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Matsuoka A, Yoshihiro S, Shida H, Aikawa G, Fujinami Y, Kawamura Y, Nakanishi N, Shimizu M, Watanabe S, Sugimoto K, Taito S, Inoue S. Effects of Mobilization within 72 h of ICU Admission in Critically Ill Patients: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2023; 12:5888. [PMID: 37762829 PMCID: PMC10531519 DOI: 10.3390/jcm12185888] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/04/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Previous systematic review and meta-analysis indicates that rehabilitation within a week of intensive care unit (ICU) admission benefits physical function in critically ill patients. This updated systematic review and meta-analysis aim to clarify effects of initiating rehabilitation within 72 h of ICU admission on long-term physical, cognitive, and mental health. We systematically searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for randomized controlled trials (RCTs) between April 2019 and November 2022 to add to the previous review. Two investigators independently selected and extracted data. Pooled effect estimates for muscle strength, cognitive function, mental health after discharge, and adverse events were calculated. Evidence certainty was assessed via Grading of Recommendations, Assessment, Development, and Evaluations. Eleven RCTs were included in the meta-analysis. Early rehabilitation may improve muscle strength (three trials; standard mean difference [SMD], 0.16; 95% confidence interval [CI], -0.04-0.36) and cognitive function (two trials; SMD, 0.54; 95% CI, -0.13-1.20). Contrastingly, early mobilization showed limited impact on mental health or adverse events. In summary, initiating rehabilitation for critically ill patients within 72 h may improve physical and cognitive function to prevent post-intensive care syndrome without increasing adverse events. The effect on mental function remains uncertain.
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Affiliation(s)
- Ayaka Matsuoka
- Department of Emergency and Critical Care Medicine, Saga University, 5-1-1 Nabeshima, Saga City 849-8501, Japan;
| | - Shodai Yoshihiro
- Department of Pharmacy, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi 722-8508, Japan;
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan;
| | - Haruka Shida
- Office of Medical Informatics and Epidemiology, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Building, 3-3-2 Kasumigaseki, Chiyodaku, Tokyo 100-0013, Japan;
| | - Gen Aikawa
- Department of Adult Health Nursing, College of Nursing, Ibaraki Christian University, 6-11-1 Omika, Hitachi 319-1295, Japan;
| | - Yoshihisa Fujinami
- Department of Emergency Medicine, Kakogawa Central City Hospital, 439 Kakogawacho Honmachi, Kakogawa 675-8611, Japan;
| | - Yusuke Kawamura
- Department of Rehabilitation, Showa General Hospital, 8-1-1 Hanakoganei, Tokyo 187-8510, Japan;
| | - Nobuto Nakanishi
- Department of Disaster and Emergency Medicine, Kobe University, 7-5-2 Kusunoki, Chuo-ward, Kobe 650-0017, Japan;
| | - Motohiro Shimizu
- Department of Intensive Care Medicine, Ryokusen-kai Yonemori Hospital, 1-7-1, Yojiro, Kagoshima 890-0062, Japan;
| | - Shinichi Watanabe
- Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, 2-92, Gifu 500-8281, Japan;
| | - Kensuke Sugimoto
- Intensive Care Unit, Gunma University Hospital; 39-15 Showa, Maebashi 371-8511, Japan;
| | - Shunsuke Taito
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan;
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3, Kasumi, Hiroshima 734-8551, Japan
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Kobe University, 7-5-2 Kusunoki, Chuo-ward, Kobe 650-0017, Japan;
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Association between Early Mobilization in the ICU and Psychiatric Symptoms after Surviving a Critical Illness: A Multi-Center Prospective Cohort Study. J Clin Med 2022; 11:jcm11092587. [PMID: 35566716 PMCID: PMC9099642 DOI: 10.3390/jcm11092587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 02/08/2023] Open
Abstract
This is a prospective multicenter cohort study aiming to investigate the association between early mobilization (EM), defined as a rehabilitation level of sitting at the edge of the bed or higher within 72 h of ICU admission, and psychiatric outcome. Consecutive patients, admitted to the ICU for more than 48 h, were enrolled. The primary outcome was the incidence of psychiatric symptoms at 3 months after hospital discharge defined as the presence of any of three symptoms: depression, anxiety, or post-traumatic stress disorder (PTSD). Risk ratio (RR) and multiple logistic regression analysis were used. As a sensitivity analysis, two methods for inverse probability of treatment weighting statistics were performed. Of the 192 discharged patients, 99 (52%) were assessed. The patients who achieved EM had a lower incidence of psychiatric symptoms compared to those who did not (25% vs. 51%, p-value 0.008, odds ratio (OR) 0.27, adjusted p = 0.032). The RR for psychiatric symptoms in the EM group was 0.49 [95% Confidence Interval, 0.29–0.83]. Sensitivity analysis accounting for the influence of death, loss to follow-up (OR 0.28, adjusted p = 0.008), or potential confounders (OR 0.49, adjusted p = 0.046) consistently showed a lower incidence of psychiatric symptoms in the EM group. EM was consistently associated with fewer psychiatric symptoms.
