MORE for multiple organ dysfunction syndrome: Multiple Organ REanimation, REgeneration, and REprogramming

The surgical intensive care unit optimal mobility score predicts mortality and length of stay

OBJECTIVES

To test if the surgical intensive care unit optimal mobility score predicts mortality and intensive care unit and hospital length of stay.

DESIGN

Prospective single-center cohort study.

SETTING

Surgical intensive care unit of the Massachusetts General Hospital.

PATIENTS

One hundred thirteen consecutive patients admitted to the surgical intensive care unit.

INVESTIGATIONS

We tested the hypotheses that the surgical intensive care unit optimal mobility score independent of comorbidity index, Acute Physiology and Chronic Health Evaluation II, creatinine, hypotension, hypernatremia, acidosis, hypoxia, and hypercarbia predicts hospital mortality, surgical intensive care unit and total hospital length of stay.

MEASUREMENTS AND MAIN RESULTS

Two nurses independently predicted the patients' mobilization capacity by using the surgical intensive care unit optimal mobility score the morning after admission, whereas a third nurse recorded the achieved mobilization levels of patients at the end of the day. A multidisciplinary expert team measured patients' grip strength and assessed their predicted mobilization capacity independently. Multivariate analysis revealed that the surgical intensive care unit optimal mobility score was the only independent predictor of mortality. Surgical intensive care unit optimal mobility score, hypotension, and hypernatremia (>144 mmol/L) independently predicted intensive care unit length of stay, whereas the surgical intensive care unit optimal mobility score and hypernatremia predicted total hospital length of stay. The Acute Physiology and Chronic Health Evaluation II score was not identified in the multivariate analysis. The surgical intensive care unit optimal mobility score was also a reliable and valid instrument in predicting achieved mobilization levels of patients.

CONCLUSIONS

In surgical critically ill patients presenting without preexisting impairment of functional mobility, the surgical intensive care unit optimal mobility score is a reliable and valid tool to predict mortality and intensive care unit and hospital length of stay.

An alternative point of view: getting by with less: what's wrong with perfection?

OBJECTIVE

Predictions about the future impact of technologic and process innovations inspire optimistic visions. Optimism and speculation require a counterweight. Because results often do not turn out as expected, anticipating failure is useful, and anticipating unintended consequences is visionary.

MEASUREMENTS

A history of unfulfilled prognostications was explored with the intent of finding something essential to the complexities of medicine. Do missed predictions signal another side to innovation that also helps us uncover new information about our world?

MAIN RESULTS

Serendipity is an important theme in medical innovation. There is no reason to think this will change. Things do not necessarily go as planned, but often the results are as important as the original prediction was supposed to be. It will not be clear where we end up until we get there.

CONCLUSIONS

Ideal goals are useful but speculative and subjective. There in fact might be several ideals and contingency is important. The detours and incidental stops on the way to an ideal are more fruitful than the goal itself.