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Trivedi JR, Endo T, Sharma A, Fox MP, Slaughter MS, van Berkel VH. Ambulatory Extracorporeal Membrane Oxygenation Use in Patients Listed for Lung Transplant. ASAIO J 2024; 70:625-632. [PMID: 38300884 DOI: 10.1097/mat.0000000000002154] [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: 02/03/2024] Open
Abstract
There has been an increase in the use of extracorporeal membrane oxygenation (ECMO) to bridge critically ill patients to lung transplant (LTX). This study evaluates how ambulatory status on ECMO affected waitlist and post-LTX outcomes. The United Network of Organ Sharing (UNOS) database was queried for patients aged of greater than or equal to 18 years and between 2016 and 2021 to identify pre-LTX patients supported by ECMO. The patients were classified in venous-arterial (VA) ECMO and veno-venous (VV) ECMO cohorts and further classified as ambulatory (AMB) and non-AMB (nAMB). Each cohort was controlled against the non-ECMO patients. Univariate statistical tests, as well as Kaplan-Meier survival curves, were used for analysis. The 90 day waitlist survival was the highest among the non-ECMO group (96%), but both AMB VV and VA groups had superior survival compared to the nAMB group (85% vs. 75%, 78% vs. 65%, p < 0.01). After adjusting for the median lung allocation score (LAS) (88) in the VV ECMO group, the waitlist survival was superior in the AMB VV ECMO compared to those not on ECMO (86% vs. 78%, p > 0.01). The 1 year post-LTX survival between non-ECMO and AMB VV ECMO was comparable (88% vs. 88%, p = 0.66). Ambulating patients or use of physical therapy while on ECMO can help improve lung transplant outcomes.
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Affiliation(s)
- Jaimin R Trivedi
- From the Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky
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Yen HC, Chuang HJ, Hsiao WL, Tsai YC, Hsu PM, Chen WS, Han YY. Assessing the impact of early progressive mobilization on moderate-to-severe traumatic brain injury: a randomized controlled trial. Crit Care 2024; 28:172. [PMID: 38778416 PMCID: PMC11112875 DOI: 10.1186/s13054-024-04940-0] [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: 02/26/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major cause of neurodisability worldwide, with notably high disability rates among moderately severe TBI cases. Extensive previous research emphasizes the critical need for early initiation of rehabilitation interventions for these cases. However, the optimal timing and methodology of early mobilization in TBI remain to be conclusively determined. Therefore, we explored the impact of early progressive mobilization (EPM) protocols on the functional outcomes of ICU-admitted patients with moderate to severe TBI. METHODS This randomized controlled trial was conducted at a trauma ICU of a medical center; 65 patients were randomly assigned to either the EPM group or the early progressive upright positioning (EPUP) group. The EPM group received early out-of-bed mobilization therapy within seven days after injury, while the EPUP group underwent early in-bed upright position rehabilitation. The primary outcome was the Perme ICU Mobility Score and secondary outcomes included Functional Independence Measure motor domain (FIM-motor) score, phase angle (PhA), skeletal muscle index (SMI), the length of stay in the intensive care unit (ICU), and duration of ventilation. RESULTS Among 65 randomized patients, 33 were assigned to EPM and 32 to EPUP group. The EPM group significantly outperformed the EPUP group in the Perme ICU Mobility and FIM-motor scores, with a notably shorter ICU stay by 5.9 days (p < 0.001) and ventilation duration by 6.7 days (p = 0.001). However, no significant differences were observed in PhAs. CONCLUSION The early progressive out-of-bed mobilization protocol can enhance mobility and functional outcomes and shorten ICU stay and ventilation duration of patients with moderate-to-severe TBI. Our study's results support further investigation of EPM through larger, randomized clinical trials. Clinical trial registration ClinicalTrials.gov NCT04810273 . Registered 13 March 2021.
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Affiliation(s)
| | | | | | | | - Po-Min Hsu
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - Yin-Yi Han
- National Taiwan University Hospital, Taipei, Taiwan.
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Neto RPM, Espósito LMB, da Rocha FC, Filho AAS, Silva JHG, de Sousa Santos EC, Sousa BLSC, dos Santos Gonçalves KRR, Garcia-Araujo AS, Hamblin MR, Ferraresi C. Photobiomodulation therapy (red/NIR LEDs) reduced the length of stay in intensive care unit and improved muscle function: A randomized, triple-blind, and sham-controlled trial. JOURNAL OF BIOPHOTONICS 2024; 17:e202300501. [PMID: 38262071 PMCID: PMC11065604 DOI: 10.1002/jbio.202300501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024]
Abstract
CONTEXT Photobiomodulation therapy (PBMT) has been widely used to improve strength, fatigue resistance and increase muscle mass in healthy individuals. These effects could help critically ill patients admitted to intensive care units (ICUs) who show reduced mobility and muscle strength. ICU-acquired weakness lessens overall health and increases the patient's length of stay in the ICU. OBJECTIVE This study evaluated the effects of PBMT using low intensity light-emitting diodes (LEDs) on the mobility and muscle strength (functional capacity) and length of stay of patients admitted to hospital ICU. METHODS This randomized, triple-blind, sham-controlled trial was conducted in a hospital ICU. Sixty patients were randomly assigned to two equal groups: (a) PBMT and (b) Sham. PBMT was applied daily to patients until their discharge from the ICU, using a flexible neoprene array of 264 LEDs (120 at 635 nm, 1.2 mW each; 144 at 880 nm, 15 mW each) for 90s (207.36 Joules) at each site. Ten sites were located bilaterally on the thighs, legs, arms, and forearms ventrally and dorsally, 15 min totaling 2,073.6 Joules per session. Outcomes were length of stay (in h) until discharge from the ICU, muscle strength by the Medical Research Council (MRC) score and handgrip dynamometry (HGD), patient mobility by Intensive Care Unit Mobility Scale (IMS) and the Simplified Acute Physiology Score 3 (SAPS 3) for predicting mortality of patients admitted to the ICU. RESULTS PBMT reduced the average length of stay in the ICU by ~30% (p = 0.028); increased mobility (IMS: 255% vs. 110% p = 0.007), increased muscle strength (MRC: 12% vs. -9% p = 0.001) and HGD (34% vs. -13% p < 0.001), and the SAPS3 score was similar (p > 0.05). CONCLUSION The results suggest that daily PBMT can reduce the length of stay of ICU patients and increase muscle strength and mobility.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Michael R. Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa
| | - Cleber Ferraresi
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, Brazil
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Woodbridge HR, McCarthy CJ, Jones M, Willis M, Antcliffe DB, Alexander CM, Gordon AC. Assessing the safety of physical rehabilitation in critically ill patients: a Delphi study. Crit Care 2024; 28:144. [PMID: 38689372 PMCID: PMC11061934 DOI: 10.1186/s13054-024-04919-x] [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: 12/03/2023] [Accepted: 04/17/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Physical rehabilitation of critically ill patients is implemented to improve physical outcomes from an intensive care stay. However, before rehabilitation is implemented, a risk assessment is essential, based on robust safety data. To develop this information, a uniform definition of relevant adverse events is required. The assessment of cardiovascular stability is particularly relevant before physical activity as there is uncertainty over when it is safe to start rehabilitation with patients receiving vasoactive drugs. METHODS A three-stage Delphi study was carried out to (a) define adverse events for a general ICU cohort, and (b) to define which risks should be assessed before physical rehabilitation of patients receiving vasoactive drugs. An international group of intensive care clinicians and clinician researchers took part. Former ICU patients and their family members/carers were involved in generating consensus for the definition of adverse events. Round one was an open round where participants gave their suggestions of what to include. In round two, participants rated their agreements with these suggestions using a five-point Likert scale; a 70% consensus agreement threshold was used. Round three was used to re-rate suggestions that had not reached consensus, whilst viewing anonymous feedback of participant ratings from round two. RESULTS Twenty-four multi-professional ICU clinicians and clinician researchers from 10 countries across five continents were recruited. Average duration of ICU experience was 18 years (standard deviation 8) and 61% had publications related to ICU rehabilitation. For the adverse event definition, five former ICU patients and one patient relative were recruited. The Delphi process had a 97% response rate. Firstly, 54 adverse events reached consensus; an adverse event tool was created and informed by these events. Secondly, 50 risk factors requiring assessment before physical rehabilitation of patients receiving vasoactive drugs reached consensus. A second tool was created, informed by these suggestions. CONCLUSIONS The adverse event tool can be used in studies of physical rehabilitation to ensure uniform measurement of safety. The risk assessment tool can be used to inform clinical practise when risk assessing when to start rehabilitation with patients receiving vasoactive drugs. Trial registration This study protocol was retrospectively registered on https://www.researchregistry.com/ (researchregistry2991).
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Affiliation(s)
- Huw R Woodbridge
- Imperial College Healthcare NHS Trust, London, UK.
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | | | | | | | - David B Antcliffe
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Caroline M Alexander
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Anthony C Gordon
- Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Taylor J, Wilcox ME. Physical and Cognitive Impairment in Acute Respiratory Failure. Crit Care Clin 2024; 40:429-450. [PMID: 38432704 DOI: 10.1016/j.ccc.2024.01.009] [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: 03/05/2024]
Abstract
Recent research has brought renewed attention to the multifaceted physical and cognitive dysfunction that accompanies acute respiratory failure (ARF). This state-of-the-art review provides an overview of the evidence landscape encompassing ARF-associated neuromuscular and neurocognitive impairments. Risk factors, mechanisms, assessment tools, rehabilitation strategies, approaches to ventilator liberation, and interventions to minimize post-intensive care syndrome are emphasized. The complex interrelationship between physical disability, cognitive dysfunction, and long-term patient-centered outcomes is explored. This review highlights the need for comprehensive, multidisciplinary approaches to mitigate morbidity and accelerate recovery.
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Affiliation(s)
- Jonathan Taylor
- Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1232, New York, NY 10029, USA
| | - Mary Elizabeth Wilcox
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
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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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Zhang C, Wang X, Mi J, Zhang Z, Luo X, Gan R, Mu S. Effects of the High-Intensity Early Mobilization on Long-Term Functional Status of Patients with Mechanical Ventilation in the Intensive Care Unit. Crit Care Res Pract 2024; 2024:4118896. [PMID: 38560481 PMCID: PMC10980544 DOI: 10.1155/2024/4118896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
Objective Intensive care unit (ICU)-acquired weakness often occurs in patients with invasive mechanical ventilation (IMV). Early active mobility may reduce ICU-acquired weakness, improve functional status, and reduce disability. The aim of this study was to investigate whether high-intensity early mobility improves post-ICU discharge functional status of IMV patients. Methods 132 adult patients in the ICU who were undergoing IMV were randomly assigned into two groups with a ratio of 1 : 1, with one group received high-intensity early mobility (intervention group, IG), while the other group received conventional treatment (control group, CG). The functional status (Barthel Index (BI)), capacity of mobility (Perme score and ICU Mobility Scale (IMS)), muscle strength (Medical Research Council sum scores (MRC-SS)), mortality, complication, length of ICU stay, and duration of IMV were evaluated at ICU discharge or after 3-month of ICU discharge. Results The patient's functional status was improved (BI scores 90.6 ± 18.0 in IG vs. 77.7 ± 27.9 in CG; p=0.005), and capacity of mobility was increased (Perme score 17.6 ± 7.1 in IG vs. 12.2 ± 8.5 in CG, p < 0.001; IMS 4.7 ± 2.6 in IG vs. 3.0 ± 2.6 in CG, p < 0.001). The IG had a higher muscle strength and lower incidence of ICU-acquired weakness (ICUAW) than that in the CG. The incidence of mortality and delirium was also lower than CG at ICU discharge. However, there were no differences in terms of length of ICU stay, duration of IMV, ventilator-associated pneumonia, and venous thrombosis. Conclusions High-intensity early mobility improved the patient's functional status and increased capacity of mobility with IMV. The benefits to functional status remained after 3 month of ICU discharge. Other benefits included higher muscle strength, lower incidence of ICUAW, mortality, and delirium in IG.
