachi, Kakogawa 675-8611, Japan;
| | - Yusuke Kawamura
- Department of Rehabilitation, Showa General Hospital, 8-1-1 Hanakoganei, Tokyo 187-8510, Japan;
| | - Nobuto Nakanishi
- Department of Disaster and Emergency Medicine, Kobe University, 7-5-2 Kusunoki, Chuo-ward, Kobe 650-0017, Japan;
| | - Motohiro Shimizu
- Department of Intensive Care Medicine, Ryokusen-kai Yonemori Hospital, 1-7-1, Yojiro, Kagoshima 890-0062, Japan;
| | - Shinichi Watanabe
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, 2-92, Gifu 500-8281, Japan;
| | - Kensuke Sugimoto
- Intensive Care Unit, Gunma University Hospital; 39-15 Showa, Maebashi 371-8511, Japan;
| | - Shunsuke Taito
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan;
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3, Kasumi, Hiroshima 734-8551, Japan
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Kobe University, 7-5-2 Kusunoki, Chuo-ward, Kobe 650-0017, Japan;
| |
Collapse
|
67
|
Capo-Lugo CE, McLaughlin KH, Ye B, Daley K, Young D, Lavezza A, Friedman M, Hoyer EH. Using Nursing Assessments of Mobility and Activity to Prioritize Patients Most Likely to Need Rehabilitation Services. Arch Phys Med Rehabil 2023; 104:1402-1408. [PMID: 37028697 DOI: 10.1016/j.apmr.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 02/03/2023] [Accepted: 03/19/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To identify nursing assessments of mobility and activity associated with lower-value rehabilitation services. DESIGN Retrospective cohort analysis of admissions from December 2016 to September 2019 SETTING: Medicine, neurology, and surgery units (n=47) at a tertiary hospital. PARTICIPANTS We included patients with a length of stay ≥7 days on units that routinely assessed patient function (n=18,065 patients). INTERVENTIONS Not applicable. MAIN OUTCOME We examined the utility of nursing assessments of function to identify patients who received lower-value rehabilitation consults, defined as those who received ≤1 therapy visit. MEASURES Patient function was assessed using 2 Activity Measure for Post-Acute Care (AM-PAC or "6 clicks") inpatient short forms: (1) basic mobility (eg, bed mobility, walking) and (2) daily activity (eg, grooming, toileting). RESULTS Using an AM-PAC cutoff value of ≥23 correctly identified 92.5% and 98.7% of lower-value physical therapy and occupational therapy visits, respectively. In our cohort, using a cutoff value of ≥23 on the AM-PAC would have eliminated 3482 (36%) of lower-value physical therapy consults and 4076 (34%) of lower-value occupational therapy consults. CONCLUSIONS Nursing assessment, using AM-PAC scores, can be used to help identify lower-value rehabilitation consults, which can then be reallocated to patients with greater rehabilitation needs. Based on our results, an AM-PAC cutoff value of ≥23 can be used as a guide to help prioritize patients with greater rehabilitation needs.
Collapse
Affiliation(s)
- Carmen E Capo-Lugo
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama; Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Kevin H McLaughlin
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Bingqing Ye
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Kelly Daley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel Young
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, Nevada, United States
| | - Annette Lavezza
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Michael Friedman
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins Hospital, Baltimore, Maryland
| |
Collapse
|
68
|
Suclupe S, Efrain Pantoja Bustillos P, Bracchiglione J, Requeijo C, Salas-Gama K, Solà I, Merchán-Galvis A, Uya Muntaña J, Robleda G, Martinez-Zapata MJ. Effectiveness of nonpharmacological interventions to prevent adverse events in the intensive care unit: A review of systematic reviews. Aust Crit Care 2023; 36:902-914. [PMID: 36572576 DOI: 10.1016/j.aucc.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Different types of interventions have been assessed for the prevention of adverse events. However, determining which patient-safety practice is most effective can be challenging when there is no systematised evidence synthesis. An overview following the best methodological standards can provide the best reliable integrative evidence. OBJECTIVES The objective of this study was to provide an overview of effectiveness nonpharmacological interventions aimed at preventing adverse events in the intensive care unit. METHODS A review of systematic reviews (SRs) was conducted according to the Cochrane Handbook and PRISMA recommendations. PubMed, CINAHL, and Cochrane Library were searched for SRs published until March 2022. Two reviewers independently assessed the study's quality, using AMSTAR-2, and extracted data on intervention characteristics and effect on prevention of adverse events. RESULTS Thirty-seven SRs were included, and 27 nonpharmacological interventions were identified to prevent 11 adverse events. Most of the reviews had critically low methodological quality. Among all the identified interventions, subglottic secretion drainage, semirecumbent position, and kinetic bed therapy were effective in preventing ventilator-associated pneumonia; the use of earplugs, early mobilisation, family participation, and music in reducing delirium; physical rehabilitation in improving muscle strength; use of respiratory support in preventing reintubation; the use of a computerised physician order entry system in reducing risk of medication errors; and the use of heated water humidifier was effective in reducing artificial airway occlusion. CONCLUSIONS Some nonpharmacological interventions reduced adverse events in the intensive care setting. These findings should be interpreted carefully due to the low methodological quality. SRs on preventing adverse events in the intensive care unit should adhere to quality assessment tools so that best evidence can be used in decision-making.
Collapse
Affiliation(s)
- Stefanie Suclupe
- Universitat Autònoma de Barcelona, Spain; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain.
| | | | - Javier Bracchiglione
- Universitat Autònoma de Barcelona, Spain; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain; Interdisciplinary Centre for Health Studies (CIESAL), Universidad de Valparaíso, Chile
| | - Carolina Requeijo
- Epidemiology and Public Health Department, Hospital de La Santa Creu I Sant Pau, Institut de Recerca IIB Sant Pau, Barcelona, Spain
| | - Karla Salas-Gama
- Universitat Autònoma de Barcelona, Spain; Vall D'Hebron University Hospital, Barcelona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain; Epidemiology and Public Health Department, Hospital de La Santa Creu I Sant Pau, Institut de Recerca IIB Sant Pau, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain
| | - Angela Merchán-Galvis
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain; Department of Social Medicine and Family Health, Universidad Del Cauca, Colombia
| | - Jaume Uya Muntaña
- Hospital Universitario de Bellvitge, Instituto Català de Salut, Nursing Research Group, Bellvitge Institute for Biomedical Research, Spain
| | - Gemma Robleda
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain; Nursing School of Barcelona, Campus Docent Sant Joan de Déu-Private Foundation, University of Barcelona, Spain
| | - Maria Jose Martinez-Zapata
- Universitat Autònoma de Barcelona, Spain; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain
| |
Collapse
|
69
|
Knecht S, Reiners H, Siebler M, Platz T, Flöel A, Busse R. [Slow demographic change and neurological rehabilitation-Part 1: state of affairs]. DER NERVENARZT 2023; 94:708-717. [PMID: 36534175 PMCID: PMC9761641 DOI: 10.1007/s00115-022-01415-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/23/2022]
Abstract
In the next two decades the aging baby boomers in Germany will gradually be leaving the work force. They are being followed by the much less numerous, "baby bust" generation who now need to finance and staff healthcare for the growing number of old people in society. In order to care for more needy persons with a smaller working population, the healthcare system must be restructured; however, despite these worrisome prospects, the awareness of the problem is still low in many areas. Here we focus on the area in the healthcare system that is growing particularly rapidly and additionally has the greatest need of personnel per patient: the care of the critically ill and functionally impaired patients. The lack of coordination of hospitals, rehabilitation centers and nursing institution is historical in origin. It promotes the tendency to discharge functionally impaired patients to nursing facilities without giving them a chance for recovery of functional autonomy. As the demographic change progresses, this tendency threatens to increase. In a first of two parts, we attempt to describe the present situation.
