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Seriu N, Tsukamoto S, Ishida Y, Yamanaka N, Mano T, Kobayashi Y, Sajiki-Ito M, Inagaki Y, Tanaka Y, Sho M, Kido A. Influences of comorbidities on perioperative rehabilitation in patients with gastrointestinal cancers: a retrospective study. World J Surg Oncol 2023; 21:336. [PMID: 37880760 PMCID: PMC10601285 DOI: 10.1186/s12957-023-03207-2] [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: 07/21/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Older patients are more likely to have comorbidities than younger patients, and multiple comorbidities are associated with mortality in patients with cancer. Therefore, we hypothesized that a functional comorbidity index could predict the therapeutic effects of rehabilitation. OBJECTIVES In this study, we investigate whether the comorbidities influenced the execution and therapeutic effects of rehabilitation. METHODS A consecutive cohort of 48 patients with gastrointestinal cancer who underwent surgery between January 1 and November 30, 2020, was analyzed. Charlson Comorbidity Index (CCI) scores were calculated based on data derived from medical records. The primary outcomes were ambulation status, duration (days) from the start of postoperative rehabilitation, and length of hospital stay. We investigated the relationship between CCI scores and primary outcomes. RESULTS The CCI did not correlate with the duration of rehabilitation or the length of hospital stay. Subsequently, patients with functional recovery problems were evaluated, and we identified the conditions that were not included in the list using CCI scores. Most conditions are associated with surgical complications. Furthermore, using the Clavien-Dindo classification (CDC), we assessed the clinical features of the severity of complications. We found that the length of stay and the duration to start rehabilitation were significantly longer in the patients with higher severity of surgical complications (CDC≧III) than in those with lower severity (CDC≦II). CONCLUSIONS Treatment-related conditions may significantly impact the perioperative period more than the original comorbidities. In addition to original comorbidities, events related to surgical complications should be assessed to determine the therapeutic effects of rehabilitation in patients with gastrointestinal cancer.
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Affiliation(s)
- Naoto Seriu
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Shinji Tsukamoto
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yukako Ishida
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Nobuki Yamanaka
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Tomoo Mano
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yasuyo Kobayashi
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Marina Sajiki-Ito
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yusuke Inagaki
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yuu Tanaka
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
- Department of Rehabilitation, Faculty of Health Science, Wakayama Professional University of Rehabilitation, Wakayama, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Nara, Japan
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
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Watanabe S, Yamauchi K, Yasumura D, Suzuki K, Koike T, Katsukawa H, Morita Y, Scheffenbichler FT, Schaller SJ, Eikermann M. Reliability and Effectiveness of the Japanese Version of the Mobilization Quantification Score. Cureus 2023; 15:e43440. [PMID: 37711928 PMCID: PMC10499052 DOI: 10.7759/cureus.43440] [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] [Accepted: 08/13/2023] [Indexed: 09/16/2023] Open
Abstract
Background The mobilization quantification score (MQS) provides an opportunity to quantify the duration and intensity of mobilization therapy in the intensive care unit (ICU) and predict functional outcomes in ICU patients after surgery and stroke. MQS is a numerical measurement of early mobilization dose in the ICU, and its relationship with activities of daily living (ADL) dependence has been shown. We created and validated the Japanese version of the MQS using the endpoint ADL in a mixed population of patients in the ICU. Materials and methods In this prospective study, consecutive patients who were admitted to one of three ICUs of a tertiary care hospital in Japan, aged ≥18 years, and who received mechanical ventilation for >48 hours were enrolled. The Japanese version of the MQS was applied twice daily by an ICU physiotherapist and data recorded for analysis. The primary outcome was ADL dependence at hospital discharge, defined as a Barthel index (BI) of <70 or in-hospital death. The reliability among assessors was verified by calculating the interclass correlation coefficient (ICC) (2.1) for the average daily MQS. We performed a multiple logistic regression analysis to examine and identify a binary cutoff point for high-/low-dose rehabilitation. Results Of the 340 target patients, eight were aged <18 years, 109 had neurological complications, 11 had a BI <70 before admission, 79 had a lack of communication skills, 16 were terminally ill, eight did not complete the assessment during their ICU stay, 18 died in the ICU, and 53 denied consent. After 302 patients were excluded, 38 were included in the study. Six assessors, two at each hospital, measured the MQS in 38 patients. The ICC (2.1) for the MQS mean value was 0.98 (0.96-0.99) during the ICU stay. Logistic regression analysis using the mean MQS on admission to ICUs as an explanatory variable showed a significant association between increased MQS and decreased ADL dependence at discharge (odds ratio (OR): 0.76, confidence interval (CI): 0.61-0.96, adjusted p = 0.009). Logistic regression analysis using a high MQS on admission to ICUs as an explanatory variable showed a significant association between increased MQS and decreased ADL dependence at hospital discharge (OR: 0.14, CI: 0.03-0.66, adjusted p = 0.013). Conclusions We present a validated version of the Japanese MQS with a high inter-rater reliability that predicts ADL dependence at hospital discharge. The instrument can be used in future clinical trials in the ICU to control for the mobilization level in the ICU. The increased utilization of mobilization acutely in the ICU setting as quantified by the MQS may improve patient outcomes.