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Affiliation(s)
- Chuanlin Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xueqin Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Mi
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- School of Nursing, Chongqing Medical University, Chongqing, China
| | - Zeju Zhang
- School of Nursing, Chongqing Medical and Pharmaceutical College, Chongqing, China
| | - Xinyi Luo
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruiying Gan
- Department of Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaoyu Mu
- School of Nursing, Chongqing Medical University, Chongqing, China
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Sutton L, Bell E, Every-Palmer S, Weatherall M, Skirrow P. Survivorship outcomes for critically ill patients in Australia and New Zealand: A scoping review. Aust Crit Care 2024; 37:354-368. [PMID: 37684157 DOI: 10.1016/j.aucc.2023.07.008] [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: 05/03/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Impairments after critical illness, termed the post-intensive care syndrome, are an increasing focus of research in Australasia. However, this research is yet to be cohesively synthesised and/or summarised. OBJECTIVE The aim of this scoping review was to explore patient outcomes of survivorship research, identify measures, methodologies, and designs, and explore the reported findings in Australasia. INCLUSION CRITERIA Studies reporting outcomes for adult survivors of critical illness from Australia and New Zealand in the following domains: physical, functional, psychosocial, cognitive, health-related quality of life (HRQoL), discharge destination, health care use, return to work, and ongoing symptoms/complications of critical illness. METHODS The Joanna Briggs Institute scoping review methodology framework was used. A protocol was published on the open science framework, and the search used Ovid MEDLINE, Scopus, ProQuest, and Google databases. Eligible studies were based on reports from Australia and New Zealand published in English between January 2000 and March 2022. RESULTS There were 68 studies identified with a wide array of study aims, methodology, and designs. The most common study type was nonexperimental cohort studies (n = 17), followed by studies using secondary analyses of other study types (n = 13). HRQoL was the most common domain of recovery reported. Overall, the identified studies reported that impairments and activity restrictions were associated with reduced HRQoL and reduced functional status was prevalent in survivors of critical illness. About 25% of 6-month survivors reported some form of disability. Usually, by 6 to12 months after critical illness, impairments had improved. CONCLUSIONS Reports of long-term outcomes for survivors of critical illness in Australia highlight that impairments and activity limitations are common and are associated with poor HRQoL. There was little New Zealand-specific research related to prevalence, impact, unmet needs, ongoing symptoms, complications from critical illness, and barriers to recovery.
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Affiliation(s)
- Lynsey Sutton
- Clinical Nurse Specialist, Wellington Intensive Care Unit, Wellington Regional Hospital, Te Whatu Ora Capital, Coast and Hutt Valley, Riddiford Street, Newtown, Wellington 6021, New Zealand; Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Elliot Bell
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
| | - Mark Weatherall
- Department of Medicine, University of Otago, Wellington, New Zealand.
| | - Paul Skirrow
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand.
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Kourek C, Kanellopoulos M, Raidou V, Antonopoulos M, Karatzanos E, Patsaki I, Dimopoulos S. Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery: A systematic review. World J Cardiol 2024; 16:27-39. [PMID: 38313389 PMCID: PMC10835467 DOI: 10.4330/wjc.v16.i1.27] [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: 11/29/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit (ICU) are major factors resulting in the development of ICU-acquired muscle weakness (ICUAW). ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery, and may be a risk factor for prolonged duration of mechanical ventilation, associated with a higher risk of readmission and higher mortality. Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay. Neuromuscular electrical stimulation (NMES) is an alternative modality of exercise in patients with muscle weakness. A major advantage of NMES is that it can be applied even in sedated patients in the ICU, a fact that might enhance early mobilization in these patients. AIM To evaluate safety, feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery. METHODS We performed a search on Pubmed, Physiotherapy Evidence Database (PEDro), Embase and CINAHL databases, selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials (RCTs) that included implementation of NMES in patients before after cardiac surgery. RCTs were assessed for methodological rigor and risk of bias via the PEDro. The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function. RESULTS Ten studies were included in our systematic review, resulting in 703 participants. Almost half of them performed NMES and the other half were included in the control group, treated with usual care. Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery. Functional capacity was assessed in 8 studies via 6MWT or other indices, and improved only in 1 study before and in 1 after cardiac surgery. Nine studies explored the effects of NMES on muscle strength and function and, most of them, found increase of muscle strength and improvement in muscle function after NMES. NMES was safe in all studies without any significant complication. CONCLUSION NMES is safe, feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery, but has no significant effect on functional capacity.
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Affiliation(s)
- Christos Kourek
- Medical School of Athens, National and Kapodistrian University of Athens, Athens 15772, Greece
| | - Marios Kanellopoulos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, Evangelismos Hospital, Athens 10676, Greece
| | - Vasiliki Raidou
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, Evangelismos Hospital, Athens 10676, Greece
| | | | - Eleftherios Karatzanos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, Evangelismos Hospital, Athens 10676, Greece
| | - Irini Patsaki
- Department of Physiotherapy, University of West Attica, Athens 12243, Greece
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise and Rehabilitation Laboratory, Evangelismos Hospital, Athens 10676, Greece
- Intensive Care Unit, Onassis Cardiac Surgery Center, Kallithea 17674, Greece.
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Kim T, Kim H. Pathophysiology and Therapeutic Management of Bone Loss in Patients with Critical Illness. Pharmaceuticals (Basel) 2023; 16:1718. [PMID: 38139844 PMCID: PMC10747168 DOI: 10.3390/ph16121718] [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: 09/28/2023] [Revised: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Patients with critical illnesses are at higher risk of comorbidities, which can include bone mineral density loss, bone turnover marker increase, and fragility fractures. Patients admitted to intensive care units (ICUs) have a higher risk of bone fractures. Since hypermetabolism is a characteristic of ICU patients, such patients are often rapidly affected by systemic deterioration, which often results in systemic wasting disease. Major risk factors for ICU-related bone loss include physical restraint, inflammation, neuroendocrine stress, malnutrition, and medications. A medical history of critical illness should be acknowledged as a risk factor for impaired bone metabolism. Bone loss associated with ICU admission should be recognized as a key component of post-intensive care syndrome, and further research that focuses on treatment protocols and prevention strategies is required. Studies aimed at maintaining gut integrity have emphasized protein administration and nutrition, while research is ongoing to evaluate the therapeutic benefits of anti-resorptive agents and physical therapy. This review examines both current and innovative clinical strategies that are used for identifying risk factors of bone loss. It provides an overview of perioperative outcomes and discusses the emerging novel treatment modalities. Furthermore, the review presents future directions in the treatment of ICU-related bone loss.
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Affiliation(s)
- Taejin Kim
- Department of Urology, CHA University Ilsan Medical Center, CHA University School of Medicine, Goyang-si 10414, Republic of Korea;
| | - Hyojin Kim
- Division of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong-si 14353, Republic of Korea
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Rajamani A, Subramaniam A, Lung B, Masters K, Gresham R, Whitehead C, Lowrey J, Seppelt I, Kumar H, Kumar J, Hassan A, Orde S, Bharadwaj PA, Arvind H, Huang S. Remi-fent 1-A pragmatic randomised controlled study to evaluate the feasibility of using remifentanil or fentanyl as sedation adjuncts in mechanically ventilated patients. CRIT CARE RESUSC 2023; 25:216-222. [PMID: 38234321 PMCID: PMC10790007 DOI: 10.1016/j.ccrj.2023.10.012] [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: 09/26/2023] [Accepted: 10/30/2023] [Indexed: 01/19/2024]
Abstract
Objective To evaluate the feasibility of conducting a prospective randomised controlled trial (pRCT) comparing remifentanil and fentanyl as adjuncts to sedate mechanically ventilated patients. Design Single-center, open-labelled, pRCT with blinded analysis. Setting Australian tertiary intensive care unit (ICU). Participants Consecutive adults between June 2020 and August 2021 expected to receive invasive ventilation beyond the next day and requiring opioid infusion were included. Exclusion criteria were pregnant/lactating women, intubation >12 h, or study-drug hypersensitivity. Interventions Open-label fentanyl and remifentanil infusions per existing ICU protocols. Outcomes Primary outcomes were feasibility of recruiting ≥1 patient/week and >90 % compliance, namely no other opioid infusion used during the study period. Secondary outcomes included complications, ICU-, ventilator- and hospital-free days, and mortality (ICU, hospital). Blinded intention-to-treat analysis was performed concealing the allocation group. Results 208 patients were enrolled (mean 3.7 patients/week). Compliance was 80.6 %. More patients developed complications with fentanyl than remifentanil: bradycardia (n = 44 versus n = 21; p < 0.001); hypotension (n = 78 versus n = 53; p < 0.01); delirium (n = 28 versus n = 15; p = 0.001). No differences were seen in ICU (24.3 % versus 27.6 %,p = 0.60) and hospital mortalities (26.2 % versus 30.5 %; p = 0.50). Ventilator-free days were higher with remifentanil (p = 0.01). Conclusions We demonstrated the feasibility of enrolling patients for a pRCT comparing remifentanil and fentanyl as sedation adjuncts in mechanically ventilated patients. We failed to attain the study-opioid compliance target, likely because of patients with complex sedative/analgesic requirements. Secondary outcomes suggest that remifentanil may reduce mechanical ventilation duration and decrease the incidence of complications. An adequately powered multicentric phase 2 study is required to evaluate these results.
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Affiliation(s)
- Arvind Rajamani
- Nepean Clinical School, University of Sydney, Derby Street, Kingswood, NSW 2747, Australia
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW 2747, Australia
| | | | - Brian Lung
- Department of Anaesthesia, Nepean Hospital, Kingswood, NSW 2747, Australia
| | - Kristy Masters
- Department of Intensive Care Medicine, Nepean Hospital, Derby Street, Kingswood, NSW 2747, Australia
| | - Rebecca Gresham
- Department of Intensive Care Medicine, Nepean Hospital, Derby Street, Kingswood, NSW 2747, Australia
| | - Christina Whitehead
- Department of Intensive Care Medicine, Nepean Hospital, Derby Street, Kingswood, NSW 2747, Australia
| | - Julie Lowrey
- Department of Intensive Care Medicine, Nepean Hospital, Derby Street, Kingswood, NSW 2747, Australia
| | - Ian Seppelt
- Department of Intensive Care Medicine, Nepean Hospital, Derby Street, Kingswood, NSW 2747, Australia
- Faculty of Medicine, University of Sydney, Australia
- Critical Care Division, The George Institute for Global Health, Sydney, Australia
| | - Hemant Kumar
- Department of Intensive Care Medicine, Nepean Hospital, Derby Street, Kingswood, NSW 2747, Australia
| | - Jayashree Kumar
- Department of Intensive Care Medicine, Nepean Hospital, Derby Street, Kingswood, NSW 2747, Australia
| | - Anwar Hassan
- Department of Intensive Care Medicine, Nepean Hospital, Derby Street, Kingswood, NSW 2747, Australia
| | - Sam Orde
- Department of Intensive Care Medicine, Nepean Hospital, Derby Street, Kingswood, NSW 2747, Australia
| | | | | | - Stephen Huang
- Nepean Clinical School, University of Sydney, Derby Street, Kingswood, NSW 2747, Australia
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12
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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).