Collapse
Affiliation(s)
- Stefan Knecht
- Institut für Klinische Neurowissenschaften, AG Neurorehabilitation, Heinrich-Heine Universität Düsseldorf, Düsseldorf, Deutschland.
| | - Harmut Reiners
- Ministerialrat a. D., Ministerium für Gesundheit und Familie (MAGS) Brandenburg, Brandenburg, Deutschland
| | - Mario Siebler
- Fachklinik für Neurologie, Rhein/Ruhr, Essen, Deutschland
| | - Thomas Platz
- Forschung, BDH-Klinik Greifswald, Greifswald, Deutschland
| | - Agnes Flöel
- Klinik und Poliklinik für Neurologie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Reinhard Busse
- Fakultät Wirtschaft und Management, Technische Universität Berlin, Berlin, Deutschland
| |
Collapse
|
70
|
King E, Nydahl P, Manning JC. Rehabilitation across the life course and critical care pathway: Much more than learning to walk again. Nurs Crit Care 2023; 28:475-477. [PMID: 37379003 DOI: 10.1111/nicc.12935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Elizabeth King
- Oxford Allied Health Professions Research & Innovation Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Peter Nydahl
- Nursing Research, University Hospital of Schleswig-Holstein, Kiel, Germany
- Institute of Nursing Science and Development, Paracelsus Medical University, Salzburg, Austria
| | - Joseph C Manning
- Children and Young People Health Research (CYPHR), School of Health Sciences, The University of Nottingham, Nottingham, United Kingdom
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| |
Collapse
|
71
|
Wang L, Hua Y, Wang L, Zou X, Zhang Y, Ou X. The effects of early mobilization in mechanically ventilated adult ICU patients: systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1202754. [PMID: 37448799 PMCID: PMC10336545 DOI: 10.3389/fmed.2023.1202754] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/02/2023] [Indexed: 07/15/2023] Open
Abstract
Background The effects of early mobilization (EM) on intensive care unit (ICU) patients remain unclear. A meta-analysis of randomized controlled trials was performed to evaluate its effect in mechanically ventilated adult ICU patients. Methods We searched randomized controlled trials (RCTs) published in Medline, Embase, and CENTRAL databases (from inception to November 2022). According to the difference in timing and type, the intervention group was defined as a systematic EM group, and comparator groups were divided into the late mobilization group and the standard EM group. The primary outcome was mortality. The secondary outcomes were ICU length of stay, duration of mechanical ventilation (MV), and adverse events. EM had no impact on 180-day mortality and hospital mortality between intervention groups and comparator groups (RR 1.09, 95% CI 0.89-1.33, p = 0.39). Systemic EM reduced the ICU length of stay (LOS) (MD -2.18, 95% CI -4.22--0.13, p = 0.04) and the duration of MV (MD -2.27, 95% CI -3.99--0.56, p = 0.009), but it may increase the incidence of adverse events in patients compared with the standard EM group (RR 1.99, 95% CI 1.25-3.16, p = 0.004). Conclusion Systematic EM has no significant effect on short- or long-term mortality in mechanically ventilated adult ICU patients, but systematic EM could reduce the ICU LOS and duration of MV.
Collapse
Affiliation(s)
- Lijie Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yusi Hua
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Luping Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xia Zou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yan Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiaofeng Ou
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
72
|
Kumpf O, Assenheimer M, Bloos F, Brauchle M, Braun JP, Brinkmann A, Czorlich P, Dame C, Dubb R, Gahn G, Greim CA, Gruber B, Habermehl H, Herting E, Kaltwasser A, Krotsetis S, Kruger B, Markewitz A, Marx G, Muhl E, Nydahl P, Pelz S, Sasse M, Schaller SJ, Schäfer A, Schürholz T, Ufelmann M, Waydhas C, Weimann J, Wildenauer R, Wöbker G, Wrigge H, Riessen R. Quality indicators in intensive care medicine for Germany - fourth edition 2022. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2023; 21:Doc10. [PMID: 37426886 PMCID: PMC10326525 DOI: 10.3205/000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Indexed: 07/11/2023]
Abstract
The measurement of quality indicators supports quality improvement initiatives. The German Interdisciplinary Society of Intensive Care Medicine (DIVI) has published quality indicators for intensive care medicine for the fourth time now. After a scheduled evaluation after three years, changes in several indicators were made. Other indicators were not changed or only minimally. The focus remained strongly on relevant treatment processes like management of analgesia and sedation, mechanical ventilation and weaning, and infections in the ICU. Another focus was communication inside the ICU. The number of 10 indicators remained the same. The development method was more structured and transparency was increased by adding new features like evidence levels or author contribution and potential conflicts of interest. These quality indicators should be used in the peer review in intensive care, a method endorsed by the DIVI. Other forms of measurement and evaluation are also reasonable, for example in quality management. This fourth edition of the quality indicators will be updated in the future to reflect the recently published recommendations on the structure of intensive care units by the DIVI.
Collapse
Affiliation(s)
- Oliver Kumpf
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Berlin, Germany
| | | | - Frank Bloos
- Jena University Hospital, Department of Anaesthesiology and Intensive Care Medicine, Jena, Germany
| | - Maria Brauchle
- Landeskrankenhaus Feldkirch, Department of Anesthesiology and Intensive Care Medicine, Feldkirch, Austria
| | - Jan-Peter Braun
- Martin-Luther-Krankenhaus, Department of Anesthesiology and Intensive Care Medicine, Berlin, Germany
| | - Alexander Brinkmann
- Klinikum Heidenheim, Department of Anesthesia, Surgical Intensive Care Medicine and Special Pain Therapy, Heidenheim, Germany
| | - Patrick Czorlich
- University Medical Center Hamburg-Eppendorf, Department of Neurosurgery, Hamburg, Germany
| | - Christof Dame
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neonatology, Berlin, Germany
| | - Rolf Dubb
- Kreiskliniken Reutlingen, Academy of the District Hospitals Reutlingen, Germany
| | - Georg Gahn
- Städt. Klinikum Karlsruhe gGmbH, Department of Neurology, Karlsruhe, Germany
| | - Clemens-A. Greim
- Klinikum Fulda, Department of Anesthesia and Surgical Intensive Care Medicine, Fulda, Germany
| | - Bernd Gruber
- Niels Stensen Clinics, Marienhospital Osnabrueck, Department Hospital Hygiene, Osnabrueck, Germany
| | - Hilmar Habermehl
- Kreiskliniken Reutlingen, Klinikum am Steinenberg, Center for Intensive Care Medicine, Reutlingen, Germany
| | - Egbert Herting
- Universitätsklinikum Schleswig-Holstein, Department of Pediatrics and Adolescent Medicine, Campus Lübeck, Germany
| | - Arnold Kaltwasser
- Kreiskliniken Reutlingen, Academy of the District Hospitals Reutlingen, Germany
| | - Sabine Krotsetis
- Universitätsklinikum Schleswig-Holstein, Nursing Development and Nursing Science, affiliated with the Nursing Directorate Campus Lübeck, Germany
| | - Bastian Kruger
- Klinikum Heidenheim, Department of Anesthesia, Surgical Intensive Care Medicine and Special Pain Therapy, Heidenheim, Germany
| | | | - Gernot Marx
- University Hospital RWTH Aachen, Department of Intensive Care Medicine and Intermediate Care, Aachen, Germany
| | | | - Peter Nydahl
- Universitätsklinikum Schleswig-Holstein, Nursing Development and Nursing Science, affiliated with the Nursing Directorate Campus Kiel, Germany
| | - Sabrina Pelz
- Universitäts- und Rehabilitationskliniken Ulm, Intensive Care Unit, Ulm, Germany
| | - Michael Sasse
- Medizinische Hochschule Hannover, Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hanover, Germany
| | - Stefan J. Schaller
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Intensive Care Medicine, Berlin, Germany
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care Medicine, Munich, Germany
| | | | - Tobias Schürholz
- University Hospital RWTH Aachen, Department of Intensive Care Medicine and Intermediate Care, Aachen, Germany
| | - Marina Ufelmann
- Technical University of Munich, Klinikum rechts der Isar, Department of Nursing, Munich, Germany
| | - Christian Waydhas
- Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Surgical University Hospital and Polyclinic, Bochum, Germany
- Medical Department of the University of Duisburg-Essen, Essen, Germany
| | - Jörg Weimann
- Sankt-Gertrauden Krankenhaus, Department of Anesthesia and Interdisciplinary Intensive Care Medicine, Berlin, Germany
| | | | - Gabriele Wöbker
- Helios Universitätsklinikum Wuppertal, Universität Witten-Herdecke, Department of Intensive Care Medicine, Wuppertal, Germany
| | - Hermann Wrigge
- Bergmannstrost Hospital Halle, Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Halle, Germany
- Martin-Luther University Halle-Wittenberg, Medical Faculty, Halle, Germany
| | - Reimer Riessen
- Universitätsklinikum Tübingen, Department of Internal Medicine, Medical Intensive Care Unit, Tübingen, Germany
| |
Collapse
|
73
|
Cancio JM, Dewey WS. Critical Care Rehabilitation of the Burn Patient. Surg Clin North Am 2023; 103:483-494. [PMID: 37149384 DOI: 10.1016/j.suc.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Despite the fact that modern burn care has significantly reduced the mortality associated with severe burn injuries, the rehabilitation and community reintegration of survivors continues to be a challenge. An interprofessional team approach is essential for optimal outcomes. This includes early occupational and physical therapy, beginning in the intensive care unit (ICU). Burn-specific techniques (edema management, wound healing, and contracture prevention) are successfully integrated into the burn ICU. Research demonstrates that early intensive rehabilitation of critically ill burn patients is safe and effective. Further work on the physiologic, functional, and long-term impact of this care is needed.
