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Xiao Z, Zeng L, Chen S, Wu J, Huang H. Development and validation of early prediction models for new-onset functional impairment in patients after being transferred from the ICU. Sci Rep 2024; 14:11902. [PMID: 38789502 PMCID: PMC11126674 DOI: 10.1038/s41598-024-62447-8] [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: 12/22/2023] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
A significant number of intensive care unit (ICU) survivors experience new-onset functional impairments that impede their activities of daily living (ADL). Currently, no effective assessment tools are available to identify these high-risk patients. This study aims to develop an interpretable machine learning (ML) model for predicting the onset of functional impairment in critically ill patients. Data for this study were sourced from a comprehensive hospital in China, focusing on adult patients admitted to the ICU from August 2022 to August 2023 without prior functional impairments. A least absolute shrinkage and selection operator (LASSO) model was utilized to select predictors for inclusion in the model. Four models, logistic regression, support vector machine (SVM), random forest (RF), and extreme gradient boosting (XGBoost), were constructed and validated. Model performance was assessed using the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Additionally, the DALEX package was employed to enhance the interpretability of the final models. The study ultimately included 1,380 patients, with 684 (49.6%) exhibiting new-onset functional impairment on the seventh day after leaving the ICU. Among the four models evaluated, the SVM model demonstrated the best performance, with an AUC of 0.909, accuracy of 0.838, sensitivity of 0.902, specificity of 0.772, PPV of 0.802, and NPV of 0.886. ML models are reliable tools for predicting new-onset functional impairments in critically ill patients. Notably, the SVM model emerged as the most effective, enabling early identification of patients at high risk and facilitating the implementation of timely interventions to improve ADL.
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Affiliation(s)
- Zewei Xiao
- Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Limei Zeng
- Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Suiping Chen
- Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Jinhua Wu
- Department of Nursing, First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China
| | - Haixing Huang
- Department of Nursing, First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, People's Republic of China.
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Uhlig SE, Rodrigues MK, Oliveira MF, Tanaka C. Timing to out-of-bed mobilization and mobility levels of COVID-19 patients admitted to the ICU: Experiences in Brazilian clinical practice. Physiother Theory Pract 2024; 40:865-873. [PMID: 36562697 DOI: 10.1080/09593985.2022.2160680] [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: 09/21/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, there was scarce data about clinical/functional conditions during hospitalization or after hospital discharge. Little was known about COVID-19 repercussions and how to do early mobilization in intensive care unit (ICU). OBJECTIVE Identify the time to the initiation of out-of-bed mobilization and the levels of mobility (sitting over the edge of the bed, sitting in a chair, standing, and ambulating) reached by critically ill patients with COVID-19 during hospitalization and the factors that could impact early mobilization. METHODS This was a retrospective observational study of patients with COVID-19 in the ICU. RESULTS There were 157 surviving COVID-19 patients included in the study (median age: 61 years; median ICU length of stay: 12 days). The median time to initiate out-of-bed mobilization in the ICU was 6 days; between patients who received mechanical ventilation (MV) compared with those who did not, this time was 8 vs. 2.5 days (p < .001). Most patients who used MV were mobilized after extubation (79.6%). During ICU stays, 88.0% of all patients were mobilized out of bed, and 41.0% were able to ambulate either with assistance or independently. The time to initiate out-of-bed mobilization is associated with sedation time and MV time. CONCLUSION Despite the pandemic scenario, patients were quickly mobilized out of bed, and most of the patients achieved higher mobility levels in the ICU and at hospital discharge. Sedation time and MV time were associated with delays in initiating mobilization.
