Elsevier

Journal of Critical Care

Volume 27, Issue 6, December 2012, Pages 542-548
Journal of Critical Care

Ventilation
Exploring the capacity to ambulate after a period of prolonged mechanical ventilation

https://doi.org/10.1016/j.jcrc.2011.12.020Get rights and content

Abstract

Purpose

The purposes were to assess the functional recovery of those who survived a prolonged intensive care unit (ICU) stay by reporting the proportion who were able to ambulate independently at hospital discharge and also to examine if the time duration between admission and when the patient first stood impacted on their capacity to ambulate at discharge.

Materials and Methods

A retrospective review was conducted of medical records of ICU patients in 2007 to 2008, who were mechanically ventilated for 168 hours or more, and survived their acute care stay. Main outcome measures were (1) ambulation status before admission and at time of hospital discharge and (2) time between admission to the ICU and when the patient first stood.

Results

A total of 190 patients were included. Before admission, 189 (99%; 95% confidence interval [CI], 98%-100%) were ambulating independently, of whom 180 (95%) did not require a gait aid. On discharge from acute care, 89 (47%; 95% CI, 40%-54%) were ambulating independently, of whom 54 (61%) did not require a gait aid. Compared with those who stood within 30 days of ICU admission, a delay in standing of between 30 and 60 days increased the odds 5-fold (95% CI, 2-11) of being unable to ambulate independently at the time of discharge.

Conclusions

After a prolonged ICU admission, more than 50% of patients were unable to ambulate independently by hospital discharge, with the time between admission and first stand, being an important predictor of this outcome.

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

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