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Affiliation(s)
- Shinichi Watanabe
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Medical Science, Gifu, JPN
- Department of Rehabilitation Medicine, Nagoya Medical Center, National Hospital Organization, Nagoya, JPN
| | - Kota Yamauchi
- Department of Rehabilitation Medicine, Steel Memorial Yawata Hospital, Kitakyushu, JPN
| | - Daisetsu Yasumura
- Department of Rehabilitation Medicine, Naha City Hospital, Okinawa, JPN
| | - Keisuke Suzuki
- Department of Physical Therapy, Gifu University of Health Science, Gifu, JPN
| | - Takayasu Koike
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, Gifu, JPN
| | - Hajime Katsukawa
- Physical Medicine and Rehabilitation, Japanese Society for Early Mobilization, Tokyo, JPN
| | - Yasunari Morita
- Department of Emergency Medicine, Nagoya Medical Center, Nagoya, JPN
| | | | - Stefan J Schaller
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Munich, DEU
- Department of Anesthesiology and Operative Intensive Care, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, DEU
| | - Matthias Eikermann
- Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
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3
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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.
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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
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Mart MF, Thompson JL, Ely EW, Pandharipande PP, Patel MB, Wilson JE, Roberson SW, Birdrow CI, Raman R, Brummel NE. In-Hospital Depressed Level of Consciousness and Long-Term Functional Outcomes in ICU Survivors. Crit Care Med 2022; 50:1618-1627. [PMID: 36005816 PMCID: PMC9594861 DOI: 10.1097/ccm.0000000000005656] [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: 02/04/2023]
Abstract
OBJECTIVES Among critically ill patients, acutely depressed level of consciousness is associated with mortality, but its relationship to long-term outcomes such as disability and physical function is unknown. We investigated the relationship of level of consciousness during hospitalization with long-term disability and physical function in ICU survivors. DESIGN Multi-center observational cohort study. SETTING Medical or surgical ICUs at five U.S. centers. PATIENTS Adult survivors of respiratory failure or shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Depressed level of consciousness during hospitalization was defined using the Richmond Agitation Sedation Scale (RASS) score (including all negative scores) by calculating the area under the curve using linear interpolation. Sedative-associated level of consciousness was similarly defined for all hospital days that sedation was received. We measured disability in basic activities of daily living (BADLs), instrumental activities of daily living (IADLs), discharge destination, and self-reported physical function. In separate models, we evaluated associations between these measures of level of consciousness and outcomes using multivariable regression, adjusted for age, sex, race, body mass index, education level, comorbidities, baseline frailty, baseline IADLs and BADLs, hospital type (civilian vs veteran), modified mean daily Sequential Organ Failure Assessment score, duration of severe sepsis, duration of mechanical ventilation, and hospital length of stay. Of the 1,040 patients enrolled in the ICU, 781 survived to hospital discharge. We assessed outcomes in 624 patients at 3 months and 527 patients at 12 months. After adjusting for covariates, there was no association between depressed level of consciousness (total or sedation-associated) with BADLs or IADLs at either 3- or 12-month follow-up. There was also no association with self-reported physical function at 3 or 12 months or with discharge destination. CONCLUSIONS Depressed level of consciousness, as defined by the RASS, was not associated with disability or self-reported physical function. Future studies should investigate additional modifiable in-hospital risk factors for disability and poor physical function following critical illness.