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Affiliation(s)
- Suélen E Uhlig
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
| | - Miguel K Rodrigues
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
| | - Mayron F Oliveira
- VO2 Care Research Group, Physiotherapy Unit, Physiotherapy Hospital Company and Care, São Paulo, Brazil
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
- Science Division, Exercise Science, Lyon College, Batesville, AR, USA
| | - Clarice Tanaka
- Department of Physiotherapy, Communication Science and Disorders, Occupational Therapy, University of São Paulo, São Paulo, Brazil
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Chrisman M, Chesnut SR, Thompson M, Hopper A, Lasiter S. Physical activity and sedentary behavior in middle-aged intensive care unit survivors discharged home: A systematic review. Intensive Crit Care Nurs 2024; 81:103608. [PMID: 38155051 DOI: 10.1016/j.iccn.2023.103608] [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: 05/27/2023] [Revised: 11/21/2023] [Accepted: 12/15/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVES The purpose of this study was to review literature on physical activity and sedentary behavior of middle-aged adults post-discharge from the intensive care unit, with a particular focus on studies using wearable activity trackers. METHODOLOGY Systematic review conducted using correlational, cohort, and intervention studies of physical activity and sedentary behavior of intensive care unit survivors' post-discharge. Literature in PubMed, Embase, and CINAHL was searched using keywords derived from patient status, activity, and activity monitoring. Two independent reviewers used the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess quality of articles and potential biases in study design. MAIN OUTCOME MEASURES Physical activity and sedentary behavior assessed via wearable activity trackers. RESULTS Two hundred and fifty-six studies met inclusion criteria; six studies comprising 265 participants were retained. Outcomes varied widely and were not synthesized, but instead discussed individually. Average steps/day ranged from 1278 to 4958 and average minutes of activity ranged from 26 to 45 min/day. One study reported 12 hours and 17 min/day spent in sedentary activity and another reported 90 % of hospitalization was in sedentary behavior compared to 58 % post-discharge. CONCLUSION Few studies have examined physical activity and sedentary levels of middle-aged intensive care unit survivors wearing activity trackers. Findings are limited in generalizability, and no randomized controlled trials were included here. Eliciting support from clinical and post-discharge care teams to encourage activity and/or attend prescribed therapy or rehabilitation sessions is important. IMPLICATIONS FOR CLINICAL PRACTICE Clinicians should emphasize the importance of physical activity throughout the day to decrease sedentary time during a hospital stay and to continue being active after discharge to home. Physical activity is valuable, even in short spurts, from hospital stay through discharge. Interventions to increase physical activity and decrease sedentary time are needed to improve intensive care unit survivor recovery and quality of life post-discharge.
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Affiliation(s)
- Matthew Chrisman
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St., Kansas City, MO 64108, United States.
| | - Steven R Chesnut
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St., Kansas City, MO 64108, United States
| | - Marie Thompson
- University of Missouri-Kansas City, Health Sciences Library, 2411 Holmes, Kansas City, MO 64108, United States
| | - Amelia Hopper
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St., Kansas City, MO 64108, United States
| | - Sue Lasiter
- University of Missouri-Kansas City, School of Nursing and Health Studies, 2464 Charlotte St., Kansas City, MO 64108, United States
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McLaughlin KH, Friedman M, Hoyer EH, Kudchadkar S, Flanagan E, Klein L, Daley K, Lavezza A, Schechter N, Young D. The Johns Hopkins Activity and Mobility Promotion Program: A Framework to Increase Activity and Mobility Among Hospitalized Patients. J Nurs Care Qual 2023; 38:164-170. [PMID: 36729980 PMCID: PMC9944180 DOI: 10.1097/ncq.0000000000000678] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Greater mobility and activity among hospitalized patients has been linked to key outcomes, including decreased length of stay, increased odds of home discharge, and fewer hospital-acquired morbidities. Systematic approaches to increasing patient mobility and activity are needed to improve patient outcomes during and following hospitalization. PROBLEM While studies have found the Johns Hopkins Activity and Mobility Promotion (JH-AMP) program improves patient mobility and associated outcomes, program details and implementation methods are not published. APPROACH JH-AMP is a systematic approach that includes 8 steps, described in this article: (1) organizational prioritization; (2) systematic measurement and daily mobility goal; (3) barrier mitigation; (4) local interdisciplinary roles; (5) sustainable education and training; (6) workflow integration; (7) data feedback; and (8) promotion and awareness. CONCLUSIONS Hospitals and health care systems can use this information to guide implementation of JH-AMP at their institutions.
