Association between the early mobilization of mechanically ventilated patients and independence in activities of daily living at hospital discharge

被引：12

作者：

Watanabe, Shinichi ^{[1
,2
]}

Hirasawa, Jun ^{[3
]}

Naito, Yuji ^{[4
]}

Mizutani, Motoki ^{[5
]}

Uemura, Akihiro ^{[6
]}

Nishimura, Shogo ^{[7
]}

Morita, Yasunari ^{[8
]}

Iida, Yuki ^{[9
]}

机构：

[1] Natl Hosp Org, Nagoya Med Ctr, Dept Rehabil Med, 4-1-1 Sannomaru,Naka Ku, Nagoya, Aichi 4600001, Japan

[2] Gifu Univ Hlth Sci, Fac Rehabil, Dept Phys Therapy, Gifu, Gifu, Japan

[3] Tosei Gen Hosp, Dept Rehabil Med, Seto, Aichi, Japan

[4] Natl Hosp Org, Shizuoka Med Ctr, Dept Rehabil Med, Nagasawa, Shizuoka, Japan

[5] Ichinomiyanishi Hosp, Dept Rehabil Med, Itinomiya, Aichi, Japan

[6] Toyohashi Municipal Hosp, Dept Rehabil, Toyohashi, Aichi, Japan

[7] Kainan Hosp, Dept Rehabil Med, Yatomi, Aichi, Japan

[8] Natl Hosp Org, Nagoya Med Ctr, Dept Emergency Med, Nagoya, Aichi, Japan

[9] Toyohashi Sozo Univ, Sch Hlth Sci, Dept Phys Therapy, 20-1 Matushita,Ushikawa Cho, Toyohashi, Aichi 4408511, Japan

来源：

SCIENTIFIC REPORTS | 2023年 / 13卷 / 01期

关键词：

INTENSIVE-CARE-UNIT; CRITICALLY-ILL PATIENTS; ICU-ACQUIRED WEAKNESS; MANAGEMENT; REHABILITATION; BARRIERS; DELIRIUM; THERAPY;

D O I：

10.1038/s41598-023-31459-1

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Physical dysfunction after discharge from the intensive care unit (ICU) is recognized as a common complication among ICU patients. Early mobilization (EM), defined as the ability to sit on the edge of the bed within 5 days, may help improve physical dysfunction. However, the barriers to, and achievement of, EM and their impact on physical dysfunction have not been fully investigated. This study aimed to investigate the achievement of EM and barriers to it and their impact on patient outcomes in mechanically ventilated ICU patients. We conducted this multicenter retrospective cohort study by collecting data from six ICUs in Japan. Consecutive patients who were admitted to the ICU between April 2019 and March 2020, were aged >= 18 years, and received mechanical ventilation for > 48 h were eligible. The primary outcome was the rate of independent activities of daily living (ADL), defined as a score >= 70 on the Barthel index at hospital discharge. Daily changes in barriers of mobilization, including consciousness, respiratory, circulatory, medical staff factors, and device factors (catheter, drain, and dialysis), along with the clinical outcomes were investigated. The association among barriers, mobilization, and Barthel index >= 70 was analyzed using multivariable logistic regression analysis. During the study period, 206 patients were enrolled. EM was achieved in 116 patients (68%) on the fifth ICU day. The primary outcome revealed that achieving EM was associated with a Barthel index >= 70 at hospital discharge [adjusted odds ratio (AOR), 3.44; 95% confidence interval (CI), 1.70-6.96]. Device factors (AOR, 0.31; 95% CI, 0.13-0.75, respectively) were significantly associated with EM achievement. EM was associated with independent ADL at hospital discharge. Time to first mobilization and barriers to achieving mobilization can be important parameters for achieving ADL independence at discharge. Further research is required to determine the most common barriers so that they can be identified and removed.

引用

页数：9