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Affiliation(s)
- Matthew F. Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- VA Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
| | - Jennifer L Thompson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - E. Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- VA Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, TN
- Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN
| | - Pratik P. Pandharipande
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Mayur B. Patel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Division of Acute Care Surgery, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Jo Ellen Wilson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Shawniqua Williams Roberson
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - Caroline I. Birdrow
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Rameela Raman
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Nathan E. Brummel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University College of Medicine, Columbus OH
- Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
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Holod AF, Choi J, Tate J. Optimizing Recovery Following Critical Illness: A Systematic Review of Home-Based Interventions. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221127440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Around 5 million Americans are treated in an intensive care unit (ICU) annually. Upon discharge, it is not uncommon for ICU survivors to experience psychological, physical, or cognitive symptoms related to their ICU stay. Home-based interventions have been touted as a potential treatment modality for post-ICU sequelae. However, limited evidence exists regarding the effectiveness of home-based interventions for patients in the post-ICU recovery period. As such, the purpose of this review was to aggregate and summarize the findings of studies focused on post-ICU rehabilitation, following critical illness, delivered in the home setting. A literature search was performed in MEDLINE, CINAHL, EMBASE, APA PsycINFO, and Google Scholar. Studies were included if they: used a RCT or quasi-experimental study design; included participants aged ≥18 years discharged home from an ICU; examined the effectiveness of a home-based, post-ICU intervention; were published in English after the year 2010; and were peer-reviewed. Nine studies met inclusion criteria. Sample sizes ranged from 21 to 386, with most participants receiving mechanical ventilation. Target outcomes included: physical function, psychological well-being, cognitive function, quality of life, and healthcare utilization. Interventions included face-to-face, web-based, telephone, or self-directed activities. Findings of included studies were mixed or inconclusive. Limitations of this review include: inclusion of only adult ICU survivors, exclusion of Post-Intensive Care Syndrome as a search term, and search restricted to pre-pandemic studies. Findings suggest a need for more rigorous research to develop and test home-based interventions.
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Affiliation(s)
- Alicia F. Holod
- The Ohio State University College of Nursing, Columbus, OH, USA
| | - JiYeon Choi
- Yonsei University College of Nursing, Seoul, South Korea
| | - Judith Tate
- The Ohio State University College of Nursing, Columbus, OH, USA
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Privitera E, Gambazza S, Rossi V, Santambrogio M, Binda F, Tarello D, Caiffa S, Turrin V, Casagrande C, Battaglini D, Panigada M, Fumagalli R, Pelosi P, Grasselli G. Association of ventilator-free days with respiratory physiotherapy in critically ill patients with Coronavirus Disease 2019 (COVID-19) during the first pandemic wave. A propensity score-weighted analysis. Front Med (Lausanne) 2022; 9:994900. [PMID: 36172535 PMCID: PMC9510617 DOI: 10.3389/fmed.2022.994900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background Respiratory physiotherapy is reported as safe and feasible in mechanically ventilated patients with severe Coronavirus Disease (COVID-19) admitted to Intensive Care Unit (ICU), but the short-term benefits remain unclear. Methods We performed a retrospective observational study in four ICUs in Northern Italy. All patients with COVID-19 admitted to ICU and under invasive mechanical ventilation (MV) between March 1st and May 30th, 2020, were enrolled into the study. Overlap weighting based on the propensity score was used to adjust for confounding in the comparison of patients who had or had not been treated by physiotherapists. The primary outcome was the number of days alive and ventilator-free (VFDs). The secondary outcomes were arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (P/F) at ICU discharge, ICU length of stay, ICU and hospital mortality, and survival at 90 days. The trial protocol was registered on clinicaltrials.gov (NCT 05067907). Results A total of 317 patients were included in the analysis. The median VFDs was 18 days [interquartile range (IQR) 10; 24] in patients performing physiotherapy and 21 days (IQR 0; 26) in the group without physiotherapy [incidence rate ratio (IRR) 0.86, 95% confidence interval (CI): 0.78; 0.95]. The chance of 0 VFDs was lower for patients treated by physiotherapists compared to those who were not [odds ratio (OR) = 0.36, 95% CI: 0.18–0.71]. Survival at 90 days was 96.0% in the physiotherapy group and 70.6% in patients not performing physiotherapy [hazard ratio (HR) = 0.14, 95% CI: 0.03–0.71]. Number of VFDs was not associated with body mass index (BMI), sex, or P/F at ICU admission for individuals with at least 1 day off the ventilator. Conclusion In patients with COVID-19 admitted to ICU during the first pandemic wave and treated by physiotherapists, the number of days alive and free from MV was lower compared to patients who did not perform respiratory physiotherapy. Survival at 90 days in the physiotherapy group was greater compared to no physiotherapy. These findings may be the starting point for further investigation in this setting.