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Affiliation(s)
- Kevin H. McLaughlin
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Michael Friedman
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Erik H. Hoyer
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Sapna Kudchadkar
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Eleni Flanagan
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Lisa Klein
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Kelly Daley
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Annette Lavezza
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Nicole Schechter
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
| | - Daniel Young
- Johns Hopkins School of Medicine, Baltimore, Maryland (Drs McLaughlin, Hoyer, Kudchadkar, and Schechter, Mr Friedman, and Mss Daley and Lavezza); Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland (Dr Flanagan and Ms Klein); and School of Physical Therapy, University of Nevada Las Vegas, Las Vegas (Dr Young)
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Martin GL, Atramont A, Mazars M, Tajahmady A, Agamaliyev E, Singer M, Leone M, Legrand M. Days Spent at Home and Mortality After Critical Illness: A Cluster Analysis Using Nationwide Data. Chest 2022; 163:826-842. [PMID: 36257472 PMCID: PMC10107061 DOI: 10.1016/j.chest.2022.10.008] [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: 04/16/2022] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Beyond the question of short-term survival, days spent at home could be considered a patient-centered outcome in critical care trials. RESEARCH QUESTION What are the days spent at home and health care trajectories during the year after surviving critical illness? STUDY DESIGN AND METHODS Data were extracted on adult survivors spending at least 2 nights in a French ICU during 2018 who were treated with invasive mechanical ventilation or vasopressors or inotropes. Trauma, burn, organ transplant, stroke, and neurosurgical patients were excluded. Stays at home, death, and hospitalizations were reported before and after ICU stay, using state sequence analysis. An unsupervised clustering method was performed to identify cohorts based on post-ICU trajectories. RESULTS Of 77,132 ICU survivors, 89% returned home. In the year after discharge, these patients spent a median of 330 (interquartile range [IQR], 283-349) days at home. At 1 year, 77% of patients were still at home and 17% had died. Fifty-one percent had been re-hospitalized, and 10% required a further ICU admission. Forty-eight percent used rehabilitation facilities, and 5.7%, hospital at home. Three clusters of patients with distinct post-ICU trajectories were identified. Patients in cluster 1 (68% of total) survived and spent most of the year at home (338 [323-354] days). Patients in cluster 2 (18%) had more complex trajectories, but most could return home (91%), spending 242 (174-277) days at home. Patients in cluster 3 (14%) died, with only 37% returning home for 45 (15-90) days. INTERPRETATION Many patients had complex health care trajectories after surviving critical illness. Wide variations in the ability to return home after ICU discharge were observed between clusters, which represents an important patient-centered outcome.
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Affiliation(s)
| | | | | | | | | | - Mervyn Singer
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | - Marc Leone
- Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anesthesia and Intensive Care Unit, Hospital Nord, Marseille, France; Société Française d'Anesthésie et de Réanimation (SFAR), Paris, France
| | - Matthieu Legrand
- Société Française d'Anesthésie et de Réanimation (SFAR), Paris, France; Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, UCSF, San Francisco, CA; INI-CRCT network, Nancy, France.
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Rousseau AF, Fadeur M, Colson C, Misset B. Measured Energy Expenditure Using Indirect Calorimetry in Post-Intensive Care Unit Hospitalized Survivors: A Comparison with Predictive Equations. Nutrients 2022; 14:nu14193981. [PMID: 36235634 PMCID: PMC9571487 DOI: 10.3390/nu14193981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Actual energy needs after a stay in intensive care units (ICUs) are unknown. The aims of this observational study were to measure the energy expenditure (mEE) of ICU survivors during their post-ICU hospitalization period, and to compare this to the estimations of predictive equations (eEE). Survivors of an ICU stay ≥ 7 days were enrolled in the general ward during the first 7 days after ICU discharge. EE was measured using the Q-NRG calorimeter in canopy mode. This measure was compared to the estimated EE using the Harris−Benedict (HB) equation multiplied by a 1.3 stress factor, the Penn−State (PS) equation or the 30 kcal weight-based (WB) equation. A total of 55 adults were included (67.3% male, age 60 (52−67) y, body mass index 26.1 (22.2−29.7) kg/m2). Indirect calorimetry was performed 4 (3−6) d after an ICU stay of 12 (7−16) d. The mEE was 1682 (1328−1975) kcal/d, corresponding to 22.9 (19.1−24.2) kcal/kg/day. The eEE values derived using HB and WB equations were significantly higher than mEE: 3048 (1805−3332) and 2220 (1890−2640) kcal/d, respectively (both p < 0.001). There was no significant difference between mEE and eEE using the PS equation: 1589 (1443−1809) kcal/d (p = 0.145). The PS equation tended to underestimate mEE with a bias of −61.88 kcal and a wide 95% limit of agreement (−717.8 to 594 kcal). Using the PS equation, agreement within 15% of the mEE was found in 32/55 (58.2%) of the patients. In the present cohort of patients who survived a prolonged ICU stay, mEE was around 22−23 kcal/kg/day. In this post-ICU hospitalization context, none of the tested equations were accurate in predicting the EE measured by indirect calorimetry.
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Affiliation(s)
- Anne-Françoise Rousseau
- Department of Intensive Care, University Hospital of Liège, University of Liège, 4000 Liège, Belgium
- Correspondence: ; Tel.: +32-43237495
| | - Marjorie Fadeur
- Multidisciplinary Nutrition Team, University Hospital of Liège, 4000 Liège, Belgium
| | - Camille Colson
- Department of Intensive Care, University Hospital of Liège, University of Liège, 4000 Liège, Belgium
| | - Benoit Misset
- Department of Intensive Care, University Hospital of Liège, University of Liège, 4000 Liège, Belgium
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