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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.
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13
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Lewis M, Cumming L, Twose P. Comparison of perceptions and barriers to mobilization in critical care: A comparison of nursing staff and physiotherapists-A single-site service evaluation. Nurs Crit Care 2023; 28:1196-1203. [PMID: 33818896 DOI: 10.1111/nicc.12625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mobilization is a key component in the recovery of those admitted to critical care. However, previous research has demonstrated challenges in the implementation of mobilization within critical care, including staff knowledge, attitudes, and behaviours. AIM The aim of the current study was to explore the perceived barriers and limitations to mobilization from the perspective of nursing staff, and to compare these with physiotherapists. STUDY DESIGN Single-site service evaluation utilizing the patient mobilizations attitudes and beliefs survey for ICU and locally developed barriers to rehabilitation questionnaire. RESULTS About 135 participants (126 nurses and 9 physiotherapists) were invited to anonymously complete the questionnaires (either paper or electronic), with a response rate of 73.0% (n = 92) for nursing staff and 100% for physiotherapists. Nursing staff reported significantly higher perceived barriers to rehabilitation on both questionnaires when compared with physiotherapy staff, which was not associated with years of experience within critical care. Behavioural barriers were most frequent in both professions which included items such as time availability and presence of perceived contra-indications to mobilization. CONCLUSION Nursing staff reported greater perceived barriers to rehabilitation when compared with physiotherapists. Further quality improvement projects are now required to reduce these barriers and assist the implementation of mobilization as part of the rehabilitation process. RELEVANCE TO CLINICAL PRACTICE Rehabilitation is an essential element of practice within critical care. Understanding the system, local and personal barriers will allow for improvement projects to enhance the delivery of care and improve clinical outcomes.
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Affiliation(s)
- Megan Lewis
- Physiotherapy Department, University of Wales, Cardiff, UK
| | - Luke Cumming
- Physiotherapy Department, University of Wales, Cardiff, UK
| | - Paul Twose
- Physiotherapy Department, University of Wales, Cardiff, UK
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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14
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Artaud-Macari E, Le Bouar G, Maris J, Dantoing E, Vatignez T, Girault C. [Ventilatory management of SARS-CoV-2 acute respiratory failure]. Rev Mal Respir 2023; 40:751-767. [PMID: 37865564 DOI: 10.1016/j.rmr.2023.09.005] [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: 04/16/2023] [Accepted: 09/19/2023] [Indexed: 10/23/2023]
Abstract
COVID-19 pneumonia presents several particularities in its clinical presentation (cytokine storm, silent hypoxemia, thrombo-embolic risk) and may lead to a number of acute respiratory distress syndrome (ARDS) phenotypes. While the optimal oxygenation strategy in cases of hypoxemic acute respiratory failure (ARF) is still under debate, ventilatory management of COVID-19-related ARF has confirmed the efficacy of high-flow oxygen therapy and restored interest in other ventilatory approaches such as continuous positive airway pressure (CPAP) and noninvasive ventilation involving a helmet, which due to patient overflow are sometimes implemented outside of critical care units. However, further studies are still needed to determine which patients should be given which oxygenation technique, and under which conditions they require invasive mechanical ventilation, given that delayed initiation potentially burdens prognosis. During invasive mechanical ventilation, ventral decubitus and extracorporeal membrane oxygenation have become increasingly prevalent. While innovative therapies such as awake prone position or lung transplantation have likewise been developed, their indications, modalities and efficacy remain to be determined.
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Affiliation(s)
- E Artaud-Macari
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France; UNIROUEN, UR-3830, Normandie université, CHU de Rouen, 76000 Rouen, France.
| | - G Le Bouar
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France
| | - J Maris
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France
| | - E Dantoing
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, 76000 Rouen, France
| | - T Vatignez
- Service de médecine intensive et réanimation, CHU de Rouen, 76000 Rouen, France
| | - C Girault
- UNIROUEN, UR-3830, Normandie université, CHU de Rouen, 76000 Rouen, France; Service de médecine intensive et réanimation, CHU de Rouen, 76000 Rouen, France
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15
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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: 4] [Impact Index Per Article: 4.0] [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.
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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
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16
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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.
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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
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17
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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.
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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.
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18
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Neves D, Marques Filho PR, Townsend RDS, Rodrigues CDS, Tagliari L, Madeira LC, Mattioni MF, de Camillis MLF, Leães CGS, de Andrade JMS, Robinson CC, Sganzerla D, Drehmer L, da Costa DFM, Machado AS, Rosa RG, Lago PD. Impact of vertical positioning on lung aeration among mechanically ventilated intensive care unit patients: a randomized crossover clinical trial. CRITICAL CARE SCIENCE 2023; 35:367-376. [PMID: 38265318 PMCID: PMC10802776 DOI: 10.5935/2965-2774.20230069-en] [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: 03/15/2023] [Accepted: 09/24/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To assess the impact of different vertical positions on lung aeration in patients receiving invasive mechanical ventilation. METHODS An open-label randomized crossover clinical trial was conducted between January and July 2020. Adults receiving invasive mechanical ventilation for > 24 hours and < 7 days with hemodynamic, respiratory and neurological stability were randomly assigned at a 1:1 ratio to the sitting position followed by passive orthostasis condition or the passive orthostasis followed by the sitting position condition. The primary outcome was lung aeration assessed using the lung ultrasound score (score ranges from 0 [better] to 36 [worse]). RESULTS A total of 186 subjects were screened; of these subjects, 19 were enrolled (57.8% male; mean age, 73.2 years). All participants were assigned to receive at least one verticalization protocol. Passive orthostasis resulted in mean lung ultrasound scores that did not differ significantly from the sitting position (11.0 versus 13.7; mean difference, -2.7; [95%CI -6.1 to 0.71; p = 0.11). Adverse events occurred in three subjects in the passive orthostasis group and in one in the sitting position group (p = 0.99). CONCLUSION This analysis did not find significant differences in lung aeration between the sitting and passive orthostasis groups. A randomized crossover clinical trial assessing the impact of vertical positioning on lung aeration in patients receiving invasive mechanical ventilation is feasible. Unfortunately, the study was interrupted due to the need to treat COVID-19 patients.ClinicalTrials.gov registry: NCT04176445.
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Affiliation(s)
- Douglas Neves
- Intensive Care Unit, Hospital Ernesto Dornelles - Porto Alegre
(RS), Brazil
| | | | | | | | - Luciana Tagliari
- Intensive Care Unit, Hospital Moinhos de Vento - Porto Alegre (RS),
Brazil
| | | | | | | | | | | | | | - Daniel Sganzerla
- Research Projects Office, Hospital Moinhos de Vento - Porto Alegre
(RS), Brazil
| | - Laura Drehmer
- Intensive Care Unit, Hospital Ernesto Dornelles - Porto Alegre
(RS), Brazil
| | | | | | - Regis Goulart Rosa
- Research Projects Office, Hospital Moinhos de Vento - Porto Alegre
(RS), Brazil
| | - Pedro Dal Lago
- Postgraduate Program in Rehabilitation Sciences, Universidade
Federal de Ciências da Saúde de Porto Alegre - Porto Alegre (RS),
Brazil
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19
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Yamada K, Kitai T, Iwata K, Nishihara H, Ito T, Yokoyama R, Inagaki Y, Shimogai T, Honda A, Takahashi T, Tachikawa R, Shirakawa C, Ito J, Seo R, Kuroda H, Doi A, Tomii K, Kohara N. Predictive factors and clinical impact of ICU-acquired weakness on functional disability in mechanically ventilated patients with COVID-19. Heart Lung 2023; 60:139-145. [PMID: 37018902 PMCID: PMC10036310 DOI: 10.1016/j.hrtlng.2023.03.008] [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: 08/11/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Patients with critical COVID-19 often require invasive mechanical ventilation (IMV) and admission to the intensive care unit (ICU), resulting in a higher incidence of ICU-acquired weakness (ICU-AW) and functional decline. OBJECTIVE This study aimed to examine the causes of ICU-AW and functional outcomes in critically ill patients with COVID-19 who required IMV. METHODS This prospective, single-center, observational study included COVID-19 patients who required IMV for ≥48 h in the ICU between July 2020 and July 2021. ICU-AW was defined as a Medical Research Council sum score <48 points. The primary outcome was functional independence during hospitalization, defined as an ICU mobility score ≥9 points. RESULTS A total of 157 patients (age: 68 [59-73] years, men: 72.6%) were divided into two groups (ICU-AW group; n = 80 versus non-ICU-AW; n = 77). Older age (adjusted odds ratio [95% confidence interval]: 1.05 [1.01-1.11], p = 0.036), administration of neuromuscular blocking agents (7.79 [2.87-23.3], p < 0.001), pulse steroid therapy (3.78 [1.49-10.1], p = 0.006), and sepsis (7.79 [2.87-24.0], p < 0.001) were significantly associated with ICU-AW development. In addition, patients with ICU-AW had significantly longer time to functional independence than those without ICU-AW (41 [30-54] vs 19 [17-23] days, p < 0.001). The development of ICU-AW was associated with delayed time to functional independence (adjusted hazard ratio: 6.08; 95% CI: 3.05-12.1; p < 0.001). CONCLUSIONS Approximately half of the patients with COVID-19 requiring IMV developed ICU-AW, which was associated with delayed functional independence during hospitalization.
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Affiliation(s)
- Kanji Yamada
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Takeshi Kitai
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiromasa Nishihara
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tsubasa Ito
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Rina Yokoyama
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuta Inagaki
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Shimogai
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Akihiro Honda
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
| | | | - Ryo Tachikawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Chigusa Shirakawa
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Jiro Ito
- Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryutaro Seo
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hirokazu Kuroda
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Asako Doi
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuo Kohara
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Kobe, Japan
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20
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Bento H, Fisk E, Johnson E, Goudelock B, Hunter M, Hoekstra D, Noren C, Hatton N, Magel J. Inspiratory Muscle Training While Hospitalized With Acute COVID-19 Respiratory Failure: A Randomized Controlled Trial. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2023; 14:134-142. [PMID: 37389410 PMCID: PMC10289076 DOI: 10.1097/jat.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Although inspiratory muscle training (IMT) has been used in outpatient settings for patients who recovered from COVID-19 respiratory failure, little data exist to support earlier implementation in acute care hospitals. This study aimed to assess the safety and feasibility of IMT during the acute disease phase of COVID-19. Design Setting and Patients Sixty patients presenting with COVID-19 to a single academic medical center were randomized to control or intervention groups using systematic randomization. Measurements Participants in the control group had their maximal inspiratory pressure (MIP) measured at enrollment and hospital discharge. They were also asked for their rating of perceived exertion on the Revised Borg Scale for Grading Severity of Dyspnea and were scored by researchers on the Activity Measure for Post-Acute Care (AM-PAC) 6-Clicks Mobility Scale and the Intensive Care Unit Mobility Scale (IMS). Control group patients otherwise received standard care. Participants in the intervention group, in addition to the measures described previously, received inspiratory threshold trainers with the goal of doing 2 sessions daily with a physical therapist for the duration of their inpatient hospitalization. In these sessions, the patient completed 3 sets of 10 breaths with the trainer. Initial resistance was set at 30% of their MIP, with resistance increasing 1 level for the subsequent session if the patients rated their during-activity rating of perceived exertion as less than 2. Changes in functional outcome measures, amount of supplemental oxygen, hospital length of stay (LOS), discharge location, adverse events, and mortality were assessed in group comparisons. Results Of 60 enrolled patients, 41 (n = 19 in intervention and n = 22 in control) were included in the final data set, which required completion of the study, initial and discharge data points collected, and survival of hospitalization. Final groups were statistically similar. A total of 161 sessions of IMT were completed among the 19 patients in the intervention group. Mortality totaled 2 in the control group and 3 in the intervention group and adverse events during intervention occurred in only 3 (1.8%) sessions, all of which were minor oxygen desaturations. Sessions were unable to be completed for all potential reasons 11% of possible times. Dropout rate in the intervention group was 3 (10%). Both intervention and control groups demonstrated improved MIP, decreased supplemental oxygen requirements, improved function on the AM-PAC, and slightly decreased function on the IMS. Length of stay was shorter in the intervention group, and discharge disposition was similar between groups. Conclusions With a low number of recorded adverse events, similar mortality between groups, and successful completion of 161 exercise sessions, IMT may be a feasible and safe intervention for some hospitalized patients with COVID-19.