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Affiliation(s)
- Emilia Privitera
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Rossi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Santambrogio
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Martina Santambrogio
| | - Filippo Binda
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Tarello
- Respiratory Physiotherapy Equipe, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Salvatore Caiffa
- Intensive Care Respiratory Physiotherapy, Rehabilitation and Functional Education, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Valentina Turrin
- Rehabilitation Department, Santa Chiara Hospital, APSS di Trento, Trento, Italy
| | - Carolina Casagrande
- Rehabilitation Department, Santa Chiara Hospital, APSS di Trento, Trento, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Mauro Panigada
- Department of Anaesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Fumagalli
- Department of Anesthesia and Intensive Care Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Giacomo Grasselli
- Department of Anaesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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One Year Post-Discharge Outcomes After Implementation of an ICU Early Mobility Protocol. Dimens Crit Care Nurs 2022; 41:209-215. [PMID: 35617586 DOI: 10.1097/dcc.0000000000000533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Early mobility benefits include improved strength, decreased length of stay (LOS), and delirium. The impact of an early mobility protocol on return to activities of daily living (ADL) is less studied. OBJECTIVE The aim of this study was to examine 1-year outcomes including ADL performance after the institution of an ICU early mobility protocol. METHODS One year after the initiation of an early mobility protocol in 7 intensive care units (ICUs) at an academic medical center, patients with an ICU stay of 7 days or more were enrolled in a 1-year follow-up phone call study. Baseline demographic data included the following: average ICU mobility and highest ICU mobility level achieved (4 levels), highest ICU mobility score (10 levels) at ICU admission, ICU discharge (DC), hospital DC, LOS, and delirium positive days. At 4 time points after DC (1, 3, 6, 12 months), patients were contacted regarding current residence, employment, readmissions, and current level of ADL from the Katz ADL (scored 0-6) and Lawton instrumental ADL scales (scored 0-8). RESULTS A convenience sample of 106 patients was enrolled with a mean age of 58 ± 15.4 years, ICU LOS of 18 ± 11.5 days, and hospital LOS of 37.5 ± 31 days; 58 (55%) were male; 4 expired before DC. Mobility results included mean mobility level of 1.6 ± 0.8, mean highest mobility level 3.3 ± 0.9; ICU mobility score was 5.9 ± 2.4 at time of ICU DC and 7.3 ± 2.5 at hospital DC. Katz ADL scores improved from 4.8 at 1 month to 5.6 at 12 months (P = .002), and Lawton IADL scores improved from 4.2 to 6.6 (P < .001). Mobility scores were predictors of 1 month Katz (P = .004) and Lawton (P < .001) scores. None of the mobility levels or scores were predictive for readmissions. Most patients were not working before admission, and not all returned to work. Days positive for delirium were predictive of 1 month Katz and Lawton (P = .014, .002) scores. Impact of delirium was gone by 1 year. DISCUSSION In this critically ill patient population followed for 1 year, ICU mobility positively impacted return to ADLs and improved ADLs over time but not readmissions. Delirium positive days decreased ADL scores, but the effect diminished over time.
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Cobert J, Jeon SY, Boscardin J, Chapman AC, Ferrante LE, Lee S, Smith AK. Trends in Geriatric Conditions Among Older Adults Admitted to US ICUs Between 1998 and 2015. Chest 2022; 161:1555-1565. [PMID: 35026299 PMCID: PMC9248079 DOI: 10.1016/j.chest.2021.12.658] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/23/2021] [Accepted: 12/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Older adults are increasingly admitted to the ICU, and those with disabilities, dementia, frailty, and multimorbidity are vulnerable to adverse outcomes. Little is known about how pre-existing geriatric conditions have changed over time. RESEARCH QUESTION How have changes in disability, dementia, frailty, and multimorbidity in older adults admitted to the ICU changed from 1998 through 2015? STUDY DESIGN AND METHODS Medicare-linked Health and Retirement Survey (HRS) data identifying patients 65 years of age and older admitted to an ICU between 1998 and 2015. ICU admission was the unit of analysis. Year of ICU admission was the exposure. Disability, dementia, frailty, and multimorbidity were identified based on responses to HRS surveys before ICU admission. Disability represented the need for assistance with ≥ 1 activity of daily living. Dementia used cognitive and functional measures. Frailty included deficits in ≥ 2 domains (physical, nutritive, cognitive, or sensory function). Multimorbidity represented ≥ 3 self-reported chronic diseases. Time trends in geriatric conditions were modeled as a function of year of ICU admission and were adjusted for age, sex, race or ethnicity, and proxy interview status. RESULTS Across 6,084 ICU patients, age at admission increased from 77.6 years (95% CI, 76.7-78.4 years) in 1998 to 78.7 years (95% CI, 77.5-79.8 years) in 2015 (P < .001 for trend). The adjusted proportion of ICU admissions with pre-existing disability rose from 15.5% (95% CI, 12.1%-18.8%) in 1998 to 24.0% (95% CI, 18.5%-29.6%) in 2015 (P = .001). Rates of dementia did not change significantly (P = .21). Frailty increased from 36.6% (95% CI, 30.9%-42.3%) in 1998 to 45.0% (95% CI, 39.7%-50.2%) in 2015 (P = .04); multimorbidity rose from 54.4% (95% CI, 49.2%-59.7%) in 1998 to 71.8% (95% CI, 66.3%-77.2%) in 2015 (P < .001). INTERPRETATION Rates of pre-existing disability, frailty, and multimorbidity in older adults admitted to ICUs increased over time. Geriatric principles need to be deeply integrated into the ICU setting.
