神经重症监护病房患者活动的临床转归。

Clinical outcomes of patient mobility in a neuroscience intensive care unit.

机构信息

Question or comments about this article may be directed to Malissa Mulkey, MSN RN, at

出版信息

J Neurosci Nurs. 2014 Jun;46(3):153-61; quiz E1-2. doi: 10.1097/JNN.0000000000000053.

DOI:10.1097/JNN.0000000000000053

PMID:24796472

Abstract

BACKGROUND

Patients treated in a neuroscience intensive care unit (NICU) are often viewed as too sick to tolerate physical activity. In this study, mobility status in NICU was assessed, and factors and outcomes associated with mobility were examined.

METHODS

Using a prospective design, daily mobility status, medical history, demographics, Acute Physiology and Chronic Health Evaluation (APACHE) III score, and clinical outcomes were collected by medical records and database review. Depression, anxiety, and hostility were assessed before NICU discharge. Analyses included comparative statistics and multivariable modeling.

RESULTS

In 228 unique patients, median (minimum, maximum) age was 64.0 (20, 95) years, 66.4% were Caucasian, and 53.6% were men. Of 246 admissions, median NICU stay was 4 (1, 61) days; APACHE III score was 56 (16, 145). Turning, range of motion, and head of bed of >30° were uniformly applied (n = 241), but 94 patients (39%) never progressed; 94 (39%) progressed to head of bed of >45° or dangling legs, 29 (12%) progressed to standing or pivoting to chair, and 24 (10%) progressed to walking. Female gender (p = .019), mechanical ventilation (p < .001), higher APACHE score (p = .004), and 30-day mortality (p = .001) were associated with less mobility. In multivariable modeling, greater mobility was associated with longer unit stay (p < .001) and discharge to home (p < .001). Psychological profile characteristics were not associated with mobility level.

CONCLUSION

Nearly 40% of patients never progressed beyond bed movement, and only 10% walked. Although limited mobility progression was not associated with many patient factors, it was associated with poorer clinical outcomes. Implementation and evaluation of a progressive mobility protocol are needed in NICU patients.

VIDEO ABSTRACT

For more insights from the authors, see Supplemental Digital Content 1, at http://link.lww.com/JNN/A10.

摘要

背景

在神经科学重症监护病房（NICU）接受治疗的患者通常被认为病得太重，无法承受身体活动。本研究评估了 NICU 中的移动状态，并研究了与移动相关的因素和结果。

方法

使用前瞻性设计，通过病历和数据库回顾收集每日移动状态、病史、人口统计学、急性生理学和慢性健康评估（APACHE）III 评分和临床结果。在离开 NICU 之前评估抑郁、焦虑和敌意。分析包括比较统计和多变量建模。

结果

在 228 名独特的患者中，中位（最小，最大）年龄为 64.0（20，95）岁，66.4%为白种人，53.6%为男性。246 例入院中，NICU 住院中位数为 4（1，61）天；APACHE III 评分为 56（16，145）。翻身、活动范围和床头超过 30°的患者均采用（n = 241），但 94 例（39%）患者从未进展；94 例（39%）进展至床头超过 45°或悬挂双腿，29 例（12%）进展至站立或旋转至椅子，24 例（10%）进展至行走。女性（p =.019）、机械通气（p <.001）、更高的 APACHE 评分（p =.004）和 30 天死亡率（p =.001）与移动能力较低相关。在多变量建模中，更大的移动性与单位停留时间更长（p <.001）和出院回家（p <.001）相关。心理特征与移动水平无关。