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Affiliation(s)
- Haley Bento
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Elizabeth Fisk
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Emma Johnson
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Bruce Goudelock
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Maxwell Hunter
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Deborah Hoekstra
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Christopher Noren
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - Nathan Hatton
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
| | - John Magel
- Acute Therapy Services, University of Utah Health, 520 Wakara Way, Salt Lake City, UT 84108 (USA). . Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- Acute Therapy Services, University of Utah Health, Salt Lake City
- School of Medicine, The University of Utah, Salt Lake City
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City
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21
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Yang X, Zhang T, Cao L, Ye L, Song W. Early Mobilization for Critically Ill Patients. Respir Care 2023; 68:781-795. [PMID: 37041029 PMCID: PMC10209006 DOI: 10.4187/respcare.10481] [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: 04/13/2023]
Abstract
Advances in the field of critical care medicine have helped improve the survival rate of these ill patients. Several studies have demonstrated the potential benefits of early mobilization as an important component of critical care rehabilitation. However, there have been some inconsistent results. Moreover, the lack of standardized mobilization protocols and the associated safety concerns are a barrier to the implementation of early mobilization in critically ill patients. Therefore, determining the appropriate modalities of implementation of early mobilization is a key imperative to leverage its potential in these patients. In this paper, we review the contemporary literature to summarize the strategies for early mobilization of critically ill patients, assess the implementation and validity based on the International Classification of Functioning, Disability and Health, as well as discuss the safety aspects of early mobilization.
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Affiliation(s)
- Xiaolong Yang
- Department of Rehabilitation Medicine, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Tiantian Zhang
- Department of Rehabilitation Medicine, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Lei Cao
- Department of Rehabilitation Medicine, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Linlin Ye
- Department of Rehabilitation Medicine, Capital Medical University Xuanwu Hospital, Beijing, China
| | - Weiqun Song
- Department of Rehabilitation Medicine, Capital Medical University Xuanwu Hospital, Beijing, China.
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Ge J, Ye Y, Tan Y, Liu F, Jiang Y, Lu J. High-frequency chest wall oscillation multiple times daily can better reduce the loss of pulmonary surfactant and improve lung compliance in mechanically ventilated patients. Heart Lung 2023; 61:114-119. [PMID: 37247538 DOI: 10.1016/j.hrtlng.2023.05.007] [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: 03/01/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND High-frequency chest wall oscillation (HFCWO) has been widely recognized for its airway secretion clearance effectiveness in critically ill ICU patients. OBJECTIVES The purpose of this randomized controlled trial is to validate and compare the effects of different frequencies of HFCWO on oxygenation, lung compliance, and pulmonary surfactant proteins (SPs) in critically ill patients admitted to the intensive care unit (ICU). METHODS Sixty patients with severe craniocerebral injury treated with a tracheostomy and mechanical ventilation were randomized into three groups (20 patients in each group): a single group (treated with 30 minutes of HFCWO once daily) and a double group (treated with 30 minutes of HFCWO twice daily), and a blank group (treated without HFCWO). Primary outcome measures included results on several specific proteins (SP-A, SP-B, SP-C, and SP-D) in serum and alveolar lavage fluid. Secondary outcome measures were lung static compliance test and oxygenation. RESULTS Patients in both the single and double groups exhibited significant oxygenation and static compliance improvement. Similar results were observed in changes in SPs concentrations in the alveolar lavage fluid. However, a significant reduction of SPs levels was observed in the serum. In the group comparison analysis for the same variables between the single and double group, twice daily HFCWO treatments showed a significantly better result. CONCLUSION Compared with HFCWO once daily, HFCWO twice daily is advantageous in patients with tracheostomy and prolonged ventilation, which demonstrated significantly greater effectiveness in improving oxygenation and lung static compliance linked to the increase of and SPs contents in the airways as well as a reduction of SPs shift from airways to the blood.
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Affiliation(s)
- Jiaqi Ge
- Department of Critical Care Medicine, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China; Jiangsu University, Zhenjiang, Jiangsu, PR China.
| | - Yinjie Ye
- Department of Critical Care Medicine, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China.
| | - Yongfei Tan
- Cardiothoracic intensive care unit, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China; Cardiac-Thoracic Surgery, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China.
| | - Fang Liu
- Department of Critical Care Medicine, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China.
| | - Yan Jiang
- Department of Critical Care Medicine, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China.
| | - Junjie Lu
- Department of Critical Care Medicine, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China.
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Lehmkuhl L, Olsen HT, Brønd JC, Rothmann MJ, Dreyer P, Jespersen E. Daily variation in physical activity during mechanical ventilation and stay in the intensive care unit. Acta Anaesthesiol Scand 2023; 67:462-469. [PMID: 36636823 DOI: 10.1111/aas.14195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND Early mobilisation of mechanically ventilated patients during their stay at an intensive care unit (ICU) can improve physical recovery. Yet, an objective and specified description of physical activities while in the ICU is lacking. Therefore, our aim was to describe the objectively assessed type, quantity, and daily variation of physical activity among mechanically ventilated patients while in the ICU. METHOD In an observational study in two mixed medical/surgical ICUs, we measured body posture in 39 patients on mechanical ventilation using a thigh- and chest-worn accelerometer while in the ICU. The accelerometer describes time spent lying, sitting, moving, in-bed cycling, standing and walking. Descriptive analysis of physical activity and daily variation was done using STATA. RESULTS We found that mechanically ventilated patients spend 20/24 h lying in bed, 3 h sitting and only 1 h standing, moving, walking or bicycling while in the ICU. Intervals of non-lying time appeared from 9.00 to 12.00 and again from 18.00 to 21.30, with peaks at the hours of 9.00 and 18.00. CONCLUSION ICU patients on mechanical ventilation were primarily sedentary. Physical activity of mechanically ventilated patients seems to be related to nurse- and/or physiotherapy-initiated activities. There is a need to create an awareness of improving clinical routines, towards active mobilisation throughout the day, for this vulnerable patient population during their stay in the ICU.
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Affiliation(s)
- Lene Lehmkuhl
- Department of Anaesthesiology and Intensive Care, Odense University Hospital Svendborg Hospital, Svendborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Hanne Tanghus Olsen
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Jan Christian Brønd
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Research Unit for Exercise Epidemiology, University of Southern Denmark, Odense, Denmark
- Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Pia Dreyer
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
- Section of Nursing, Institute of Public Health, Aarhus University, Aarhus, Denmark
- Bergen University, Bergen, Norway
| | - Eva Jespersen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Battaglini D, Ciaravolo E, Caiffa S, Delpiano L, Ball L, Vena A, Giacobbe DR, Bassetti M, Matta B, Pelosi P, Robba C. Systemic and Cerebral Effects of Physiotherapy in Mechanically Ventilated Subjects. Respir Care 2023; 68:452-461. [PMID: 36810363 PMCID: PMC10173117 DOI: 10.4187/respcare.10227] [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: 02/24/2023]
Abstract
BACKGROUND Physiotherapy may result in better functional outcomes, shorter duration of delirium, and more ventilator-free days. The effects of physiotherapy on different subpopulations of mechanically ventilated patients on respiratory and cerebral function are still unclear. We evaluated the effect of physiotherapy on systemic gas exchange and hemodynamics as well as on cerebral oxygenation and hemodynamics in mechanically ventilated subjects with and without COVID-19 pneumonia. METHODS This was an observational study in critically ill subjects with and without COVID-19 who underwent protocolized physiotherapy (including respiratory and rehabilitation physiotherapy) and neuromonitoring of cerebral oxygenation and hemodynamics. PaO2 /FIO2 , PaCO2 , hemodynamics (mean arterial pressure [MAP], mm Hg; heart rate, beats/min), and cerebral physiologic parameters (noninvasive intracranial pressure, cerebral perfusion pressure using transcranial Doppler, and cerebral oxygenation using near-infrared spectroscopy) were assessed before (T0) and immediately after physiotherapy (T1). RESULTS Thirty-one subjects were included (16 with COVID-19 and 15 without COVID-19). Physiotherapy improved PaO2 /FIO2 in the overall population (T1 = 185 [108-259] mm Hg vs T0 = 160 [97-231] mm Hg, P = .02) and in the subjects with COVID-19 (T1 = 119 [89-161] mm Hg vs T0 = 110 [81-154] mm Hg, P = .02) and decreased the PaCO2 in the COVID-19 group only (T1 = 40 [38-44] mm Hg vs T0 = 43 [38-47] mm Hg, P = .03). Physiotherapy did not affect cerebral hemodynamics, whereas increased the arterial oxygen part of hemoglobin both in the overall population (T1 = 3.1% [-1.3 to 4.9] vs T0 = 1.1% [-1.8 to 2.6], P = .007) and in the non-COVID-19 group (T1 = 3.7% [0.5-6.3] vs T0 = 0% [-2.2 to 2.8], P = .02). Heart rate was higher after physiotherapy in the overall population (T1 = 87 [75-96] beats/min vs T0 = 78 [72-92] beats/min, P = .044) and in the COVID-19 group (T1 = 87 [81-98] beats/min vs T0 = 77 [72-91] beats/min, P = .01), whereas MAP increased in the COVID-19 group only (T1 = 87 [82-83] vs T0 = 83 [76-89], P = .030). CONCLUSIONS Protocolized physiotherapy improved gas exchange in subjects with COVID-19, whereas it improved cerebral oxygenation in non-COVID-19 subjects.