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Affiliation(s)
- Julien Cobert
- Anesthesia Service, San Francisco VA Health Care System, San Francisco, CA; Department of Anesthesiology, University of California, San Francisco, CA.
| | - Sun Young Jeon
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA; Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - John Boscardin
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA; Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Allyson C Chapman
- Division of Critical Care and Palliative Medicine, Department of Internal Medicine, University of California, San Francisco, CA; Department of Surgery, University of California, San Francisco, CA
| | - Lauren E Ferrante
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Sei Lee
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA; Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
| | - Alexander K Smith
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA; Department of Geriatrics, Palliative, and Extended Care, Veterans Affairs Medical Center, San Francisco, CA
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Rossi V, Del Monaco C, Gambazza S, Santambrogio M, Binda F, Retucci M, Privitera E, Mantero M, Bottino N, Laquintana D, Blasi F. Time to active sitting position: One-year findings from a temporary COVID-19 intensive care unit. Respir Med 2022; 194:106773. [PMID: 35203010 PMCID: PMC8843323 DOI: 10.1016/j.rmed.2022.106773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 01/08/2023]
Abstract
Objective To investigate the association between time to active sitting position and clinical features in people with COVID-19 admitted to intensive care unit (ICU) and referred to physiotherapists. Method Prospective study conducted in the largest temporary ICU in Lombardy (Italy) between April 2020 and June 2021. All individuals with COVID-19 who received physiotherapy were included. Multivariable Cox proportional hazard model was fitted to explore the statistical association between active sitting position and characteristics of patients referred to physiotherapists, also accounting for the different multidisciplinary teams responsible for patients. Results 284 individuals over 478 (59.4%) had access to physiotherapy, which was performed for a median of 8 days, without difference between multidisciplinary teams (P = 0.446). The active sitting position was reached after a median of 18 (IQR: 10.0–32.0) days. Sex was the only characteristic associated with the time to active sitting position, with males showing a reduced hazard by a factor of 0.65 (95% CI: 0.48–0.87; P = 0.0042) compared to females. At ICU discharge, nearly 50% individuals increased Manchester Mobility Score by 3 points. During physiotherapy no major adverse event was recorded. Conclusion Individuals with COVID-19 take long time to reach active sitting position in ICU, with males requiring longer rehabilitation than females.
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10
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Rossi V, Santambrogio M, Del Monaco C, Retucci M, Tammaro S, Ceruti C, Saderi L, Aliberti S, Privitera E, Grasselli G, Sotgiu G, Blasi F. Safety and feasibility of physiotherapy in ICU-admitted severe COVID-19 patients: an observational study. Monaldi Arch Chest Dis 2022; 92. [PMID: 35086328 DOI: 10.4081/monaldi.2022.2087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/14/2022] [Indexed: 01/08/2023] Open
Abstract
Early physiotherapy could play an important role in the management of severe COVID-19 subjects with consequences of prolonged ICU stay, although its effectiveness is still unclear. Aim of this study is to describe physiotherapy performed in severe COVID-19 patients and to evaluate its safety and feasibility. Consecutive adults with confirmed SARS-CoV-2 infection, admitted to the ICU, needing invasive mechanical ventilation for >24 hours and receiving early physiotherapy, have been enrolled. Adverse events occurred during physiotherapy sessions and timing and type of physiotherapy delivered were analysed, to identify the interventions most frequently performed and to determine the time taken to first mobilize, stand and walk. Functional and clinical assessment of patients was also performed at hospital discharge. Eighty-four severe COVID-19 subjects were enrolled. Few minor adverse events were recorded. Active mobilization was promoted over passive mobilization and independence in daily life activities was supported. Time interval from patients' intubation to the first physiotherapy treatment was 13 days and to walking was 27 days. Forty-eight (57.1%) subjects returned at home, whereas 29 (34.5%) were discharged to in-patient rehabilitation. Patients with tracheostomy experienced a delay in time from ICU admission until sit out of bed and ambulation, if compared with subjects without tracheostomy, although no differences were found in 6MWT and 1m-STST performances. This study reporting early physiotherapy during pandemic suggests that this intervention is feasible and safe for severe COVID-19 subjects, as well as healthcare workers, although delayed compared to other critically ill patients.
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Affiliation(s)
- Veronica Rossi
- Health Professions Department Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Martina Santambrogio
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Cesare Del Monaco
- Health Professions Department Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Mariangela Retucci
- Health Professions Department Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Mila.
| | - Serena Tammaro
- Health Professions Department Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Clara Ceruti
- Health Professions Department Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Laura Saderi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari.
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan.
| | - Emilia Privitera
- Health Professions Department Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan.
| | - Giovanni Sotgiu
- Department of Medical, Surgical and Experimental Sciences, University of Sassari.
| | - Francesco Blasi
- Respiratory Unit and Cystic Fibrosis Adult Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan.