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Watanabe S, Liu K, Morita Y, Kanaya T, Naito Y, Suzuki S, Hasegawa Y. Effects of Mobilization among Critically Ill Patients in the Intensive Care Unit: A Single-center Retrospective Study. Prog Rehabil Med 2022; 7:20220013. [PMID: 35415279 PMCID: PMC8938413 DOI: 10.2490/prm.20220013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/04/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: This study investigated the effect of early mobilization [EM; physical rehabilitation
with the intensity needed to sit on the edge of the bed started within 5 days of
intensive care unit (ICU) admission] in relation to improvements in gait independence
and other clinical outcomes. Methods: This retrospective single-center study evaluated patients aged at least 18 years who
stayed in the ICU for at least 48 h and were categorized into EM and late mobilization
(LM; physical rehabilitation started more than 5 days after ICU admission) groups.
Outcomes were compared after adjusting for 20 background factors by propensity score
matching and inverse probability of treatment weighting. The primary outcome was
independent gait at discharge. The secondary outcomes were medical costs, 90-day
survival, and durations of ICU and hospital stays. Results: Of 177 patients, 85 and 92 were enrolled in the EM and LM groups, respectively.
Propensity score matching created 37 patient pairs. There was no significant difference
in the 90-day survival rate (P=0.308) or medical costs (P=0.054), whereas independent
gait at discharge (P=0.025) and duration of hospital stay (P=0.013) differed
significantly. Multivariate logistic regression analysis showed that EM was
independently associated with independent gait at discharge (P=0.011) and duration of
hospital stay (P=0.010) but was not associated with 90-day survival (odds ratio: 2.64,
95% confidence interval: 0.67–13.12, P=0.169). Conclusions: Early mobilization in the ICU did not affect 90-day survival and did not lower medical
costs but was associated with independent gait at discharge and shorter hospital
stays.