Collapse
Affiliation(s)
- Jill M Cancio
- US Army Institute of Surgical Research, 3698 Chambers Pass Suite B, JBSA Fort Sam Houston, TX 78234-7767, USA.
| | - William S Dewey
- US Army Institute of Surgical Research, 3698 Chambers Pass Suite B, JBSA Fort Sam Houston, TX 78234-7767, USA
| |
Collapse
|
74
|
Romanet C, Wormser J, Fels A, Lucas P, Prudat C, Sacco E, Bruel C, Plantefève G, Pene F, Chatellier G, Philippart F. Effectiveness of exercise training on the dyspnoea of individuals with long COVID: A randomised controlled multicentre trial. Ann Phys Rehabil Med 2023; 66:101765. [PMID: 37271020 PMCID: PMC10237688 DOI: 10.1016/j.rehab.2023.101765] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND COVID-19-related acute respiratory distress syndrome (CARDS) is a severe evolution of the Sars-Cov-2 infection and necessitates intensive care. COVID-19 may subsequently be associated with long COVID, whose symptoms can include persistent respiratory symptoms up to 1 year later. Rehabilitation is currently recommended by most guidelines for people with this condition. OBJECTIVES To evaluate the effects of exercise training rehabilitation (ETR) on dyspnoea and health-related quality of life measures in people with continuing respiratory discomfort following CARDS. METHODS In this multicentre, two-arm, parallel, open, assessor-blinded, randomised controlled trial, we enroled adults previously admitted with CARDS to 3 French intensive care units who had been discharged at least 3 months earlier and who presented with an mMRC dyspnoea scale score > 1. Participants received either ETR or standard physiotherapy (SP) for 90 days. The primary outcome was dyspnoea, as measured by the Multidimensional Dyspnoea Profile (MDP), at day 0 (inclusion) and after 90 days of physiotherapy. Secondary outcomes were the mMRC and 12-item Short-Form Survey scores. RESULTS Between August 7, 2020, and January 26, 2022, 487 participants with CARDS were screened for inclusion, of whom 60 were randomly assigned to receive either ETR (n = 27) or SP (n = 33). Mean MDP following ETR was 42% lower than after SP (26.15 vs. 44.76); a difference of -18.61 (95% CI -27.78 to -9.44; p<10-4). CONCLUSION People who were still suffering from breathlessness three months after being discharged from hospital with CARDS had significantly improved dyspnoea scores when treated with ETR therapy for 90 days unlike those who only received SP. Study registered 29/09/2020 on Clinicaltrials.gov (NCT04569266).
Collapse
Affiliation(s)
- Christophe Romanet
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France.
| | - Johan Wormser
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Audrey Fels
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Pauline Lucas
- Department of Intensive Care, Hopital Cochin - Port Royal, Paris, France
| | - Camille Prudat
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Emmanuelle Sacco
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Cédric Bruel
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Gaëtan Plantefève
- Department of Intensive Care, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Frédéric Pene
- Department of Intensive Care, Hopital Cochin - Port Royal, Paris, France
| | - Gilles Chatellier
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - François Philippart
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
| |
Collapse
|
75
|
Cerier E, Manerikar A, Kandula V, Nykiel T, Lane S, Gabaldon R, Toyoda T, Yagi Y, Bharat A, Kurihara C. Early initiation of physical and occupational therapy while on extracorporeal life support improves patients' functional activity. Artif Organs 2023; 47:870-881. [PMID: 36310407 PMCID: PMC10148928 DOI: 10.1111/aor.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Managing acute respiratory distress syndrome (ARDS) patients on venovenous extracorporeal membrane oxygenation (V-V ECMO), without sedation/neuromuscular blockade to allow physical and occupational therapy (PT/OT) participation, is untraditional. Here, we investigate the impact of early PT/OT initiation on discharge functional activity for ARDS patients managed on V-V ECMO. METHODS This is a retrospective review of 67 ARDS patients managed with V-V ECMO at a single academic center from February 2018 to June 2021. Data collected included patient characteristics, days of V-V ECMO support, day of PT/OT initiation, and ambulation distance and Activity Measure for Post-Acute Care (AMPAC) Six-Clicks score on day of discharge. RESULTS Patients with >7 days of V-V ECMO support had decreased ambulation and AMPAC scores compared to those with <7 days (70.5 vs. 162.1, p < 0.01 and 12.3 vs. 16.4, p = 0.01, respectively). PT/OT initiation within 7 days after starting V-V ECMO significantly improved ambulation and AMPAC scores (163.5 vs. 59.5, p < 0.001, and 16.6 vs. 11.8, p < 0.01, respectively). Additionally, in patients with >7 days of V-V ECMO support, those who began PT/OT within 8 days of V-V ECMO cannulation had significantly improved ambulation and AMPAC scores (151.8 vs. 44.2, p < 0.01, and 16.5 vs. 11.0, p < 0.01, respectively). CONCLUSION Early PT/OT initiation in severe ARDS patients managed on V-V ECMO is associated with improved patient functional activity on day of discharge. Our study further supports the use of V-V ECMO in treatment of severe ARDS without sedation/neuromuscular blockade and specifically demonstrates PT/OT should be started early following V-V ECMO cannulation.
Collapse
Affiliation(s)
- Emily Cerier
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adwaiy Manerikar
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Viswajit Kandula
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tara Nykiel
- Department of Rehabilitation Services, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shelby Lane
- Department of Rehabilitation Services, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rebecca Gabaldon
- Department of Rehabilitation Services, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Takahide Toyoda
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Yuriko Yagi
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ankit Bharat
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chitaru Kurihara
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
76
|
Qi W, Murphy TE, Doyle MM, Ferrante LE. Association Between Daily Average of Mobility Achieved During Physical Therapy Sessions and Hospital-Acquired or Ventilator-Associated Pneumonia among Critically Ill Patients. J Intensive Care Med 2023; 38:418-424. [PMID: 36278257 PMCID: PMC10065937 DOI: 10.1177/08850666221133318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Hospital-acquired and ventilator-associated pneumonias (HAP and VAP) are associated with increased morbidity and mortality. Immobility is a risk factor for developing ICU-acquired weakness (ICUAW). Early mobilization is associated with improved physical function, but its association with hospital-acquired (HAP) and ventilator-associated pneumonias (VAP) is unknown. The purpose of this study is to evaluate the association between daily average of highest level of mobility achieved during physical therapy (PT) and incidence of HAP or VAP among critically ill patients. MATERIALS AND METHODS In a retrospective cohort study of progressive mobility program participants in the medical ICU, we used a validated method to abstract new diagnoses of HAP and VAP. We captured scores on a mobility scale achieved during each inpatient physical therapy session and used a Bayesian, discrete time-to-event model to evaluate the association between daily average of highest level of mobility achieved and occurrence of HAP or VAP. RESULTS The primary outcome of HAP/VAP occurred in 55 (26.8%) of the 205 participants. Each increase in the daily average of highest level of mobility achieved during PT (0-6 mobility scale) exhibited a protective association with occurrence of HAP or VAP (adjusted hazard ratio [HR] 0.61; 95% CI 0.44, 0.85). Age, baseline ambulatory status, Acute Physiology and Chronic Health Evaluation (APACHE) II, and previous day's mechanical ventilation (MV) status were not significantly associated with the occurrence of HAP/VAP. CONCLUSIONS Among critically ill patients in a progressive mobility program, a higher daily average of highest level of mobility achieved during PT was associated with a decreased risk of HAP or VAP.
Collapse
Affiliation(s)
- Wei Qi
- Brigham and Women’s Hospital Department of Medicine, Division of Pulmonary and Critical Care Medicine, Boston, MA, USA
| | - Terrence E. Murphy
- Yale University, Internal Medicine, Geriatrics Section, New Haven, CT, USA
| | - Margaret M. Doyle
- Yale University, Internal Medicine, Geriatrics Section, New Haven, CT, USA
| | - Lauren E. Ferrante
- Yale School of Medicine, Internal Medicine; Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA
| |
Collapse
|
77
|
O'Grady HK, Reid JC, Farley C, Hanna QEB, Unger J, Zorko DJ, Bosch J, Turkstra LS, Kho ME. Comparator Groups in ICU-Based Studies of Physical Rehabilitation: A Scoping Review of 125 Studies. Crit Care Explor 2023; 5:e0917. [PMID: 37181539 PMCID: PMC10171473 DOI: 10.1097/cce.0000000000000917] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
To characterize comparator groups (CGs) in ICU-based studies of physical rehabilitation (PR), including the type, content, and reporting. DATA SOURCES We followed a five-stage scoping review methodology, searching five databases from inception to June 30, 2022. Study selection and data extraction were completed independently, in duplicate. STUDY SELECTION We screened studies by title and abstract, then full-text. We included prospective studies with greater than or equal to two arms enrolling mechanically ventilated adults (≥ 18 yr), with any planned PR intervention initiated in the ICU. DATA EXTRACTION We conducted a quantitative content analysis of authors' description of CG type and content. We categorized similar CG types (e.g., usual care), classified content into unique activities (e.g., positioning), and summarized these data using counts (proportions). We assessed reporting using Consensus on Exercise Reporting Template (CERT; proportion of reported items/total applicable). DATA SYNTHESIS One hundred twenty-five studies were included, representing 127 CGs. PR was planned in 112 CGs (88.2%; 110 studies), representing four types: usual care (n = 81, 63.8%), alternative treatment than usual care (e.g., different from intervention; n = 18, 14.2%), alternative treatment plus usual care (n = 7, 5.5%), and sham (n = 6, 4.7%). Of 112 CGs with planned PR, 90 CGs (88 studies) reported 60 unique activities, most commonly passive range of motion (n = 47, 52.2%). The remaining 22 CGs (19.6%; 22 studies) reported vague descriptions. PR was not planned in 12 CGs (9.5%; 12 studies), and three CGs (2.4%; three studies) reported no details. Studies reported a median (Q1-Q3) of 46.6% (25.0-73.3%) CERT items. Overall, 20.0% of studies reported no detail to understand planned CG activities. CONCLUSIONS The most common type of CG was usual care. We identified heterogeneity in planned activities and CERT reporting deficiencies. Our results could help guide the selection, design, and reporting of CGs in future ICU-based PR studies.