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11
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Watanabe S, Morita Y, Suzuki S, Kochi K, Ohno M, Liu K, Iida Y. Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients. Prog Rehabil Med 2021; 6:20210054. [PMID: 35083381 PMCID: PMC8710675 DOI: 10.2490/prm.20210054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the association between the Rehabilitation Activity Time score (RATs)-a score based on the level and duration of rehabilitation activities-of ventilated patients in the intensive care unit (ICU) and activities of daily living (ADL) dependence at discharge. METHODS This retrospective, single-center study evaluated patients aged >18 years who underwent mechanical ventilation in the ICU for at least 48 h. The patients were categorized into the low- and high-dose rehabilitation groups based on the median RATs. The primary outcome was the rate of ADL dependence at discharge, defined as a Barthel index of <70. The association between low or high doses of rehabilitation and the primary outcome was assessed using multiple logistic regression analysis adjusted by baseline factors. RESULTS The rate of ADL dependence at discharge was significantly lower in the high-dose rehabilitation group (low dose 81% vs. high dose 22%, P<0.001). Multivariate analysis showed a significantly lower ADL dependence at discharge among those who received high-dose rehabilitation (P<0.001). Increased RATs during the entire ICU admission period and during ICU admission after meeting the criteria for physiological stability was significantly associated with lower ADL dependence at discharge (P<0.001). Moreover, a higher RATs from low-level activity before meeting the criteria for physiological stability also showed a significant association with lower ADL dependence at discharge (P=0.047). CONCLUSIONS ADL dependence was significantly lower among those who underwent high-dose rehabilitation. The RATs was consistently associated with ADL dependence at discharge.
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Affiliation(s)
- Shinichi Watanabe
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Yasunari Morita
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Shuichi Suzuki
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Kaito Kochi
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Mika Ohno
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
| | - Yuki Iida
- Department of Physical Therapy, School of Health Science, Toyohashi Sozo University, Toyohashi, Aichi, Japan
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12
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Cortés OL, Herrera-Galindo M, Becerra C, Rincón-Roncancio M, Povea-Combariza C, Esparza-Bohorquez M. Preoperative walking recommendation for non-cardiac surgery patients to reduce the length of hospital stay: a randomized control trial. BMC Sports Sci Med Rehabil 2021; 13:80. [PMID: 34321092 PMCID: PMC8320206 DOI: 10.1186/s13102-021-00317-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 07/07/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Even though the importance of preparing patients for a surgical event is recognized, there are still gaps about the benefit of improving functional capacity by walking during the waiting time among patients scheduled for non-cardiac surgery. The aim of this study was to evaluate the impact of pre-surgical walking in-hospital length of stay, early ambulation, and the appearance of complications after surgery among patients scheduled for non-cardiac surgery. METHODS A two-arm, single- blinded randomized controlled trial was developed from May 2016 to August 2017. Eligible outpatients scheduled for non-cardiac surgery, capable of walking, were randomized (2:1 ratio) to receive a prescription of walking 150 min/week during the whole pre-surgical waiting time (n = 249) or conventional care (n = 119). The primary outcome was the difference in hospital length of stay, and secondary results were time to first ambulation during hospitalization, description of ischemic events during hospitalization and after six months of hospital discharge, and the walking continuation. We performed an intention to treat analysis and compared length of stay between both groups by Kaplan-Meier estimator (log-rank test). RESULTS There were no significant differences in the length of hospital stay between both groups (log-rank test p = 0.367) and no differences in the first ambulation time during hospitalization (log-rank test p = 0.299). Similar rates of postoperative complications were observed in both groups, but patients in the intervention group continued to practice walking six months after discharge (p < 0.001). CONCLUSION Our study is the first clinical trial evaluating the impact of walking before non-cardiac surgery in the length of stay, early ambulation, and complications after surgery. Prescription of walking for patients before non-cardiac surgery had no significant effect in reducing the length of stay, and early ambulation. The results become a crucial element for further investigation. TRIAL REGISTRATION PAMP-Phase2 was registered in ClinicalTrials.gov NCT03213496 on July 11, 2017.
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Affiliation(s)
- Olga L Cortés
- Research Unit and Nursing Department, Fundación Cardioinfantil-Instituto de Cardiología, Cl. 163a #13B-60, Bogotá D.C, Colombia.