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Affiliation(s)
- Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Medicine, University of Barcelona, Barcelona, Spain.
| | - Elena Ciaravolo
- Anesthesia and Emergency Department, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Salvatore Caiffa
- Intensive Care Respiratory Physiotherapy, Rehabilitation and Functional Education, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Lara Delpiano
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Antonio Vena
- Department of Health Sciences, University of Genoa, Genoa, Italy; and Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Daniele R Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy; and Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences, University of Genoa, Genoa, Italy; and Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Basil Matta
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; and Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
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25
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Polastri M, Sepúlveda MI. Rehabilitative insights on intensive care unit–acquired weakness and post–intensive care syndrome: same setting, different conditions. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2023. [DOI: 10.12968/ijtr.2023.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
- Massimiliano Polastri
- Department of Continuity of Care and Integration, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Noone CE, Franck LS, Staveski SL, Rehm RS. Barriers and facilitators to early mobilization programmes in the paediatric intensive care unit: A scoping literature review. Nurs Crit Care 2023. [DOI: 10.1111/nicc.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Affiliation(s)
- Chelsea E. Noone
- Department of Family Health Care Nursing University of California at San Francisco San Francisco California USA
| | - Linda S. Franck
- Department of Family Health Care Nursing University of California at San Francisco San Francisco California USA
| | - Sandra L. Staveski
- Department of Family Health Care Nursing University of California at San Francisco San Francisco California USA
| | - Roberta S. Rehm
- Department of Family Health Care Nursing University of California at San Francisco San Francisco California USA
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27
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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]
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28
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Sosnowski K, Lin F, Chaboyer W, Ranse K, Heffernan A, Mitchell M. The effect of the ABCDE/ABCDEF bundle on delirium, functional outcomes, and quality of life in critically ill patients: A systematic review and meta-analysis. Int J Nurs Stud 2023; 138:104410. [PMID: 36577261 DOI: 10.1016/j.ijnurstu.2022.104410] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/04/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effect of the ABCDEF bundle (Assess, prevent, and manage pain; Both spontaneous awakening and spontaneous breathing trials; Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; and Family engagement and empowerment) on patient outcomes such as delirium is potentially optimised when the bundle is implemented in its entirety. OBJECTIVE To systematically synthesise the evidence on the effectiveness of the ABCDEF bundle delivered in its entirety on delirium, function, and quality of life in adult intensive care unit patients. DESIGN Systematic review and meta-analysis. DATA SOURCE Electronic databases including MEDLINE, CINAHL, PsycINFO, Web of Science, Cochrane Library, Joanna Briggs Institute's Evidence Based Practice, Australian New Zealand Clinical Trials Registry, and Embase were searched from 2000 until December 2021. REVIEW METHODS Inclusion criteria included (1) adult intensive care unit patients (2) studies that described the ABCDE or ABCDEF bundle in its entirety (3) studies that evaluated delirium, functional outcomes, or quality of life. Studies were excluded if they investigated long-term intensive care unit rehabilitation patients. Two reviewers independently screened records and full text, extracted data, and undertook quality appraisals with discrepancies discussed until consensus was reached. Random effects meta-analyses were conducted for delirium but was not possible for other outcomes. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess the certainty of the synthesised findings of the body of evidence. The study protocol was registered on PROSPERO (CRD 42019126407). RESULTS A total of 18 studies (29,576 patients) were included in the descriptive synthesis. Meta-analysis of six studies (2000 patients) identified decreased delirium incidence following implementation of the ABCDEF bundle when compared with standard practice, (risk ratio = 0.57; CI, 0.36-0.90 p = 0.02) although heterogeneity was high (I2 = 92%). When compared with standard practice, a meta-analysis of five studies (3418 patients) showed the ABCDEF bundle statistically significantly reduced the duration of intensive care unit delirium (mean difference (days) - 1.37, 95% CI -2.61 to -0.13 p = 0.03; I2 96%). Valid functional assessments were included in two studies, and quality of life assessment in one. CONCLUSIONS Although the evidence on the effect of the ABCDEF bundle delivered in its entirety is limited, positive patient delirium outcomes have been shown in this meta-analysis. As this meta-analysis was based on only 4736 patients in eight studies, further evidence is required to support its use in the adult intensive care unit. REGISTRATION DETAILS PROSPERO (CRD 42019126407).
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Affiliation(s)
- Kellie Sosnowski
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Intensive Care Unit, Logan Hospital, Queensland, Australia; Menzies Health Institute, Queensland, Australia.
| | - Frances Lin
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Queensland, Australia
| | - Wendy Chaboyer
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Menzies Health Institute, Queensland, Australia; National Health and Medical Research Council (NHMRC), Centre of Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | - Kristen Ranse
- School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Aaron Heffernan
- Intensive Care Unit, Logan Hospital, Queensland, Australia; School of Medicine and Dentistry, Griffith University, Australia; Faculty of Medicine, University of Queensland, Australia
| | - Marion Mitchell
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Menzies Health Institute, Queensland, Australia
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Younger DS. Critical illness-associated weakness and related motor disorders. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:707-777. [PMID: 37562893 DOI: 10.1016/b978-0-323-98818-6.00031-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Weakness of limb and respiratory muscles that occurs in the course of critical illness has become an increasingly common and serious complication of adult and pediatric intensive care unit patients and a cause of prolonged ventilatory support, morbidity, and prolonged hospitalization. Two motor disorders that occur singly or together, namely critical illness polyneuropathy and critical illness myopathy, cause weakness of limb and of breathing muscles, making it difficult to be weaned from ventilatory support, commencing rehabilitation, and extending the length of stay in the intensive care unit, with higher rates of morbidity and mortality. Recovery can take weeks or months and in severe cases, and may be incomplete or absent. Recent findings suggest an improved prognosis of critical illness myopathy compared to polyneuropathy. Prevention and treatment are therefore very important. Its management requires an integrated team approach commencing with neurologic consultation, creatine kinase (CK) measurement, detailed electrodiagnostic, respiratory and neuroimaging studies, and potentially muscle biopsy to elucidate the etiopathogenesis of the weakness in the peripheral and/or central nervous system, for which there may be a variety of causes. These tenets of care are being applied to new cases and survivors of the coronavirus-2 disease pandemic of 2019. This chapter provides an update to the understanding and approach to critical illness motor disorders.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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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]
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Attwell C, Sauterel L, Jöhr J, Piquilloud L, Kuntzer T, Diserens K. Early detection of ICU-acquired weakness in septic shock patients ventilated longer than 72 h. BMC Pulm Med 2022; 22:466. [PMID: 36474276 PMCID: PMC9724444 DOI: 10.1186/s12890-022-02193-7] [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: 04/21/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE ICU-acquired weakness, comprising Critical Illness Polyneuropathy (CIP) and Myopathy (CIM) is associated with immobilization and prolonged mechanical ventilation. This study aims to assess feasibility of early detection of CIP and CIM by peroneal nerve test (PENT) and sensory sural nerve action potential (SNAP) screening in patients with septic shock and invasively ventilated for more than 72 h. METHODS We performed repetitive PENT screening from 72 h after intubation until detecting a pathological response. We tested SNAPs in pathological PENT to differentiate CIP from CIM. We performed muscle strength examination in awake patients and recorded time from intubation to first in-bed and out-of-bed mobilization. RESULTS Eighteen patients were screened with PENT and 88.9% had abnormal responses. Mean time between intubation and first screening was 94.38 (± 22.41) hours. Seven patients (38.9%) had CIP, two (11.1%) had CIM, one (5.6%) had CIP and CIM, six (33.3%) had a pathological response on PENT associated with ICU-acquired weakness (but no SNAP could be performed to differentiate between CIP and CIM) and two patients had (11.1%) had no peripheral deficit. In patients where it could be performed, muscle strength testing concorded with electrophysiological findings. Twelve patients (66.7%) had out-of-bed mobilization 10.8 (± 7.4) days after admission. CONCLUSION CIP and CIM are frequent in septic shock patients and can be detected before becoming symptomatic with simple bedside tools. Early detection of CIP and CIM opens new possibilities for their timely management through preventive measures such as passive and active mobilization.
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Affiliation(s)
- Caroline Attwell
- grid.8515.90000 0001 0423 4662Acute Neuro-Rehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Laurent Sauterel
- grid.8515.90000 0001 0423 4662Lausanne University Hospital, Lausanne, Switzerland
| | - Jane Jöhr
- grid.8515.90000 0001 0423 4662Acute Neuro-Rehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Lise Piquilloud
- grid.8515.90000 0001 0423 4662Adult Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Kuntzer
- grid.8515.90000 0001 0423 4662Nerve-Muscle Unit, Neurology Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Karin Diserens
- grid.8515.90000 0001 0423 4662Acute Neuro-Rehabilitation Unit, Lausanne University Hospital, Lausanne, Switzerland
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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.
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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
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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: 108] [Impact Index Per Article: 54.0] [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.).
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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.)
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Tadyanemhandu C, van Aswegen H, Ntsiea V. Barriers and facilitators to implementation of early mobilisation of critically ill patients in Zimbabwean and South African public sector hospitals: a qualitative study. Disabil Rehabil 2022; 44:6699-6709. [PMID: 34461792 PMCID: PMC9183945 DOI: 10.1080/09638288.2021.1970827] [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: 01/11/2021] [Revised: 06/21/2021] [Accepted: 08/15/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Implementing early mobilisation in intensive care is challenging, and a detailed knowledge of factors that may hinder or facilitate implementation is essential for success. The study was done to explore the perceived barriers and facilitators to early mobilisation by physiotherapists in Zimbabwean and South African public sector hospital ICUs. METHODS A qualitative study was done in eight public sector hospitals from South Africa and four hospitals from Zimbabwe. Physiotherapists from the participating hospitals who had at least two years working experience in ICU were invited to participate in semi-structured, in-depth, face-to-face interviews. Purposive sampling was done. Data collected included interpretation of early mobilisation, perceived barriers, and facilitators to early mobilisation. Data analysis was done using the content analysis method. FINDINGS A total of 22 physiotherapists were interviewed. In defining the activities regarded as early mobilisation, there was diversity in relation to the specific activities and the nature of the patients in which the defined activities were suitable for. Perceived barriers which emerged included lack of professional autonomy or boundaries, motivation, and clinical skills. Perceived facilitators to early mobilisation included the availability of guidelines, good communication, adequate staff, and mobilisation equipment. CONCLUSIONS Barriers and facilitators to early mobilisation are multifactorial. There is need for multidisciplinary team collaboration and planning before implementing early mobilisation activities.Implications to rehabilitationProfessional roles/identity and or boundaries emerged to be a barrier that hinder implementation of early mobilisation if not clearly defined.Non-rotational physiotherapy coverage was highlighted to be important in facilitating good communication and teamwork and sustainability of services in ICU.Good communication channels and referrals between different disciplines should be employed in ICU to prevent delay in rendering services to ICU patients.
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Affiliation(s)
- Cathrine Tadyanemhandu
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Heleen van Aswegen
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Veronica Ntsiea
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
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Vargas M, Buonanno P, Kotfis K, Marra A. Editorial: The ABCDEF bundle: Laying the foundations for long term wellness in ICU survivors. Front Med (Lausanne) 2022; 9:1056056. [DOI: 10.3389/fmed.2022.1056056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
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Yen HC, Han YY, Hsiao WL, Hsu PM, Pan GS, Li MH, Chen WS, Chuang HJ. Functional mobility effects of progressive early mobilization protocol on people with moderate-to-severe traumatic brain injury: A pre-post intervention study. NeuroRehabilitation 2022; 51:303-313. [DOI: 10.3233/nre-220023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Brain plasticity evoked by environmental enrichment through early mobilization may improve sensorimotor functions of patients with moderate-to-severe traumatic brain injury (TBI). Increasing evidence also suggests that early mobilization increases verticalization, which is beneficial to TBI patients in critical care. However, there are limited data on early mobilization interventions provided to patients with moderate-to-severe TBI. OBJECTIVE: We investigated the possible enhancing effects of revised progressive early mobilization on functional mobility and the rate of out-of-bed mobility attained by patients with moderate-to-severe TBI. METHODS: This is a quantitative study with a retrospective and prospective pre–post intervention design. We implemented a revised progressive early mobilization protocol for patients with moderate-to-severe TBI admitted to the trauma intensive care unit (ICU) within the previous seven days. The outcome parameters were the rate of patients attaining early mobilization (sitting on the edge of the bed) and the Perme ICU Mobility Score at discharge from the ICU. The outcome parameters in the intervention cohort were compared with those from a historical control cohort who received standard medical care a year previously. Differences in the Perme ICU Mobility Score between the two cohorts were assessed using univariate analysis of covariance. RESULTS: Forty-two patients were included in the progressive early mobilization program and were compared with 44 patients who underwent standard medical care. In the intervention cohort, 100% and 57.2% of the patients completed early rehabilitation and early mobilization, respectively, compared to 0% in the control cohort. The intervention cohort at ICU discharge showed significantly improved the Perme ICU Mobility Scores. CONCLUSIONS: The implementation of the revised progressive early mobilization program for patients with moderate-to-severe TBI resulted in significantly improved mobility at ICU discharge; however, the length of overall stay in the ICU may be not affected.