Collapse
Affiliation(s)
- Heather K O'Grady
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Julie C Reid
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Christopher Farley
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Quincy E B Hanna
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Janelle Unger
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
| | - David J Zorko
- Department of Pediatric Critical Care Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jackie Bosch
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lyn S Turkstra
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Physiotherapy Department, St. Joseph's Healthcare, Hamilton, ON, Canada
| |
Collapse
|
78
|
Abstract
PURPOSE OF REVIEW Sepsis, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a leading cause of hospital and ICU admission. The central and peripheral nervous system may be the first organ system to show signs of dysfunction, leading to clinical manifestations such as sepsis-associated encephalopathy (SAE) with delirium or coma and ICU-acquired weakness (ICUAW). In the current review, we want to highlight developing insights into the epidemiology, diagnosis, prognosis, and treatment of patients with SAE and ICUAW. RECENT FINDINGS The diagnosis of neurological complications of sepsis remains clinical, although the use of electroencephalography and electromyography can support the diagnosis, especially in noncollaborative patients, and can help in defining disease severity. Moreover, recent studies suggest new insights into the long-term effects associated with SAE and ICUAW, highlighting the need for effective prevention and treatment. SUMMARY In this manuscript, we provide an overview of recent insights and developments in the prevention, diagnosis, and treatment of patients with SAE and ICUAW.
Collapse
Affiliation(s)
- Simone Piva
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital
| | - Michele Bertoni
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital
| | - Nicola Gitti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
| | - Francesco A. Rasulo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital
- ’Alessandra Bono’ University Research Center on Long-term Outcome in Critical Illness Survivors, University of Brescia, Brescia, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital
- ’Alessandra Bono’ University Research Center on Long-term Outcome in Critical Illness Survivors, University of Brescia, Brescia, Italy
| |
Collapse
|
79
|
Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Heart Lung Transplant 2023; 42:e1-e64. [PMID: 36805198 DOI: 10.1016/j.healun.2022.10.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
80
|
Clarissa C. Recovery after intensive care—A critical commentary on
Dear ICU Survivor
by Mark Hudson. Nurs Crit Care 2023. [PMID: 37379005 DOI: 10.1111/nicc.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
|
81
|
Modrykamien AM. Enhancing the awakening to family engagement bundle with music therapy. World J Crit Care Med 2023; 12:41-52. [PMID: 37034022 PMCID: PMC10075048 DOI: 10.5492/wjccm.v12.i2.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/19/2022] [Accepted: 02/02/2023] [Indexed: 03/07/2023] Open
Abstract
Survivors of prolonged intensive care unit (ICU) admissions may present undesirable long-term outcomes. In particular, physical impairment and cognitive dysfunction have both been described in patients surviving episodes requiring mechanical ventilation and sedation. One of the strategies to prevent the aforementioned outcomes involves the implementation of a bundle composed by: (1) Spontaneous awakening trial; (2) Spontaneous breathing trial; (3) Choosing proper sedation strategies; (4) Delirium detection and management; (5) Early ICU mobility; and (6) Family engagement (ABCDEF bundle). The components of this bundle contribute in shortening length of stay on mechanical ventilation and reducing incidence of delirium. Since the first description of the ABCDEF bundle, other relevant therapeutic factors have been proposed, such as introducing music therapy. This mini-review describes the current evidence supporting the use of the ABCDEF bundle, as well as current knowledge on the implementation of music therapy.
Collapse
Affiliation(s)
- Ariel M Modrykamien
- Department of Pulmonary and Critical Care, Baylor University Medical Center, Dallas, TE 75246, United States
| |
Collapse
|
82
|
Al-Dorzi HM, AlQahtani S, Al-Dawood A, Al-Hameed FM, Burns KEA, Mehta S, Jose J, Alsolamy SJ, Abdukahil SAI, Afesh LY, Alshahrani MS, Mandourah Y, Almekhlafi GA, Almaani M, Al Bshabshe A, Finfer S, Arshad Z, Khalid I, Mehta Y, Gaur A, Hawa H, Buscher H, Lababidi H, Al Aithan A, Arabi YM. Association of early mobility with the incidence of deep-vein thrombosis and mortality among critically ill patients: a post hoc analysis of PREVENT trial. Crit Care 2023; 27:83. [PMID: 36869382 PMCID: PMC9985278 DOI: 10.1186/s13054-023-04333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/24/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND This study assessed the mobility levels among critically ill patients and the association of early mobility with incident proximal lower-limb deep-vein thrombosis and 90-day mortality. METHODS This was a post hoc analysis of the multicenter PREVENT trial, which evaluated adjunctive intermittent pneumatic compression in critically ill patients receiving pharmacologic thromboprophylaxis with an expected ICU stay ≥ 72 h and found no effect on the primary outcome of incident proximal lower-limb deep-vein thrombosis. Mobility levels were documented daily up to day 28 in the ICU using a tool with an 8-point ordinal scale. We categorized patients according to mobility levels within the first 3 ICU days into three groups: early mobility level 4-7 (at least active standing), 1-3 (passive transfer from bed to chair or active sitting), and 0 (passive range of motion). We evaluated the association of early mobility and incident lower-limb deep-vein thrombosis and 90-day mortality by Cox proportional models adjusting for randomization and other co-variables. RESULTS Of 1708 patients, only 85 (5.0%) had early mobility level 4-7 and 356 (20.8%) level 1-3, while 1267 (74.2%) had early mobility level 0. Patients with early mobility levels 4-7 and 1-3 had less illness severity, femoral central venous catheters, and organ support compared to patients with mobility level 0. Incident proximal lower-limb deep-vein thrombosis occurred in 1/85 (1.3%) patients in the early mobility 4-7 group, 7/348 (2.0%) patients in mobility 1-3 group, and 50/1230 (4.1%) patients in mobility 0 group. Compared with early mobility group 0, mobility groups 4-7 and 1-3 were not associated with differences in incident proximal lower-limb deep-vein thrombosis (adjusted hazard ratio [aHR] 1.19, 95% confidence interval [CI] 0.16, 8.90; p = 0.87 and 0.91, 95% CI 0.39, 2.12; p = 0.83, respectively). However, early mobility groups 4-7 and 1-3 had lower 90-day mortality (aHR 0.47, 95% CI 0.22, 1.01; p = 0.052, and 0.43, 95% CI 0.30, 0.62; p < 0.0001, respectively). CONCLUSIONS Only a small proportion of critically ill patients with an expected ICU stay ≥ 72 h were mobilized early. Early mobility was associated with reduced mortality, but not with different incidence of deep-vein thrombosis. This association does not establish causality, and randomized controlled trials are required to assess whether and to what extent this association is modifiable. TRIAL REGISTRATION The PREVENT trial is registered at ClinicalTrials.gov, ID: NCT02040103 (registered on 3 November 2013) and Current controlled trials, ID: ISRCTN44653506 (registered on 30 October 2013).
