VentilationExploring the capacity to ambulate after a period of prolonged mechanical ventilation
Section snippets
Design and data extraction procedures
A retrospective audit of the medical records was undertaken by 2 investigators (SP and KH). Approval was obtained from the relevant human research ethics committees. Given that patients were not contacted, informed consent was deemed unnecessary.
A standardized form was developed. At the beginning of study, both investigators extracted data from the same 8 medical records. Data were compared, and the form was modified to optimize the extent to which both investigators extracted the same
Results
A total of 2590 individual patients were admitted to our ICU during the study period, of whom 190 fulfilled the study criteria (Fig. 1). The sample was predominantly male (n = 126; 66%), and 100 (53%) had a smoking history. The mean age was 52 ± 18 years, and APACHE II score was 20 ± 8. Median (interquartile range) length of stay in the ICU and acute care facility was 14 (10) and 42 (38) days, respectively. Median duration of MV in ICU, inotropic support, and sedation was 13 (9), 3 (5), and 7
Discussion
The novel and important findings of this study are: (1) after a period of prolonged MV, less than 50% of patients could ambulate independently at the time of acute care discharge, and of those who could, many required a gait aid; (2) compared with those who could ambulate independently, those who could not were more likely to have been admitted with a neurologic insult due to trauma, stay longer in both ICU and the hospital, as well as take longer to achieve functional milestones such as
Conclusions
To our knowledge, this is the first study to explore ambulation status at the time of discharge from ICU in all patients who required MV for a prolonged period, regardless of the reason for admission. After a period of prolonged MV, less than 50% of patients were able to ambulate independently at the time of acute hospital discharge. Of those who could, 39% required a gait aid to achieve independence. Even among those patients characterized by prolonged MV and preponderance of neurologic
Acknowledgments
The authors gratefully acknowledge the following: (1) Adjunct Assoc/Prof Jeff Tapper, Head of Physiotherapy Department, Sir Charles Gairdner Hospital (SCGH) for his support and facilitation of this project; (2) Tracy Hebden-Todd and Lisa Marsh (senior ICU physiotherapists at SCGH) for their general collaboration and assistance with independent reviews of the data extraction; (3) Brigit Roberts, SCGH ICU research coordinator, for support and access to the ICU admissions database; and (4) Leigha
References (23)
- et al.
ICU-Acquired Weakness—a call to arms (and legs)
Crit Care Resusc
(2011) - et al.
Early physical medicine and rehabilitation for patients with acute respiratory failure: a quality improvement project
Arch Phys Med Rehabil
(2010) - et al.
Should we mobilise critically ill patients? A review
Crit Care Resusc
(2009) - et al.
Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial
Lancet
(2009) - et al.
An observational study of sitting out of bed in tracheostomised patients in the intensive care unit
Physiotherapy
(2008) - et al.
Validation of a combined comorbidity index
J Clin Epidemiol
(1994) - et al.
The incidence of falls in intensive care survivors
Aust Crit Care
(2011) - et al.
How do Australian ICU survivors fare functionally 6 months after admission?
Crit Care Resusc
(2011) - et al.
Long-term functional outcome and performance status after intensive care unit re-admission: a prospective survey
Br J Anaesth
(2008) - et al.
Differences in one-year health outcomes and resource utilization by definition of prolonged mechanical ventilation: a prospective cohort study
Crit Care
(2007)
Healthcare utilisation among patients discharged from hospital after intensive care
Anaesth Intensive Care
Cited by (3)
Relationships between mortality, morbidity, and physical function in adults who survived a period of prolonged mechanical ventilation
2013, Journal of Critical CareCitation Excerpt :Of the 73 (40%) who were discharged directly home, 69 (95%) were dependent of assistance from others. Additional details can be found elsewhere [10,11]. Twenty-two patients (12%) within our sample did not survive the 12-month period after discharge from the acute care facility.
Geriatric age is not a barrier to early physical rehabilitation and walking in the intensive care unit
2015, Topics in Geriatric Rehabilitation