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Affiliation(s)
- Hsiao-Ching Yen
- Department of Physical Medicine and Rehabilitation, Division of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Yin-Yi Han
- Department of Traumatology, Trauma ICU, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ling Hsiao
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Min Hsu
- Department of Physical Medicine and Rehabilitation, Division of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Guan-Shuo Pan
- Department of Physical Medicine and Rehabilitation, Division of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Hao Li
- Department of Physical Medicine and Rehabilitation, Division of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
| | - Hung-Jui Chuang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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Ho L, Tsang JHC, Cheung E, Chan WY, Lee KW, Lui SR, Lee CY, Lee ALH, Lam PKN. Improving mobility in the intensive care unit with a protocolized, early mobilization program: observations of a single center before-and-after the implementation of a multidisciplinary program. Acute Crit Care 2022; 37:286-294. [PMID: 35791658 PMCID: PMC9475150 DOI: 10.4266/acc.2021.01564] [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: 11/01/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Early intensive care unit (ICU) protocolized rehabilitative programs have been described previously, yet with differing starting time points and mostly on mechanically ventilated patients. We extended the concept to all admitted ICU patients and investigate the efficacy of early mobilization in improving mobility of the critically ill, address issues surrounding the timing and intensity of an early rehabilitative program. Methods Prospective cohorts of patients admitted consecutively before-and-after (control, n=92; intervention, n=90) the introduction of an early mobilization program in a single center, general hospital ICU. Improvement in mobility as assessed by ICU mobility score, on ICU admission and upon ICU discharge, was measured as a primary outcome. Results Those receiving early mobilization in the intensive care unit had higher ICU mobility score (2.63; 95% confidence interval, 0.65–4.61; P<0.001) upon discharge from the intensive care, with earlier out of bed mobilization on day 5 compared to the control group of day 21 (P<0.001). No differences were found in terms of mortality, intensive care hospitalization and subsequent hospitalization duration after discharge from ICU. Conclusions Here, we report that improvement in mobility score earlier in the course of intensive care hospitalization with the introduction of a protocolized early rehabilitative program.
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Tilahun L, Molla A, Ayele FY, Nega A, Dagnaw K. Time to recovery and its predictors among critically ill patients on mechanical ventilation from intensive care unit in Ethiopia: a retrospective follow up study. BMC Emerg Med 2022; 22:125. [PMID: 35820844 PMCID: PMC9277794 DOI: 10.1186/s12873-022-00689-3] [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: 04/25/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction For critically ill patients, mechanical ventilation is considered a pillar of respiratory life support. The mortality of victims in intensive care units is high in resource-constrained Sub-Saharan African countries. The recovery and prognosis of mechanically ventilated victims are unknown, according to evidence. The goal of the study was to see how long critically ill patients on mechanical ventilation survived. Methods A retrospective follow-up study was conducted. A total of 376 study medical charts were reviewed. Data was collected through reviewing medical charts. Data was entered into Epi-data manager version 4.6.0.4 and analyzed through Stata version 16. Descriptive analysis was performed. Kaplan- Meier survival estimates and log rank tests were performed. Cox proportional hazard model was undertaken. Results Median recovery time was 15 days (IQR: 6–30) with a total recovery rate of 4.49 per 100 person-days. In cox proportional hazard regression, diagnosis category {AHR: 1.690, 95% CI: (1.150- 2.485)}, oxygen saturation {AHR: 1.600, 95% CI: (1.157- 2.211)}, presence of comorbidities {AHR: 1.774, 95% CI: (1.250–2.519)}, Glasgow coma scale {AHR: 2.451, 95% CI: (1.483- 4.051)}, and use of tracheostomy {AHR: 0.276, 95% CI: (0.180–0.422)} were statistically significant predictors. Discussion Based on the outcomes of this study, discussions with suggested possible reasons and its implications were provided. Conclusion and Recommendations Duration and recovery rate of patients on mechanical ventilation is less than expected of world health organization standard. Diagnosis category, oxygen saturation, comorbidities, Glasgow coma scale and use of tracheostomy were statistically significant predictors. Mechanical ventilation durations should be adjusted for chronic comorbidities, trauma, and use of tracheostomy. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00689-3.
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Affiliation(s)
- Lehulu Tilahun
- Department of Emergency and Ophthalmic Health, Wollo University, Dessie, Ethiopia.
| | - Asressie Molla
- School of Public Health, Department of Epidemiology and Biostatistics, Wollo University, Dessie, Ethiopia
| | | | - Aytenew Nega
- Desssie Comprehensive Specialized Hospital, Department of Intensive Care Unit, Dessie, Ethiopia
| | - Kirubel Dagnaw
- Department of Comprehensive Health, Wollo University, Dessie, Ethiopia
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Effect of Combined Protein-Enriched Enteral Nutrition and Early Cycle Ergometry in Mechanically Ventilated Critically Ill Patients—A Pilot Study. Nutrients 2022; 14:nu14081589. [PMID: 35458151 PMCID: PMC9027967 DOI: 10.3390/nu14081589] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Cycle ergometry (CE) is a method of exercise used in clinical practice. Limited data demonstrate its effectiveness in critically ill patients. We aimed to evaluate the combination of CE and a high-protein diet in critically ill patients. Methods: This was an open label pilot trial comparing conventional physiotherapy with enteral nutrition (EN) (control, Group 1), CE with EN (Group 2), and CE with protein-enriched EN (Group 3). The primary outcome was length of ventilation (LOV). Secondary outcomes were intensive care unit (ICU) mortality, length of ICU stay (ICU LOS), length of hospital stay (Hospital LOS), and rate of re-intubation. Results: Per protocol, 41 ICU patients were enrolled. Thirteen patients were randomized to Group 1 (control), fourteen patients to Group 2, and fourteen patients to Group 3 (study groups). We found no statistically significant difference in LOV between the study arms (14.2 ± 9.6 days, 15.8 ± 7.1 days, and 14.9 ± 9.4 days, respectively, p = 0.89). Secondary outcomes did not demonstrate any significant differences between arms. Conclusions: In this pilot trial, CE combined with either standard EN or protein-enriched EN was not associated with better clinical outcomes, as compared to conventional physiotherapy with standard EN. Larger trials are needed in order to further evaluate this combination.
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Kwan BPM, Hill AM, Elliott M, van der Lee L. A retrospective study of physiotherapy management for patients with pneumonia requiring invasive ventilation in a single-center Australian ICU. Hong Kong Physiother J 2022; 42:55-64. [PMID: 35782697 PMCID: PMC9244597 DOI: 10.1142/s1013702522500068] [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: 09/12/2021] [Accepted: 01/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Pneumonia is a frequent diagnosis for patients admitted to Australian intensive care units (ICUs) for invasive ventilation. Physiotherapists in ICU provide interventions to enhance respiratory function and physical recovery. Objective: This retrospective cohort study aimed to describe physiotherapy management of adults with pneumonia who require invasive mechanical ventilation in a single Level 3 ICU in a quaternary teaching hospital. Methods: All adults admitted with a medical diagnosis of pneumonia requiring invasive mechanical ventilation over a two-year period were included. Demographic and clinical data, including APACHE II score, ventilator-free days (VFDs) to day 28, ICU length of stay (LOS), and type and frequency of physiotherapy episodes of care delivered in ICU, were collected from electronic medical records. Correlations between VFDs to day 28 and the frequency of physiotherapy interventions delivered per subject were examined using Spearman’s rho analysis. Results: From 208 records screened, 66 subjects with an ICU admission diagnosis of pneumonia, who required invasive mechanical ventilation, were included. Median (IQR) ICU LOS was 10 (5–17) days, and mortality rate was 15.2% (n=10). The cohort had a median of 20.5 (IQR 2–25) VFDs to day 28. Community-acquired pneumonia (66.7%, n=44) was the most frequent type of pneumonia diagnosis. There were 1110 episodes of physiotherapy care, with patients receiving a median of 13.5 (IQR 6.8–21.3) episodes during their ICU stay, with a median rate of 1.2 (IQR 1.0–1.6) episodes per day. Over 96.7% of patients with pneumonia received physiotherapy treatment during their ICU stay. Overall, physiotherapy treatments consisting only of respiratory techniques were most commonly provided (55.1%, n=612). Airway suctioning (92.4%, n=61), patient positioning (72.7%, n=48) or positioning advice to nurses (77.3%, n=51), and hyperinflation techniques (63.6%, n=42) were among the respiratory techniques most delivered. Conclusion: This study described the current intensive care physiotherapy management in a single center for adults with pneumonia who required invasive mechanical ventilation, demonstrating that respiratory physiotherapy interventions are often provided for this ICU patient cohort. Further research is warranted to determine the efficacy of respiratory physiotherapy interventions to justify their use for ICU patients with pneumonia receiving invasive mechanical ventilation.