Collapse
Affiliation(s)
- Hasan M Al-Dorzi
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Samah AlQahtani
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Al-Dawood
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Fahad M Al-Hameed
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia
| | - Karen E A Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Unity Health Toronto - St Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Sangeeta Mehta
- Department of Medicine, University of Toronto, Toronto, Canada.,Medical Surgical ICU, Sinai Health, Toronto, Canada
| | - Jesna Jose
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Sami J Alsolamy
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Sheryl Ann I Abdukahil
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Lara Y Afesh
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed S Alshahrani
- Department of Emergency and Critical Care Medicine, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Yasser Mandourah
- Military Medical Services, Ministry of Defense, Riyadh, Kingdom of Saudi Arabia
| | - Ghaleb A Almekhlafi
- Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Almaani
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ali Al Bshabshe
- Department of Critical Care Medicine, King Khalid University, Asir Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Zia Arshad
- Department of Anesthesiology and Critical Care, King George's Medical University, Lucknow, India
| | - Imran Khalid
- Critical Care Section, Department of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Yatin Mehta
- Institute of Critical Care and Anaesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Atul Gaur
- Intensive Care Department, Gosford Hospital, Gosford, NSW, Australia
| | - Hassan Hawa
- Critical Care Medicine Department, King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Hergen Buscher
- Department of Intensive Care Medicine, Center for Applied Medical Research, St. Vincent's Hospital, University of New South Wales, Sydney, Australia
| | - Hani Lababidi
- Department of Pulmonary and Critical Care Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Abdulsalam Al Aithan
- Intensive Care Division, Department of Medicine, King Abdulaziz Hospital, Ministry of National Guard Health Affairs, Al Ahsa, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center , Al Ahsa, Kingdom of Saudi Arabia
| | - Yaseen M Arabi
- Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia. .,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
| | | |
Collapse
|
83
|
Levine Z, Vijayan A. Prolonged Intermittent Kidney Replacement Therapy. Clin J Am Soc Nephrol 2023; 18:383-391. [PMID: 36041792 PMCID: PMC10103225 DOI: 10.2215/cjn.04310422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Kidney replacement therapy (KRT) is a vital, supportive treatment for patients with critical illness and severe AKI. The optimal timing, dose, and modality of KRT have been studied extensively, but gaps in knowledge remain. With respect to modalities, continuous KRT and intermittent hemodialysis are well-established options, but prolonged intermittent KRT is becoming more prevalent worldwide, particularly in emerging countries. Compared with continuous KRT, prolonged intermittent KRT offers similar hemodynamic stability and overall cost savings, and its intermittent nature allows patients time off therapy for mobilization and procedures. When compared with intermittent hemodialysis, prolonged intermittent KRT offers more hemodynamic stability, particularly in patients who remain highly vulnerable to hypotension from aggressive ultrafiltration over a shorter duration of treatment. The prescription of prolonged intermittent KRT can be tailored to patients' progression in their recovery from critical illness, and the frequency, flow rates, and duration of treatment can be modified to avert hemodynamic instability during de-escalation of care. Dosing of prolonged intermittent KRT can be extrapolated from urea kinetics used to calculate clearance for continuous KRT and intermittent hemodialysis. Practice variations across institutions with respect to terminology, prescription, and dosing of prolonged intermittent KRT create significant challenges, especially in creating specific drug dosing recommendations during prolonged intermittent KRT. During the coronavirus disease 2019 pandemic, prolonged intermittent KRT was rapidly implemented to meet the KRT demands during patient surges in some of the medical centers overwhelmed by sheer volume of patients with AKI. Ideally, implementation of prolonged intermittent KRT at any institution should be conducted in a timely manner, with judicious planning and collaboration among nephrology, critical care, dialysis and intensive care nursing, and pharmacy leadership. Future analyses and clinical trials with respect to prescription and delivery of prolonged intermittent KRT and clinical outcomes will help to guide standardization of practice.
Collapse
Affiliation(s)
- Zoey Levine
- Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri
| | - Anitha Vijayan
- Division of Nephrology, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
84
|
Bernhardt AM, Copeland H, Deswal A, Gluck J, Givertz MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America Guideline on Acute Mechanical Circulatory Support. J Card Fail 2023; 29:304-374. [PMID: 36754750 DOI: 10.1016/j.cardfail.2022.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
| | - Hannah Copeland
- Department of Cardiac Surgery, Lutheran Health Physicians, Fort Wayne, Indiana
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Gluck
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Michael M Givertz
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
85
|
Paton M, Chan S, Tipping CJ, Stratton A, Serpa Neto A, Lane R, Young PJ, Romero L, Broadley T, Hodgson CL. The Effect of Mobilization at 6 Months after Critical Illness - Meta-Analysis. NEJM EVIDENCE 2023; 2:EVIDoa2200234. [PMID: 38320036 DOI: 10.1056/evidoa2200234] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND: The comparative efficacy and safety of early active mobilization compared with usual care regarding long-term outcomes for adult critically ill survivors remain uncertain. METHODS: We systematically reviewed randomized clinical trials comparing early active mobilization versus usual care in critically ill adults. The primary outcome was days alive and out of hospital to day 180 after pooling data using random effects modeling. We also performed a Bayesian meta-analysis to describe the treatment effect in probability terms. Secondary outcomes were mortality, physical function, strength, health-related quality of life at 6 months, and adverse events. RESULTS: Fifteen trials from 11 countries were included with data from 2703 participants. From six trials (1121 participants) reporting the primary outcome, the pooled mean difference was an increase of 4.28 days alive and out of hospital to day 180 in those patients who received early active mobilization (95% confidence interval, −4.46 to 13.03; I2=41%). Using Bayesian analyses with vague priors, the probability that the intervention increased days alive and out of hospital was 75.1%. In survivors, there was a 95.1% probability that the intervention improved physical function measured through a patient-reported outcome measure at 6 months (standardized mean difference, 0.2; 95% confidence interval, 0.09 to 0.32; I2=0%). Although no treatment effect was identified on any other secondary outcome, there was a 66.4% possibility of increased adverse events with the implementation of early active mobilization and a 72.2% chance it increased 6-month mortality. CONCLUSIONS: Use of early active mobilization for critically ill adults did not significantly affect days alive and out of hospital to day 180. Early active mobilization was associated with improved physical function in survivors at 6 months; however, the possibility that it might increase mortality and adverse events needs to be considered when interpreting this finding. (PROSPERO number, CRD42022309650.)
Collapse
Affiliation(s)
- Michelle Paton
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, Monash Health, Clayton, Victoria, Australia
| | - Sarah Chan
- Department of Physiotherapy, Monash Health, Clayton, Victoria, Australia
| | - Claire J Tipping
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | - Anne Stratton
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
| | - Ary Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rebecca Lane
- Department of Physiotherapy, Victoria University, Footscray, Victoria, Australia
| | - Paul J Young
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Ian Potter Library, The Alfred, Melbourne, Victoria, Australia
| | - Tessa Broadley
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Physiotherapy, The Alfred, Melbourne, Victoria, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Critical Care Division, The George Institute for Global Health, Sydney
| |
Collapse
|
86
|
Kho ME, Connolly B. From Strict Bedrest to Early Mobilization. Crit Care Clin 2023; 39:479-502. [DOI: 10.1016/j.ccc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
|
87
|
van Bochove-Waardenburg M, van der Jagt M, de Man-van Ginkel J, Ista E. Sustained adherence to a delirium guideline five years after implementation in an intensive care setting: A retrospective cohort study. Intensive Crit Care Nurs 2023; 76:103398. [PMID: 36731265 DOI: 10.1016/j.iccn.2023.103398] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To explore the level of sustained adherence to a delirium guideline in a university intensive care unit setting five years after cessation of a multifaceted implementation program conducted between April 2012 and February 2015. RESEARCH METHODOLOGY/DESIGN A quantitative retrospective cohort study was conducted using the medical records of all eligible patients admitted to the intensive care unit from November 2019 to February 2020. SETTING Four adult intensive care units in a university hospital. MAIN OUTCOME MEASURES Primary outcome is adherence to seven performance indicators indicated in the guideline being: light sedation days, mobilisation, physical therapy, analgesics use, delirium and sedation screening and avoiding benzodiazepines. Clinical patient outcomes such as Intensive care unit stay and prevalence of delirium were also collected. Data were compared with the results of the original implementation study's using descriptive statistics and Kruskal-wallis and Chi-square tests. RESULTS Data of 236 patients were included. The most notable decrease in adherence concerned 'number of light sedation days' (-28 %). Adherence to three indicators had increased: 'number of days receiving out-of-bed mobilisation' (+11 %); 'number of days receiving physical therapy' (+9%); and 'use of analgesics' (+12 %). Comparison of clinical outcomes showed an increased intensive care unit length-of-stay from 3 to 5 days (P < 0.001). Prevalence of delirium increased over five years from 41 % to 43 % of patients while delirium duration decreased from a median of 3 days to a median of 2 days. CONCLUSION Five years after ceasing of implementation efforts regarding the delirium guideline, partial sustainability has been achieved. The decrease in adherence to 'number of light sedation days' could have contributed to the increased length-of-stay on the intensive care unit. IMPLICATIONS FOR CLINICAL PRACTICE After implementation, routine monitoring of performance indicators is required to evaluate the level of sustainment. Further, revisiting reasons for decrease in guideline adherence when contextual changes occur. Reassessment of the perceived barriers and facilitators can guide adaptations to sustain, or even improve, adherence.