| | - Mauricio Herrera-Galindo
- Faculty of Health Sciences, Universidad Autónoma de Bucaramanga, Avenida 42 No 48-11PBX, Bucaramanga, Colombia
| | - Claudia Becerra
- Nursing Department, Fundación Cardioinfantil-Instituto de Cardiología, Cl. 163a #13B-60, Bogotá D.C, Colombia
| | - Mónica Rincón-Roncancio
- Cardiovascular Rehabilitation Department, Fundación Cardioinfantil-Instituto de Cardiología, Cl. 163a #13B-60, Bogotá D.C, Colombia
| | | | - Maribel Esparza-Bohorquez
- Nursing Department, Fundación Oftalmológica de Santander-Clínica Carlos Ardila Lulle, FOSCAL, Calle 155A No23-60, Floridablanca, Colombia
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13
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Mart MF, Girard TD, Thompson JL, Whitten-Vile H, Raman R, Pandharipande PP, Heyland DK, Ely EW, Brummel NE. Nutritional Risk at intensive care unit admission and outcomes in survivors of critical illness. Clin Nutr 2021; 40:3868-3874. [PMID: 34130034 PMCID: PMC8243837 DOI: 10.1016/j.clnu.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/07/2021] [Accepted: 05/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Risk factors for poor outcomes after critical illness are incompletely understood. While nutritional risk is associated with mortality in critically ill patients, its association with disability, cognitive, and health-related quality of life is unclear in survivors of critical illness. This study's objective was to determine whether greater nutritional risk at ICU admission is associated with greater disability, worse cognition, and worse HRQOL at 3 and 12-month follow-up. METHODS We enrolled adults (≥18 years of age) with respiratory failure or shock treated in medical and surgical intensive care units from two U.S. centers. We measured nutritional risk using the modified Nutrition Risk in Critically Ill (mNUTRIC) score (range 0-9 [highest risk]) at intensive care unit admission. We measured associations between mNUTRIC scores and discharge destination, disability in basic activities of daily living (ADLs) using the Katz ADL, instrumental ADLs using the Functional Activities Questionnaire (FAQ), global cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), executive function using the Trail Making Test Part B (Trails B), and health-related quality of life using the SF-36, adjusting for sex, education, BMI, baseline frailty, disability, and cognition, severity of illness, days of delirium, coma, and mechanical ventilation. RESULTS Of the 821 patients enrolled in the ICU, 636 patients survived to hospital discharge. We assessed outcomes in 448 of 535 survivors (84%) at 3 months and 382 of 476 survivors (80%) at 12 months. Higher mNUTRIC scores predicted greater odds of discharge to an institution (OR 2.0, 95% CI: 1.6 to 2.6; P < 0.01). Higher mNUTRIC scores were associated with a trend towards greater disability in basic activities of daily living (IRR 1.3, 95% CI 1.0 to 1.7) at 3 months that did not reach significance (p = 0.09) with no association demonstrated at 12 months. There were no associations between mNUTRIC scores and FAQ, RBANS, or Trails B scores. mNUTRIC scores were inconsistently associated with SF-36 physical and mental component scale scores. CONCLUSIONS Greater nutritional risk at ICU admission is associated with disability in survivors of critical illness. Future studies should evaluate interventions in those at high nutritional risk as a means to speed recovery.
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Affiliation(s)
- Matthew F Mart
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA
| | - Timothy D Girard
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer L Thompson
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Hannah Whitten-Vile
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA
| | - Rameela Raman
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Pratik P Pandharipande
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Department of Anesthesiology, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daren K Heyland
- Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada; Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
| | - E Wesley Ely
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; VA Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center (GRECC), Nashville, TN, USA; Vanderbilt Center for Quality Aging, Nashville, TN, USA
| | - Nathan E Brummel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, The Ohio State University College of Medicine, Columbus OH, USA; Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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14
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Urinary Titin Is a Novel Biomarker for Muscle Atrophy in Nonsurgical Critically Ill Patients: A Two-Center, Prospective Observational Study. Crit Care Med 2021; 48:1327-1333. [PMID: 32706557 DOI: 10.1097/ccm.0000000000004486] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Although skeletal muscle atrophy is common in critically ill patients, biomarkers associated with muscle atrophy have not been identified reliably. Titin is a spring-like protein found in muscles and has become a measurable biomarker for muscle breakdown. We hypothesized that urinary titin is useful for monitoring muscle atrophy in critically ill patients. Therefore, we investigated urinary titin level and its association with muscle atrophy in critically ill patients. DESIGN Two-center, prospective observational study. SETTING Mixed medical/surgical ICU in Japan. PATIENTS Nonsurgical adult patients who were expected to remain in ICU for greater than 5 days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Urine samples were collected on days 1, 2, 3, 5, and 7 of ICU admission. To assess muscle atrophy, rectus femoris cross-sectional area and diaphragm thickness were measured with ultrasound on days 1, 3, 5, and 7. Secondary outcomes included its relationship with ICU-acquired weakness, ICU Mobility Scale, and ICU mortality. Fifty-six patients and 232 urinary titin measurements were included. Urinary titin (normal range: 1-3 pmol/mg creatinine) was 27.9 (16.8-59.6), 47.6 (23.5-82.4), 46.6 (24.4-97.6), 38.4 (23.6-83.0), and 49.3 (27.4-92.6) pmol/mg creatinine on days 1, 2, 3, 5, and 7, respectively. Cumulative urinary titin level was significantly associated with rectus femoris muscle atrophy on days 3-7 (p ≤ 0.03), although urinary titin level was not associated with change in diaphragm thickness (p = 0.31-0.45). Furthermore, cumulative urinary titin level was associated with occurrence of ICU-acquired weakness (p = 0.01) and ICU mortality (p = 0.02) but not with ICU Mobility Scale (p = 0.18). CONCLUSIONS In nonsurgical critically ill patients, urinary titin level increased 10-30 times compared with the normal level. The increased urinary titin level was associated with lower limb muscle atrophy, occurrence of ICU-acquired weakness, and ICU mortality.