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Affiliation(s)
- Baldwin Pok Man Kwan
- Discipline of Physiotherapy, School of Allied Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Anne-Marie Hill
- Discipline of Physiotherapy, School of Allied Health, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - Mercedes Elliott
- Physiotherapy Department, Fiona Stanley Hospital Perth, Locked Bag 100, Palmyra DC, WA 6961, Australia
| | - Lisa van der Lee
- Physiotherapy Department, Fiona Stanley Hospital Perth, Locked Bag 100, Palmyra DC, WA 6961, Australia
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Carbon NM, Engelhardt LJ, Wollersheim T, Grunow JJ, Spies CD, Märdian S, Mai K, Spranger J, Weber-Carstens S. Impact of protocol-based physiotherapy on insulin sensitivity and peripheral glucose metabolism in critically ill patients. J Cachexia Sarcopenia Muscle 2022; 13:1045-1053. [PMID: 35075782 PMCID: PMC8978012 DOI: 10.1002/jcsm.12920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 11/22/2021] [Accepted: 12/14/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The impact of physiotherapy on insulin sensitivity and peripheral glucose metabolism in critically ill patients is not well understood. METHODS This pooled analysis investigates the impact of different physiotherapeutic strategies on insulin sensitivity in critically ill patients. We pooled data from two previous trials in adult patients with sequential organ failure assessment score (SOFA)≥ 9 within 72 h of intensive care unit (ICU) admission, who received hyperinsulinaemic euglycaemic (HE) clamps. Patients were divided into three groups: standard physiotherapy (sPT, n = 22), protocol-based physiotherapy (pPT, n = 8), and pPT with added muscle activating measures (pPT+, n = 20). Insulin sensitivity index (ISI) was determined by HE clamp. Muscle metabolites lactate, pyruvate, and glycerol were measured in the M. vastus lateralis via microdialysis during the HE clamp. Histochemical visualization of glucose transporter-4 (GLUT4) translocation was performed in surgically extracted muscle biopsies. All data are reported as median (25th/75th percentile) (trial registry: ISRCTN77569430 and ISRCTN19392591/ethics approval: Charité-EA2/061/06 and Charité-EA2/041/10). RESULTS Fifty critically ill patients (admission SOFA 13) showed markedly decreased ISIs on Day 17 (interquartile range) 0.029 (0.022/0.048) (mg/min/kg)/(mU/L) compared with healthy controls 0.103 (0.087/0.111), P < 0.001. ISI correlated with muscle strength measured by medical research council (MRC) score at first awakening (r = 0.383, P = 0.026) and at ICU discharge (r = 0.503, P = 0.002). Different physiotherapeutic strategies showed no effect on the ISI [sPT 0.029 (0.019/0.053) (mg/min/kg)/(mU/L) vs. pPT 0.026 (0.023/0.041) (mg/min/kg)/(mU/L) vs. pPT+ 0.029 (0.023/0.042) (mg/min/kg)/(mU/L); P = 0.919]. Regardless of the physiotherapeutic strategy metabolic flexibility was reduced. Relative change of lactate/pyruvate ratio during HE clamp is as follows: sPT 0.09 (-0.13/0.27) vs. pPT 0.07 (-0.16/0.31) vs. pPT+ -0.06 (-0.19/0.16), P = 0.729, and relative change of glycerol concentration: sPT -0.39 (-0.8/-0.12) vs. pPT -0.21 (-0.33/0.07) vs. pPT+ -0.21 (-0.44/-0.03), P = 0.257. The majority of ICU patients showed abnormal localization of GLUT4 with membranous GLUT4 distribution in 37.5% (3 of 8) of ICU patients receiving sPT, in 42.9% (3 of 7) of ICU patients receiving pPT, and in 53.8% (7 of 13) of ICU patients receiving pPT+ (no statistical testing possible). CONCLUSIONS Our data suggest that a higher duration of muscle activating measures had no impact on insulin sensitivity or metabolic flexibility in critically ill patients with sepsis-related multiple organ failure.
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Affiliation(s)
- Niklas M Carbon
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lilian J Engelhardt
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Wollersheim
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Julius J Grunow
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia D Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sven Märdian
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Knut Mai
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolism, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM/CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
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Suzuki G, Kanayama H, Ichibayashi R, Arai Y, Iwanami Y, Masuyama Y, Yamamoto S, Serizawa H, Nakamichi Y, Watanabe M, Honda M, Ebihara S. Early mobilisation using a mobile patient lift in the intensive care unit: protocol for a randomised controlled trial. BMJ Open 2022; 12:e057942. [PMID: 35264368 PMCID: PMC8915332 DOI: 10.1136/bmjopen-2021-057942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION It is important to prevent the deterioration of activities of daily living to improve the long-term prognoses of patients in the intensive care unit (ICU). The patients' conditions, along with the lack of human and technical resources, often become barriers to achieving early mobilisation after the introduction of mechanical ventilation. We plan to verify the usefulness of a mobile patient lift for early mobilisation. METHODS AND ANALYSIS We will conduct a single-centre, open-label, randomised controlled trial. The inclusion criteria are as follows: age ≥18 years, independent walking before admission and expected mechanical ventilation for at least 48 hours. The participants will be randomly divided into groups with (intervention group) or without (control group) a mobile lift protocol. A mobile lift will be used in the intervention group. The primary endpoint will be the number of days required to achieve an ICU mobility scale of ≥4 (standing position). The results of the two groups will be analysed using the Student's t-test. ETHICS AND DISSEMINATION This study will be conducted in accordance with the Declaration of Helsinki and with the approval of the Toho University Omori Medical Center Ethics Committee (approval number M20259). The results of this study will be presented internationally at academic conferences and published in the literature. TRIAL REGISTRATION NUMBER UMIN000044965.
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Affiliation(s)
- Ginga Suzuki
- Toho University Omori Medical Center, Tokyo, Japan
| | | | | | | | - Yuji Iwanami
- Toho University Omori Medical Center, Tokyo, Japan
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Clarissa C, Salisbury L, Rodgers S, Kean S. A Constructivist Grounded Theory of Staff Experiences Relating to Early Mobilisation of Mechanically Ventilated Patients in Intensive Care. Glob Qual Nurs Res 2022; 9:23333936221074990. [PMID: 35224137 PMCID: PMC8874193 DOI: 10.1177/23333936221074990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Early mobilisation of mechanically ventilated patients has been suggested to be effective in mitigating muscle weakness, yet it is not a common practice. Understanding staff experiences is crucial to gain insights into what might facilitate or hinder its implementation. In this constructivist grounded theory study, data from two Scottish intensive care units were collected to understand healthcare staff experiences relating to early mobilisation in mechanical ventilation. Data included observations of mobilisation activities, individual staff interviews and two focus groups with multidisciplinary staff. Managing Risks emerged as the core category and was theorised using the concept of risk. The middle-range theory developed in this study suggests that the process of early mobilisation starts by staff defining patient status and includes a process of negotiating patient safety, which in turn enables performing accountable mobilisation within the dynamic context of an intensive care unit setting.
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Kourek C, Nanas S, Kotanidou A, Raidou V, Dimopoulou M, Adamopoulos S, Karabinis A, Dimopoulos S. Modalities of Exercise Training in Patients with Extracorporeal Membrane Oxygenation Support. J Cardiovasc Dev Dis 2022; 9:jcdd9020034. [PMID: 35200688 PMCID: PMC8875180 DOI: 10.3390/jcdd9020034] [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: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/18/2022] [Indexed: 02/07/2023] Open
Abstract
The aim of this qualitative systematic review is to summarize and analyze the different modalities of exercise training and its potential effects in patients on extracorporeal membrane oxygenation (ECMO) support. ECMO is an outbreaking, life-saving technology of the last decades which is being used as a gold standard treatment in patients with severe cardiac, respiratory or combined cardiorespiratory failure. Critically ill patients on ECMO very often present intensive care unit-acquired weakness (ICU-AW); thus, leading to decreased exercise capacity and increased mortality rates. Early mobilization and physical therapy have been proven to be safe and feasible in critically ill patients on ECMO, either as a bridge to lung/heart transplantation or as a bridge to recovery. Rehabilitation has beneficial effects from the early stages in the ICU, resulting in the prevention of ICU-AW, and a decrease in episodes of delirium, the duration of mechanical ventilation, ICU and hospital length of stay, and mortality rates. It also improves functional ability, exercise capacity, and quality of life. Rehabilitation requires a very careful, multi-disciplinary approach from a highly specialized team from different specialties. Initial risk assessment and screening, with appropriate physical therapy planning and exercise monitoring in patients receiving ECMO therapy are crucial factors for achieving treatment goals. However, more randomized controlled trials are required in order to establish more appropriate individualized exercise training protocols.
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Affiliation(s)
- Christos Kourek
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Serafim Nanas
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Anastasia Kotanidou
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Vasiliki Raidou
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Maria Dimopoulou
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
| | - Stamatis Adamopoulos
- Heart Failure and Transplant Unit, Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
| | - Andreas Karabinis
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
| | - Stavros Dimopoulos
- Clinical Ergospirometry, Exercise & Rehabilitation Laboratory, 1st Critical Care Medicine Department, Evangelismos Hospital, National and Kapodistrian University of Athens, 106 76 Athens, Greece; (C.K.); (S.N.); (A.K.); (V.R.); (M.D.)
- Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, 176 74 Athens, Greece;
- Correspondence: ; Tel.: +30-213-204-3389
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Frade-Mera MJ, Arias-Rivera S, Zaragoza-García I, Martí JD, Gallart E, San José-Arribas A, Velasco-Sanz TR, Blazquez-Martínez E, Raurell-Torredà M. The impact of ABCDE bundle implementation on patient outcomes: A nationwide cohort study. Nurs Crit Care 2022; 27:772-783. [PMID: 34994034 DOI: 10.1111/nicc.12740] [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] [Received: 01/31/2021] [Revised: 11/11/2021] [Accepted: 11/30/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND The ABCDE bundle is a set of evidence-based practices to systematically reduce the risks of sedation, delirium, and immobility in intensive care patients. Implementing the bundle improves clinical outcome. AIMS AND OBJECTIVES To investigate the association between patient outcomes and compliance with bundle components ABC (analgosedation algorithms), D (delirium protocol), and E (early mobilization protocol). DESIGN A Spanish multicentre cohort study of adult patients receiving invasive mechanical ventilation (IMV) for ≥48 h until extubation. METHODS The primary outcome was pain level, cooperation to permit Medical Research Council Scale administration, patient days of delirium, and mobility. The secondary outcome was cumulative drug dosing by IMV days. Tertiary outcomes (ICU days, IMV days, bed rest days, ICU mortality, ICUAW) and independent variables (analgosedation, delirium, early mobilization protocols) were also studied. RESULTS Data were collected from 605 patients in 80 ICUs and 5214 patient days with IMV. Two-thirds of the ICUs studied applied no protocols. Pain was not assessed on 83.6% of patient days. Patient cooperation made scale administration feasible on 20.7% of days. Delirium and immobility were found on 4.2% and 69.9% of days, respectively. Patients had shorter stays in ICUs with bundle protocols and fewer days of IMV in ICUs with delirium and mobilization bundle components (P = 0.006 and P = 0.03, respectively). Analgosedation protocols were associated with more opioid dosing (P = 0.02), and delirium and early mobilization protocols with more propofol (P = 0.001), dexmedetomidine (P = 0.001), and lower benzodiazepine dosing (P = 0.008). CONCLUSIONS The implementation rate of ABCDE bundle components was very low in our Spanish setting, but when implemented, patients had a shorter ICU stay, more analgesia dosing, and lighter sedation. RELEVANCE TO CLINICAL PRACTICE Applying some but not all the bundle components, there is increased analgesia and light sedation drug use, decreased benzodiazepines, and increased patient cooperation and mobility, resulting in a shorter ICU stay and fewer days of IMV.