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Affiliation(s)
- Shinichi Watanabe
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
| | - Yasunari Morita
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Takahiro Kanaya
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Yuji Naito
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Shuichi Suzuki
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
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Watanabe S, Morita Y, Suzuki S, Kochi K, Ohno M, Liu K, Iida Y. Effects of the Intensity and Activity Time of Early Rehabilitation on Activities of Daily Living Dependence in Mechanically Ventilated Patients. Prog Rehabil Med 2021; 6:20210054. [PMID: 35083381 PMCID: PMC8710675 DOI: 10.2490/prm.20210054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the association between the Rehabilitation Activity Time score (RATs)-a score based on the level and duration of rehabilitation activities-of ventilated patients in the intensive care unit (ICU) and activities of daily living (ADL) dependence at discharge. METHODS This retrospective, single-center study evaluated patients aged >18 years who underwent mechanical ventilation in the ICU for at least 48 h. The patients were categorized into the low- and high-dose rehabilitation groups based on the median RATs. The primary outcome was the rate of ADL dependence at discharge, defined as a Barthel index of <70. The association between low or high doses of rehabilitation and the primary outcome was assessed using multiple logistic regression analysis adjusted by baseline factors. RESULTS The rate of ADL dependence at discharge was significantly lower in the high-dose rehabilitation group (low dose 81% vs. high dose 22%, P<0.001). Multivariate analysis showed a significantly lower ADL dependence at discharge among those who received high-dose rehabilitation (P<0.001). Increased RATs during the entire ICU admission period and during ICU admission after meeting the criteria for physiological stability was significantly associated with lower ADL dependence at discharge (P<0.001). Moreover, a higher RATs from low-level activity before meeting the criteria for physiological stability also showed a significant association with lower ADL dependence at discharge (P=0.047). CONCLUSIONS ADL dependence was significantly lower among those who underwent high-dose rehabilitation. The RATs was consistently associated with ADL dependence at discharge.
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Affiliation(s)
- Shinichi Watanabe
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Yasunari Morita
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Shuichi Suzuki
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Kaito Kochi
- Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Mika Ohno
- Department of Critical Care Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Aichi, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Chermside, Australia
| | - Yuki Iida
- Department of Physical Therapy, School of Health Science, Toyohashi Sozo University, Toyohashi, Aichi, Japan
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Mankowski RT, Laitano O, Clanton TL, Brakenridge SC. Pathophysiology and Treatment Strategies of Acute Myopathy and Muscle Wasting after Sepsis. J Clin Med 2021; 10:1874. [PMID: 33926035 PMCID: PMC8123669 DOI: 10.3390/jcm10091874] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/14/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023] Open
Abstract
Sepsis survivors experience a persistent myopathy characterized by skeletal muscle weakness, atrophy, and an inability to repair/regenerate damaged or dysfunctional myofibers. The origins and mechanisms of this persistent sepsis-induced myopathy are likely complex and multifactorial. Nevertheless, the pathobiology is thought to be triggered by the interaction between circulating pathogens and impaired muscle metabolic status. In addition, while in the hospital, septic patients often experience prolonged periods of physical inactivity due to bed rest, which may exacerbate the myopathy. Physical rehabilitation emerges as a potential tool to prevent the decline in physical function in septic patients. Currently, there is no consensus regarding effective rehabilitation strategies for sepsis-induced myopathy. The optimal timing to initiate the rehabilitation intervention currently lacks consensus as well. In this review, we summarize the evidence on the fundamental pathobiological mechanisms of sepsis-induced myopathy and discuss the recent evidence on in-hospital and post-discharge rehabilitation as well as other potential interventions that may prevent physical disability and death of sepsis survivors.
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Affiliation(s)
- Robert T. Mankowski
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL 32603, USA
| | - Orlando Laitano
- Department of Nutrition and Integrated Physiology, Florida State University, Tallahassee, FL 32306, USA;
| | - Thomas L. Clanton
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL 32611, USA;
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Okada Y, Unoki T, Matsuishi Y, Egawa Y, Hayashida K, Inoue S. Reply to the comment. J Intensive Care 2020; 8:22. [PMID: 32191227 PMCID: PMC7068915 DOI: 10.1186/s40560-020-00438-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/18/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Yohei Okada
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Syogoin Kawaramachi 54, Sakyo, Kyoto, 606-8507 Japan
- Preventive Services, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Unoki
- School of Nursing, Sapporo City University, Sapporo, Japan
| | - Yujiro Matsuishi
- Emergency and Intensive Care Laboratory, University of Tsukuba, Ibaraki, Japan
- Pediatric Intensive Care Unit, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yuko Egawa
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Kei Hayashida
- The Feinstein Institutes for Medical Research, Department of Emergency Med-Cardiopulmonary, North Shore University Hospital, Northwell Health System, New York, USA
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan
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