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15
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Environmental Factors Affecting Early Mobilization and Physical Disability Post-Intensive Care: An Integrative Review Through the Lens of the World Health Organization International Classification of Functioning, Disability, and Health. Dimens Crit Care Nurs 2021; 40:92-117. [PMID: 33961378 DOI: 10.1097/dcc.0000000000000461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Early mobilization (EM) is one of few potential protective factors associated with reduced physical disability post-intensive care (PD PIC). However, only 45% of intensive care units (ICUs) in the United States routinely practice EM despite its recognized benefits. OBJECTIVES To analyze the evidence on the relationship between critical care EM, PD PIC, and environmental factors, using the theoretical lens of the World Health Organization's (WHO's) International Classification of Functioning, Disability, and Health (ICF). METHOD The Whittemore and Knafl methodology for integrative reviews and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines were followed. Qualitative, quantitative, and mixed-methods studies (n = 38) that evaluated EM and 1 or more domains of the WHO ICF were included. Quality was appraised using the Mixed-Methods Appraisal Tool. Study characteristics were evaluated for common themes and relationships. The ICF domains and subdomains pertaining to each study were synthesized. RESULTS Early mobilization was related to improved functioning on the disability continuum of the WHO ICF. Early mobilization was influenced by several WHO ICF environmental factors. Dedicated physical and occupational therapy teams in the ICU, interdisciplinary rounds, and positive family and staff perception of EM facilitated intervention delivery. However, poor staffing levels, negative unit culture, perceived workload burden, and lack of equipment, education, and financial support impeded delivery of EM. DISCUSSION Early mobilization is a promising intervention that may reduce PD PIC. However, environmental factors negatively influence delivery of EM in the ICU. Several gaps in EM research limit its acceptability in ICU practice. Existing EM research is challenged by poor methodological quality. Further study is necessary to better understand the role of EM on PD PIC and improve patient outcomes following critical illness.
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16
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Nakanishi N, Doi S, Kawahara Y, Shiraishi M, Oto J. Effect of vibration therapy on physical function in critically ill adults (VTICIA trial): protocol for a single-blinded randomised controlled trial. BMJ Open 2021; 11:e043348. [PMID: 33653754 PMCID: PMC7929803 DOI: 10.1136/bmjopen-2020-043348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Vibration therapy has been used as an additional approach in passive rehabilitation. Recently, it has been demonstrated to be feasible and safe for critically ill patients, whose muscle weakness and intensive care unit (ICU)-acquired weakness are serious problems. However, the effectiveness of vibration therapy in this population is unclear. METHODS AND ANALYSIS This study will enrol 188 adult critically ill patients who require further ICU stay after they can achieve sitting at the edge of the bed or wheelchair. The sample size calculation is based on a 15% improvement of Functional Status Score for the ICU. They will be randomised to vibration therapy coupled with protocolised mobilisation or to protocolised mobilisation alone; outcomes will be compared between the two groups. Therapy will be administered using a low-frequency vibration device (5.6-13 Hz) for 15 min/day from when the patient first achieves a sitting position and onward until discharge from the ICU. Outcome assessments will be blinded to the intervention. Primary outcome will be measured using the Functional Status Score for the ICU during discharge. Secondary outcomes will be identified as follows: delirium, Medical Research Council Score, ICU-acquired weakness, the change of biceps brachii and rectus femoris muscle mass measured by ultrasound, ICU mobility scale and ventilator-free and ICU-free days (number of free days during 28 days after admission). For safety assessment, vital signs will be monitored during the intervention. ETHICS AND DISSEMINATION This study has been approved by the Clinical Research Ethics Committee of Tokushima University Hospital. Results will be disseminated through publication in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER UMIN000039616.
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Affiliation(s)
- Nobuto Nakanishi
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Satoshi Doi
- Department of Nursing, Tokushima University Hospital, Tokushima, Japan
| | - Yoshimi Kawahara
- Department of Nursing, Tokushima University Hospital, Tokushima, Japan
| | - Mie Shiraishi
- Department of Nursing, Tokushima University Hospital, Tokushima, Japan
| | - Jun Oto
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
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