Collapse
Affiliation(s)
- Marlies van Bochove-Waardenburg
- Department of Intensive Care, Erasmus MC, Erasmus University Medical Center Rotterdam, The Netherlands; Department of Nursing Science, Program in Clinical Health Science, UMC Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Mathieu van der Jagt
- Department of Intensive Care, Erasmus MC, Erasmus University Medical Center Rotterdam, The Netherlands
| | - Janneke de Man-van Ginkel
- Department of Nursing Science, Program in Clinical Health Science, UMC Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Gerontology and Geriatrics, Leiden University Medical Centre, The Netherlands
| | - Erwin Ista
- Department of Pediatric Surgery, Intensive Care Unit, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, The Netherlands; Department of Internal Medicine, Section Nursing Science, Erasmus MC, Erasmus University Medical Center Rotterdam, The Netherlands
| |
Collapse
|
88
|
The Intersection of Health Rehabilitation Services with Quality of Life in Saudi Arabia: Current Status and Future Needs. Healthcare (Basel) 2023; 11:healthcare11030389. [PMID: 36766964 PMCID: PMC9914340 DOI: 10.3390/healthcare11030389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Quality of life (QoL) is essential for maintaining a healthy, balanced lifestyle, especially among individuals with chronic diseases. Saudi Arabia (SA) launched a health sector transformation program as part of the nationwide Vision 2030 initiative to ensure the sustainable development of efficient healthcare services, aiming to improve health by increasing well-being and QoL. More investigation into the current status of health rehabilitation services provided to individuals with chronic diseases and future needs to optimize services and improve QoL is needed. This was narratively discussed by experts from different health rehabilitation services in SA. Comprehensive health rehabilitation services including orthopedic, occupational, cardiac, pulmonary, critical care, perioperative, hearing and speech, substance use disorders, and vocational rehabilitation services were addressed. Health rehabilitation services in SA, as in other countries, are suboptimal for individuals in health rehabilitation programs. To optimize the QoL of individuals with chronic diseases, health rehabilitation services should be tailored based on the unique requirements of each service and its serving patients. The shared need to improve health rehabilitation services includes the adoption of home-based and telehealth services, the integration of multi-governmental sectors, the empowerment and allocation of health rehabilitation specialists, public awareness campaigns, policy legislation and guideline development, and the implementation of a long-term follow-up system. This review is one of the first to address the intersection of health rehabilitation services and QoL in SA; urgent and holistic actions are paramount to address the pressing need to optimize SA's health rehabilitation services. The experts' recommendations in this study may be applicable to other countries' health systems, as health rehabilitation services are not well optimized globally.
Collapse
|
89
|
Carvalho AC, Moreira J, Cubelo P, Cantista P, Aguiar Branco C, Guimarães B. Multidisciplinary rehabilitation in intensive care for COVID-19: randomised controlled trial. ERJ Open Res 2023; 9:00350-2022. [PMID: 36628269 PMCID: PMC9571162 DOI: 10.1183/23120541.00350-2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/20/2022] [Indexed: 01/13/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has led to an increasing number of patients in intensive care units (ICUs). The size of this post-ICU cohort will be unprecedented, with many patients vulnerable to post-intensive care syndrome. We analysed the respiratory and functional effects of a multidisciplinary rehabilitation programme on functional performance, in patients hospitalised in the ICU due to COVID-19. We conducted a randomised controlled clinical trial. 96 patients who fulfilled the eligibility criteria were randomised into control or intervention group. The control group received standard of care in the ICU, and the intervention group received a functional and respiratory rehabilitation protocol that included medical, nursing, physiotherapy and occupational therapy interventions. At discharge, the intervention group showed significantly better muscular strength and respiratory capacity, and significantly fewer days of hospitalisation (12.90±5.8 versus 15.60±6.7 days, p=0.037). At the 4- and 12-week follow-up, we applied our main outcome measure, the 6-min walk test (6MWT). The intervention group had significantly better results than the control group on the 6MWT at the 4-week follow-up (604±67 versus 571±57 m, p=0.018) and at the 12-week follow-up (639±53 versus 611±67 m, p=0.025). These results support the role of a multidisciplinary rehabilitation programme in COVID-19 patients hospitalised in the ICU and adds evidence that the implementation of rehabilitation programmes in ICUs could result in beneficial outcomes for critically ill patients.
Collapse
Affiliation(s)
- Ana Cristina Carvalho
- Public Health Unit – Porto Oriental, ACeS Grande Porto VI, Porto, Portugal,Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal,Corresponding author: Ana Cristina Carvalho ()
| | - Jorge Moreira
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Pedro Cubelo
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Pedro Cantista
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal,Department of Physical and Rehabilitation Medicine, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Catarina Aguiar Branco
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal,Department of PRM/Integrated Clinic, Faculty of Dental Medicine, University of Porto, Porto, Portugal
| | - Bruno Guimarães
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal,Cardiovascular Research Center, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
90
|
Cartotto R, Johnson L, Rood JM, Lorello D, Matherly A, Parry I, Romanowski K, Wiechman S, Bettencourt A, Carson JS, Lam HT, Nedelec B. Clinical Practice Guideline: Early Mobilization and Rehabilitation of Critically Ill Burn Patients. J Burn Care Res 2023; 44:1-15. [PMID: 35639543 DOI: 10.1093/jbcr/irac008] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This Clinical Practice Guideline addresses early mobilization and rehabilitation (EMR) of critically ill adult burn patients in an intensive care unit (ICU) setting. We defined EMR as any systematic or protocolized intervention that could include muscle activation, active exercises in bed, active resistance exercises, active side-to-side turning, or mobilization to sitting at the bedside, standing, or walking, including mobilization using assistance with hoists or tilt tables, which was initiated within at least 14 days of injury, while the patient was still in an ICU setting. After developing relevant PICO (Population, Intervention, Comparator, Outcomes) questions, a comprehensive literature search was conducted with the help of a professional medical librarian. Available literature was reviewed and systematically evaluated. Recommendations were formulated through the consensus of a multidisciplinary committee, which included burn nurses, physicians, and rehabilitation therapists, based on the available scientific evidence. No recommendation could be formed on the use of EMR to reduce the duration of mechanical ventilation in the burn ICU, but we conditionally recommend the use of EMR to reduce ICU-acquired weakness in critically ill burn patients. No recommendation could be made regarding EMR's effects on the development of hospital-acquired pressure injuries or disruption or damage to the skin grafts and skin substitutes. We conditionally recommend the use of EMR to reduce delirium in critically ill burn patients in the ICU.
Collapse
Affiliation(s)
- Robert Cartotto
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
| | - Laura Johnson
- Burns and Trauma, MedStar Washington Hospital Center, Georgetown University, Washington, DC, USA
| | - Jody M Rood
- Regions Hospital Burn Center, St. Paul, Minneapolis, USA
| | | | - Annette Matherly
- University of Utah Health Burn Center, Salt Lake City, Utah, USA
| | - Ingrid Parry
- Shriners Hospital for Children, Northern California, University of California at Davis, Sacramento, California, USA
| | - Kathleen Romanowski
- Firefighters Burn Institute Regional Burn Center, University of California at Davis, Sacramento, California, USA
| | - Shelley Wiechman
- Regional Burn Center at Harborview, University of Washington, Seattle, Washington, USA
| | | | | | - Henry T Lam
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | |
Collapse
|
91
|
Azevedo P, Gomes B, Macedo J, Ferreira S, Pereira J, Pires A. Debilidad muscular en pacientes críticos: efectos de un programa de rehabilitación sistematizado de enfermería. ENFERMERIA CLINICA 2023. [DOI: 10.1016/j.enfcli.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
|
92
|
Borges LF, Fraga Righetti R, de Souza Francisco D, Pereira Yamaguti W, Barros CFD. Hemodynamic impact of early mobilization in critical patients receiving vasoactive drugs: A prospective cohort study. PLoS One 2022; 17:e0279269. [PMID: 36538515 PMCID: PMC9767358 DOI: 10.1371/journal.pone.0279269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Vasoactive drugs are one of the most common patient-related barriers to early mobilization. Little is known about the hemodynamic effects of early mobilization on patients receiving vasoactive drugs. This study aims to observe and describe the impact of mobilization on the vital signs of critical patients receiving vasoactive drugs as well as the occurrence of adverse events. METHODS This is a cohort study performed in an Intensive Care Unit with patients receiving vasoactive drugs. All patients, either mobilized or non-mobilized, had their clinical data such as vital signs [heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation], type and dosage of the vasoactive drug, and respiratory support collected at rest. For mobilized patients, the vital signs were also collected after mobilization, and so was the highest level of mobility achieved and the occurrence of adverse events. The criteria involved in the decision of mobilizing the patients were registered. RESULTS 53 patients were included in this study and 222 physiotherapy sessions were monitored. In most of the sessions (n = 150, 67.6%), patients were mobilized despite the use of vasoactive drugs. There was a statistically significant increase in heart rate and respiratory rate after mobilization when compared to rest (p<0.05). Only two (1.3%) out of 150 mobilizations presented an adverse event. Most of the time, non-mobilizations were justified by the existence of a clinical contraindication (n = 61, 84.7%). CONCLUSIONS The alterations observed in the vital signs of mobilized patients may have reflected physiological adjustments of patients' cardiovascular and respiratory systems to the increase in physical demand imposed by the early mobilization. The adverse events were rare, not serious, and reversed through actions such as a minimal increase of the vasoactive drug dosage.