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Affiliation(s)
- María Jesús Frade-Mera
- Critical Care Department, 12 Octubre University Hospital, Madrid, Spain.,Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain
| | - Susana Arias-Rivera
- Department of Nursing Management, University Hospital of Getafe, Madrid, Spain.,Research Department, CIBER Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Ignacio Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.,Research department (Invecuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Centro de Actividades Ambulatorias, Madrid, Spain
| | - Joan Daniel Martí
- Cardiovascular Surgery Intensive Care Department, Instituto Clínico Cardiovascular, Clinic University Hospital, Barcelona, Spain
| | - Elisabet Gallart
- Critical Care Department, Vall Hebron University Hospital, Barcelona, Spain
| | - Alicia San José-Arribas
- Department of Nursing, Escola Universitaria d'Infermeria Sant Pau (Hospital de la Santa Creu i Sant Pau), Barcelona, Spain
| | - Tamara Raquel Velasco-Sanz
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, Madrid, Spain.,Critical Care Department, San Carlos University Hospital, Madrid, Spain
| | | | - Marta Raurell-Torredà
- Department of Fundamental and Medical Surgical Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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de Campos Biazon TMP, Libardi CA, Junior JCB, Caruso FR, da Silva Destro TR, Molina NG, Borghi-Silva A, Mendes RG. The effect of passive mobilization associated with blood flow restriction and combined with electrical stimulation on cardiorespiratory safety, neuromuscular adaptations, physical function, and quality of life in comatose patients in an ICU: a randomized controlled clinical trial. Trials 2021; 22:969. [PMID: 34969405 PMCID: PMC8719392 DOI: 10.1186/s13063-021-05916-z] [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: 12/13/2020] [Accepted: 12/06/2021] [Indexed: 11/14/2022] Open
Abstract
Background Intensive care unit-acquired atrophy and weakness are associated with high mortality, a reduction in physical function, and quality of life. Passive mobilization (PM) and neuromuscular electrical stimulation were applied in comatose patients; however, evidence is inconclusive regarding atrophy and weakness prevention. Blood flow restriction (BFR) associated with PM (BFRp) or with electrical stimulation (BFRpE) was able to reduce atrophy and increase muscle mass in spinal cord-injured patients, respectively. Bulky venous return occurs after releasing BFR, which can cause unknown repercussions on the cardiovascular system. Hence, the aim of this study was to investigate the effect of BFRp and BFRpE on cardiovascular safety and applicability, neuromuscular adaptations, physical function, and quality of life in comatose patients in intensive care units (ICUs). Methods Thirty-nine patients will be assessed at baseline (T0–18 h of coma) and randomly assigned to the PM (control group), BFRp, or BFRpE groups. The training protocol will be applied in both legs alternately, twice a day with a 4-h interval until coma awake, death, or ICU discharge. Cardiovascular safety and applicability will be evaluated at the first training session (T1). At T0 and 12 h after the last session (T2), muscle thickness and quality will be assessed. Global muscle strength and physical function will be assessed 12 h after T2 and ICU and hospital discharge for those who wake up from coma. Six and 12 months after hospital discharge, physical function and quality of life will be re-assessed. Discussion In view of applicability, the data will be used to inform the design and sample size of a prospective trial to clarify the effect of BFRpE on preventing muscle atrophy and weakness and to exert the greatest beneficial effects on physical function and quality of life compared to BFRp in comatose patients in the ICU. Trial registration Universal Trial Number (UTN) Registry UTN U1111-1241-4344. Retrospectively registered on 2 October 2019. Brazilian Clinical Trials Registry (ReBec) RBR-2qpyxf. Retrospectively registered on 21 January 2020, http://ensaiosclinicos.gov.br/rg/RBR-2qpyxf/ Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05916-z.
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Affiliation(s)
- Thaís Marina Pires de Campos Biazon
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil
| | - Cleiton Augusto Libardi
- Laboratory of Neuromuscular Adaptations to Resistance Training, Department of Physical Education, Federal University of São Carlos, São Carlos, Brazil
| | - Jose Carlos Bonjorno Junior
- Department of Medicine, Federal University of São Carlos, São Carlos, Brazil.,Department of Anesthesiology and Intensive Care Unit at the Irmandade da Santa Casa de Misericórdia de São Carlos, São Carlos, Brazil
| | - Flávia Rossi Caruso
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil
| | - Tamara Rodrigues da Silva Destro
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil
| | - Naiara Garcia Molina
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil
| | - Renata Gonçalves Mendes
- Cardiopulmonary Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, Rod. Washington Luiz, km 235 - SP 310, CEP 13565-905, São Carlos, Brazil.
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Dziegielewski C, Talarico R, Imsirovic H, Qureshi D, Choudhri Y, Tanuseputro P, Thompson LH, Kyeremanteng K. Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort study. BMC Health Serv Res 2021; 21:1312. [PMID: 34872546 PMCID: PMC8647444 DOI: 10.1186/s12913-021-07318-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare expenditure within the intensive care unit (ICU) is costly. A cost reduction strategy may be to target patients accounting for a disproportionate amount of healthcare spending, or high-cost users. This study aims to describe high-cost users in the ICU, including health outcomes and cost patterns. Methods We conducted a population-based retrospective cohort study of patients with ICU admissions in Ontario from 2011 to 2018. Patients with total healthcare costs in the year following ICU admission (including the admission itself) in the upper 10th percentile were defined as high-cost users. We compared characteristics and outcomes including length of stay, mortality, disposition, and costs between groups. Results Among 370,061 patients included, 37,006 were high-cost users. High-cost users were 64.2 years old, 58.3% male, and had more comorbidities (41.2% had ≥3) when likened to non-high cost users (66.1 years old, 57.2% male, 27.9% had ≥3 comorbidities). ICU length of stay was four times greater for high-cost users compared to non-high cost users (22.4 days, 95% confidence interval [CI] 22.0–22.7 days vs. 5.56 days, 95% CI 5.54–5.57 days). High-cost users had lower in-hospital mortality (10.0% vs.14.2%), but increased dispositioning outside of home (77.4% vs. 42.2%) compared to non-high-cost users. Total healthcare costs were five-fold higher for high-cost users ($238,231, 95% CI $237,020–$239,442) compared to non-high-cost users ($45,155, 95% CI $45,046–$45,264). High-cost users accounted for 37.0% of total healthcare costs. Conclusion High-cost users have increased length of stay, lower in-hospital mortality, and higher total healthcare costs when compared to non-high-cost users. Further studies into cost patterns and predictors of high-cost users are necessary to identify methods of decreasing healthcare expenditure. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07318-y.
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Affiliation(s)
| | | | | | - Danial Qureshi
- ICES, University of Ottawa, Ottawa, Ontario, Canada.,Bruyere Research Institute, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yasmeen Choudhri
- Department of Life Sciences, Queen's University, Kingston, Ontario, Canada
| | - Peter Tanuseputro
- ICES, University of Ottawa, Ottawa, Ontario, Canada.,Bruyere Research Institute, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Kwadwo Kyeremanteng
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Thiolliere F, Allaouchiche B, Boyer H, Marie M, Friggeri A, Vacheron CH. Association between out-of-bed mobilization during the ICU stay of elderly patients and long-term autonomy: A cohort study. J Crit Care 2021; 68:10-15. [PMID: 34844035 DOI: 10.1016/j.jcrc.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Our objective was to estimate the impact of the absence of Out-of-Bed (OoB) mobilization during intensive care unit (ICU) stay among patients ≥70 years on their long-term autonomy. METHODS We conducted an ancillary study of the multicenter FRAGIREA study, including patients aged over 70 years, admitted to ICU for more than 48 h. We excluded the patients who died before day 180, who were lost to follow-up, and for whom the baseline autonomy (ADL) score was not available. Patients were classified into the OoB or non-OoB-mobilization group, and the impact of OoB mobilization on the decreased 6-month autonomy was estimated. RESULTS Among the 548 patients of the FRAGIREA cohort, 276 were included in the present study. Among them, 226 had OoB mobilization and 50 did not. 220/276 (80%) patients experienced the transfer to chair as rehabilitation therapy, passive mobilization and transfer to upright sitting were also frequently performed. A decrease in the 6-month autonomy was observed for 63 (23%) patients. After the elimination of potential confounders, non-OoB-mobilization patients had a greater risk of 6-month decreased autonomy (aOR 2.43 [1.18; 4.98]). CONCLUSIONS Mobilization during the ICU stay of elderly ICU patient survivors was associated with a lower decreased autonomy at 6 months.
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Affiliation(s)
- Fabrice Thiolliere
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France.
| | - Bernard Allaouchiche
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard, Lyon1, France; Université de Lyon, VetAgro Sup, Campus Vétérinaire de Lyon, UPSP 2016.A101, Pulmonary and Cardiovascular Aggression in Sepsis, F-69280 Marcy l'Étoile, France.
| | - Hélène Boyer
- Direction de la Recherche en Santé, Hospices Civils de Lyon, Lyon, France.
| | - Manon Marie
- CHU Edouard Heriot, AZUREA Study Group, France.
| | - Arnaud Friggeri
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard, Lyon1, France; CIRI, Centre International de Recherche en Infectiologie (Equipe Laboratoire des Pathogènes Emergents), Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Lyon, France.
| | - Charles-Hervé Vacheron
- Département d'Anesthésie Réanimation, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard, Lyon1, France; CIRI, Centre International de Recherche en Infectiologie (Equipe Laboratoire des Pathogènes Emergents), Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, Lyon, France; Pôle Santé Publique, Service de Biostatistique - Bioinformatique, Hospices Civils de Lyon, Lyon, France.
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Weinberger J, Cocoros N, Klompas M. Ventilator-Associated Events: Epidemiology, Risk Factors, and Prevention. Infect Dis Clin North Am 2021; 35:871-899. [PMID: 34752224 DOI: 10.1016/j.idc.2021.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The Centers for Disease Control and Prevention shifted the focus of safety surveillance in mechanically ventilated patients from ventilator-associated pneumonia to ventilator-associated events in 2013 to increase the objectivity and reproducibility of surveillance and to encourage quality improvement programs to focus on preventing a broader array of complications. Ventilator-associated events are associated with a doubling of the risk of dying. Prospective studies have found that minimizing sedation, increasing spontaneous awakening and breathing trials, and conservative fluid management can decrease event rates and the duration of ventilation. Multifaceted interventions to enhance these practices can decrease ventilator-associated event rates.
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Affiliation(s)
- Jeremy Weinberger
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Street, Suite 401, Boston, MA 02215, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center, 200 Washington Street, Boston, MA 02111, USA
| | - Noelle Cocoros
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Street, Suite 401, Boston, MA 02215, USA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Street, Suite 401, Boston, MA 02215, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
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50
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Eimer C, Freier K, Weiler N, Frerichs I, Becher T. The Effect of Physical Therapy on Regional Lung Function in Critically Ill Patients. Front Physiol 2021; 12:749542. [PMID: 34616313 PMCID: PMC8488288 DOI: 10.3389/fphys.2021.749542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/23/2021] [Indexed: 02/04/2023] Open
Abstract
Early mobilization has become an important aspect of treatment in intensive care medicine, especially in patients with acute pulmonary dysfunction. As its effects on regional lung physiology have not been fully explored, we conceived a prospective observational study (Registration number: DRKS00023076) investigating regional lung function during a 15-min session of early mobilization physiotherapy with a 30-min follow-up period. The study was conducted on 20 spontaneously breathing adult patients with impaired pulmonary gas exchange receiving routine physical therapy during their intensive care unit stay. Electrical impedance tomography (EIT) was applied to continuously monitor ventilation distribution and changes in lung aeration during mobilization and physical therapy. Baseline data was recorded in the supine position, the subjects were then transferred into the seated and partly standing position for physical therapy. Afterward, patients were transferred back into the initial position and followed up with EIT for 30 min. EIT data were analyzed to assess changes in dorsal fraction of ventilation (%dorsal), end-expiratory lung impedance normalized to tidal variation (ΔEELI), center of ventilation (CoV) and global inhomogeneity index (GI index).Follow-up was completed in 19 patients. During exercise, patients exhibited a significant change in ventilation distribution in favor of dorsal lung regions, which did not persist during follow-up. An identical effect was shown by CoV. ΔEELI increased significantly during follow-up. In conclusion, mobilization led to more dorsal ventilation distribution, but this effect subsided after returning to initial position. End-expiratory lung impedance increased during follow-up indicating a slow increase in end-expiratory lung volume following physical therapy.
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Affiliation(s)
- Christine Eimer
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Katharina Freier
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Norbert Weiler
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
| | - Tobias Becher
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Kiel, Germany
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