Collapse
|
93
|
Cheng H, Wang Z, Gu WJ, Yang X, Song S, Huang T, Lyu J. Impact of Falls Within 3 Months on the Short-Term Prognoses of Elderly Patients in Intensive Care Units: A Retrospective Cohort Study Using Stabilized Inverse Probability Treatment Weighting. Clin Interv Aging 2022; 17:1779-1792. [PMID: 36506850 PMCID: PMC9733442 DOI: 10.2147/cia.s387148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
Background Falls are a major public health problem in the older adults that can lead to poor clinical outcomes. There have been few reports on the short-term prognoses of older critically ill patients, and so we sought to determine the impact of falls on elderly patients in intensive care units (ICUs). Patients and Methods This retrospective study of 4503 patients (aged 65 years or older) analyzed data in the Medical Information Mart for Intensive Care-III critical care database. Of those, 2459 (54.6%) older adults are males, and 2044 (45.4%) older adults are females. Based on information from the medical care record assessment forms, patients were classified into the following two groups based on whether they had a fall within the previous 3 months: falls (n=1142) and nonfalls (n=3361). The primary outcomes of this study were 30- and 90-day mortality. Associations between the results of the Kaplan-Meier (KM) survival analysis, Cox proportional-hazards regression models, and subgroup analysis and its outcomes were analyzed using stabilized inverse probability treatment weighting (IPTW). Results KM survival curves with stabilized IPTW indicated that 30- and 90-day survival rates were significantly lower in elderly critically ill patients with a history of falls within the previous 3 months than in those patients without a history of falls (all p<0.001). Multivariate Cox proportional-hazards regression analysis indicated that 30- and 90-day mortality rates were 1.35 times higher (95% confidence interval [CI]=1.16-1.57, p<0.001) and 1.36 times higher (95% CI=1.19-1.55, p<0.001), respectively, in elderly critically ill patients with a history of falls within the previous 3 months than in those patients without a history of falls. Conclusion Experience of falls within the previous 3 months prior to ICU admission increased the risk of short-term mortality and affected the prognoses of elderly patients. Falls should therefore receive adequate attention from clinical healthcare providers and management decision-makers.
Collapse
Affiliation(s)
- Hongtao Cheng
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Zichen Wang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Wan-Jie Gu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Xin Yang
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Simeng Song
- School of Nursing, Jinan University, Guangzhou, People’s Republic of China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China,Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, People’s Republic of China,Correspondence: Jun Lyu, Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China, Tel +86-20-38680061, Email
| |
Collapse
|
94
|
Bach C, Hetland B. A Step Forward for Intensive Care Unit Patients: Early Mobility Interventions and Associated Outcome Measures. Crit Care Nurse 2022; 42:13-24. [DOI: 10.4037/ccn2022459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background
Critical illness survivors have impairments across physical, psychological, and cognitive health domains known as post–intensive care syndrome. Although physical activity can improve outcomes across all health domains, most intensive care unit early mobility studies focus solely on physical outcomes.
Objective
To explore the role of early mobility for adult patients in the intensive care unit by analyzing early mobility intervention studies with physical, psychological, or cognitive outcome measures.
Methods
This integrative review used Whittemore and Knafl’s methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, Embase, PubMed, PsycINFO, and Scopus databases were searched for primary research articles published from 2005 through 2021 on adult intensive care unit early mobility interventions evaluated by physical, cognitive, or psychological outcome measures during or after intervention delivery. Interventions comprising only passive mobility were excluded.
Results
Of 1009 articles screened, 20 were included. Variations in outcome measures, measurement timing, instruments, and control groups made synthesis difficult. No study evaluated an intervention using outcome measures from all 3 health domains. Five studies measured physical and cognitive outcomes; 6 studies measured physical and psychological outcomes.
Conclusion
Early mobility is primarily addressed objectively and unidimensionally, limiting understanding of the implications of early mobility for patients. Post–intensive care syndrome prevention begins in the intensive care unit; early mobility is a promising intervention for targeting multiple risk factors. Studies that measure outcomes in all health domains during or after early mobility are needed to better evaluate the comprehensive effects of early mobility.
Collapse
Affiliation(s)
- Christina Bach
- Christina Bach is a PhD student and research assistant at the University of Nebraska Medical Center College of Nursing and a staff nurse and relief lead in the oncology intensive care unit at Nebraska Medicine in Omaha, Nebraska
| | - Breanna Hetland
- Breanna Hetland is an assistant professor at the University of Nebraska Medical Center College of Nursing and a critical nurse scientist at Nebraska Medicine in Omaha
| |
Collapse
|
95
|
Do JG, Suh GY, Won YH, Chang WH, Hiser S, Needham DM, Chung CR. Reliability and validity of the Korean version of the Functional Status Score for the ICU after translation and cross-cultural adaptation. Disabil Rehabil 2022; 44:7528-7534. [PMID: 34713766 DOI: 10.1080/09638288.2021.1994660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The Functional Status Score for the Intensive Care Unit (FSS-ICU) evaluates the physical function of ICU patients. The objective of the study was to translate and cross-culturally adapt the FSS-ICU into Korean and assess its reliability and validity. METHODS An expert committee supervised the forward and backward translation process and the final translated version. Experienced physiotherapists assessed patients (n= 31) from a medical ICU using the Korean version of FSS-ICU. Intra-class correlation coefficients (ICCs) and Bland-Altman's plots were used to evaluate reliability, and Cronbach's alpha for internal consistency. Construct validity was evaluated using Spearman's correlation coefficients. RESULTS Two physiotherapists in each of the two university hospitals independently assessed 31 medical ICU patients, with a mean FSS-ICU total score of 23 (range: 4-35). The FSS-ICU Korean version demonstrated excellent internal consistency, with Cronbach's alpha of 0.897 for the total FSS-ICU score, and a range of 0.844-0.892 with deletion of each individual activity within the FSS-ICU. Intra-rater and inter-rater reliability were excellent for all of five FSS-ICU activities and the total score, with an ICC range of 0.930-0.993. Bland-Altman's plots revealed a mean difference in FSS-ICU total score of 0.2 (95% limits of agreement: -1.9 to 2.3) between two physiotherapists. The Korean version of FSS-ICU had good convergent and divergent validity with moderate to strong correlation with mobility and muscle strength measures, and poor correlation with unrelated measures. CONCLUSIONS The Korean version of the FSS-ICU showed excellent intra-rater and inter-rater reliability, internal consistency, and construct validity for medical ICU patients. The results of this study, along with prior publications, support that the FSS-ICU Korean version is a valid and reliable assessment tool for the ICU environment.Implications for rehabilitationIntensive care unit patients usually experience decreased muscle strength and physical function.The Korean version of the Functional Status Score for the Intensive Care Unit (FSS-ICU) is suitable for use with Korean speakers and has a valid, reliable measurement tool for physical function of intensive care unit patients.A well-standardized training with videos and written materials is important to ensure correct implementation of the Korean version of the FSS-ICU.
Collapse
Affiliation(s)
- Jong Geol Do
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yu Hui Won
- Department of Physical Medicine & Rehabilitation, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Stephanie Hiser
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA
| | - Dale M Needham
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, MD, USA.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
96
|
Moon CH, Groman R, Jasak RS, Burnetta EC, Gonzalez-Fernandez M, Annaswamy T, Jayabalan P, Venesy DA, Sereiko TJ, Flanagan SR. PM&R BOLD: The American Academy of Physical Medicine and Rehabilitation's strategic initiative to envision - and effectuate - The future of care across the rehabilitation care continuum. PM R 2022; 14:1497-1508. [PMID: 36349903 DOI: 10.1002/pmrj.12907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Cindy H Moon
- Hart Health Strategies, Washington, District of Columbia, USA
| | - Rachel Groman
- Hart Health Strategies, Washington, District of Columbia, USA
| | - Robert S Jasak
- Hart Health Strategies, Washington, District of Columbia, USA
| | | | | | | | | | | | - Tracy J Sereiko
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | | |
Collapse
|
97
|
Zaaqoq AM, Lorusso R. "Awake" extracorporeal membrane oxygenation: A challenge worth taking. J Card Surg 2022; 37:4543-4544. [PMID: 36321710 DOI: 10.1111/jocs.17078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 10/17/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Akram M Zaaqoq
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Georgetown University, Washington DC, USA
| | - Roberto Lorusso
- Department and Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| |
Collapse
|
98
|
Barros-Poblete M, Bernardes Neto SC, Benavides-Cordoba V, Vieira RP, Baz M, Martí JD, Spruit MA, Torres-Castro R. Early mobilization in intensive care unit in Latin America: A survey based on clinical practice. Front Med (Lausanne) 2022; 9:1005732. [PMID: 36479097 PMCID: PMC9720404 DOI: 10.3389/fmed.2022.1005732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/28/2022] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The application of early mobilization (EM) in intensive care units (ICUs) has shown to improve the physical and ventilatory status of critically ill patients, even after ICU stay. This study aimed to describe the practices regarding EM in ICUs in Latin America. METHODS We conducted an observational, cross-sectional study of professionals from all countries in Latin America. Over 3 months, professionals working in ICU units in Latin America were invited to answer the survey, which was designed by an expert committee and incorporated preliminary questions based on studies about EM recommendations. RESULTS As many as 174 health professionals from 17 countries completed the survey. The interventions carried out within each ICU were active mobilization (90.5%), passive mobilization (85.0%), manual and instrumental techniques for drainage of mucus secretion (81.8%), and positioning techniques (81%). The professionals who most participated in the rehabilitation process in ICUs were physiotherapists (98.7%), intensive care physicians (61.6%), nurses (56.1%), and respiratory therapists (43.8%). In only 36.1% of the ICUs, protocols were established to determine when a patient should begin EM. In 38.1% of the cases, the onset of EM was established by individual evaluation, and in 25.0% of the cases, it was the medical indication to start rehabilitation and EM. CONCLUSION This report shows us that EM of critically ill patients is an established practice in our ICUs like in other developed countries.
Collapse
Affiliation(s)
- Marisol Barros-Poblete
- Programa de Doctorado en Ciencias Médicas, Escuela de Graduados Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Saint-Clair Bernardes Neto
- FACISA—Faculdade de Ciências de Saúde do Trairi, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Rodolfo P. Vieira
- Evangelical University of Goias (Unievangélica), Goiás, Brazil
- Brazil University, São Paulo, Brazil
- Brazilian Institute of Teaching and Research in Pulmonary and Exercise Immunology (IBEPIPE), São Paulo, Brazil
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Manuel Baz
- Área de Cuidados Intermedios, Departamento Clínico de Medicina, Facultad de Medicina, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Joan-Daniel Martí
- Cardiovascular Surgery Intensive Care Unit, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Martijn A. Spruit
- Department of Research and Development, CIRO, Horn, Netherlands
- Department of Respiratory Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, NUTRIM School, Maastricht University, Maastricht, Netherlands
| | - Rodrigo Torres-Castro
- Departamento de Kinesiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- International Physiotherapy Research Network (PhysioEvidence), Barcelona, Spain
| |
Collapse
|
99
|
Azevedo P, Gomes B, Macedo J, Ferreira S, Pereira J, Pires A. Muscle weakness in critically ill patients: Effects of a systematized rehabilitation nursing program. ENFERMERIA CLINICA (ENGLISH EDITION) 2022:S2445-1479(22)00125-4. [PMID: 36400166 DOI: 10.1016/j.enfcle.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/01/2022] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Intensive care unit-acquired muscle weakness (ICUAW) in critically ill patients is frequent and associated with negative outcomes. Early rehabilitation is a strategy to improve outcomes. The aim was to assess the effects of a rehabilitation nursing programme at discharge from intensive care unit. METHODS Quasi-experimental study with the comparison between two groups: one enrolled in a systematized nursing rehabilitation program and the other with usual nursing rehabilitation care. A non-probabilistic sample, sequential, of 42 critically ill ventilated patients, 21 patients in the control group and 21 patients the intervention group (June 2017 to June 2019), in three intensive care units of one large Portuguese teaching hospital. Mann-Whitney test was performed to compare Medical Research Council Sum Score (MRC-SS) values between groups. RESULTS Patients undergoing the rehabilitation program had a decrease in ICUAW (at ICU discharge mean MRC-SS = 38 vs. mean MRC-SS = 42.7, p = 0.043, U = 152,5). There was a decrease in severe muscle weakness (9.5% vs. 28.6%) and significant muscle weakness (42.9% vs. 52.4%) and an increase without muscle weakness (47,6% vs. 19%). CONCLUSIONS The systematic rehabilitation nursing program can improve muscle strength and reduce functional disability at the time of discharge from intensive care.
Collapse
Affiliation(s)
- Paulo Azevedo
- Portuguese Red Cross Northern Health School, Rua da Cruz Vermelha, Cidacos, 3720-126 Oliveira de Azeméis, Portugal.
| | | | - José Macedo
- Centro Hospitalar São João, Unidade de Cuidados Intensivos Polivalente Geral, Porto, Portugal
| | - Soraia Ferreira
- Centro Hospitalar São João, Unidade de Cuidados Intensivos Polivalente da Urgência, Porto, Portugal
| | - José Pereira
- Centro Hospitalar São João, Serviço de Neurocríticos, Porto, Portugal
| | - Ana Pires
- Centro Hospitalar São João, Unidade de Cuidados Intensivos Polivalente Geral, Porto, Portugal
| |
Collapse
|
100
|
Hodgson CL, Bailey M, Bellomo R, Brickell K, Broadley T, Buhr H, Gabbe BJ, Gould DW, Harrold M, Higgins AM, Hurford S, Iwashyna TJ, Serpa Neto A, Nichol AD, Presneill JJ, Schaller SJ, Sivasuthan J, Tipping CJ, Webb S, Young PJ. Early Active Mobilization during Mechanical Ventilation in the ICU. N Engl J Med 2022; 387:1747-1758. [PMID: 36286256 DOI: 10.1056/nejmoa2209083] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Intensive care unit (ICU)-acquired weakness often develops in patients who are undergoing invasive mechanical ventilation. Early active mobilization may mitigate ICU-acquired weakness, increase survival, and reduce disability. METHODS We randomly assigned 750 adult patients in the ICU who were undergoing invasive mechanical ventilation to receive increased early mobilization (sedation minimization and daily physiotherapy) or usual care (the level of mobilization that was normally provided in each ICU). The primary outcome was the number of days that the patients were alive and out of the hospital at 180 days after randomization. RESULTS The median number of days that patients were alive and out of the hospital was 143 (interquartile range, 21 to 161) in the early-mobilization group and 145 days (interquartile range, 51 to 164) in the usual-care group (absolute difference, -2.0 days; 95% confidence interval [CI], -10 to 6; P = 0.62). The mean (±SD) daily duration of active mobilization was 20.8±14.6 minutes and 8.8±9.0 minutes in the two groups, respectively (difference, 12.0 minutes per day; 95% CI, 10.4 to 13.6). A total of 77% of the patients in both groups were able to stand by a median interval of 3 days and 5 days, respectively (difference, -2 days; 95% CI, -3.4 to -0.6). By day 180, death had occurred in 22.5% of the patients in the early-mobilization group and in 19.5% of those in the usual-care group (odds ratio, 1.15; 95% CI, 0.81 to 1.65). Among survivors, quality of life, activities of daily living, disability, cognitive function, and psychological function were similar in the two groups. Serious adverse events were reported in 7 patients in the early-mobilization group and in 1 patient in the usual-care group. Adverse events that were potentially due to mobilization (arrhythmias, altered blood pressure, and desaturation) were reported in 34 of 371 patients (9.2%) in the early-mobilization group and in 15 of 370 patients (4.1%) in the usual-care group (P = 0.005). CONCLUSIONS Among adults undergoing mechanical ventilation in the ICU, an increase in early active mobilization did not result in a significantly greater number of days that patients were alive and out of the hospital than did the usual level of mobilization in the ICU. The intervention was associated with increased adverse events. (Funded by the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand; TEAM ClinicalTrials.gov number, NCT03133377.).
Collapse
Affiliation(s)
- Carol L Hodgson
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Michael Bailey
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Rinaldo Bellomo
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Kathy Brickell
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Tessa Broadley
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Heidi Buhr
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Belinda J Gabbe
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Doug W Gould
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Meg Harrold
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Alisa M Higgins
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Sally Hurford
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Theodore J Iwashyna
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Ary Serpa Neto
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Alistair D Nichol
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Jeffrey J Presneill
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Stefan J Schaller
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Janani Sivasuthan
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Claire J Tipping
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Steven Webb
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| | - Paul J Young
- From the Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine (C.L.H., M.B., R.B., T.B., A.M.H., A.S.N., A.D.N., J.J.P., J.S., S.W., P.J.Y.), School of Public Health and Preventive Medicine (B.J.G.), Monash University, the Data Analytics Research and Evaluation Centre, University of Melbourne and Austin Hospital (R.B., A.S.N.), the Department of Critical Care (C.L.H., R.B., A.S.N., J.J.P., P.J.Y.) and the School of Medicine (J.J.P.), University of Melbourne, the Department of Intensive Care (A.D.N.) and the Intensive Care Unit and Physiotherapy Department (C.L.H., C.J.T.), Alfred Hospital, and the Department of Intensive Care, Royal Melbourne Hospital (R.B., J.J.P.), Melbourne, VIC, the Critical Care Division, the George Institute for Global Health (C.L.H., A.M.H.), and Intensive Care Services, Royal Prince Alfred Hospital (H.B.), Sydney, the Curtin School of Allied Health, Curtin University, Bentley, WA (M.H.), and the Department of Physiotherapy, Royal Perth Hospital (M.H.), and the Intensive Care Unit, St. John of God Subiaco Hospital (S.W.), Perth, WA - all in Australia; the Intensive Care Unit, Wellington Hospital (P.J.Y.), and the Medical Research Institute of New Zealand (S.H., P.J.Y.) - both in Wellington, New Zealand; the Department of Anesthesiology and Intensive Care, School of Medicine, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, and the Department of Anesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin - both in Germany (S.J.S); the Department of Internal Medicine Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor (T.J.I.); the Department of Medicine Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore (T.J.I.); the Clinical Trials Unit, Intensive Care National Audit and Research Centre, London (D.W.G.); the Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo (A.S.N.); and University College Dublin-Clinical Research Centre at St. Vincent's University Hospital, Dublin (K.B., A.D.N.)
| |
Collapse
|