Department of Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Box C272, 12700 E 19th Ave, Aurora, CO, 80045, USA.
Crit Care. 2019 May 16;23(1):175. doi: 10.1186/s13054-019-2467-9.
Timely initiation of physical, occupational, and speech therapy in critically ill patients is crucial to reduce morbidity and improve outcomes. Over a 5-year time interval, we sought to determine the utilization of these rehabilitation therapies in the USA.
We performed a retrospective cohort study utilizing a large, national administrative database including ICU patients from 591 hospitals. Patients over 18 years of age with acute respiratory failure requiring invasive mechanical ventilation within the first 2 days of hospitalization and for a duration of at least 48 h were included.
A total of 264,137 patients received invasive mechanical ventilation for a median of 4.0 [2.0-8.0] days. Overall, patients spent a median of 5.0 [3.0-10.0] days in the ICU and 10.0 [7.0-16.0] days in the hospital. During their hospitalization, 66.5%, 41.0%, and 33.2% (95% CI = 66.3-66.7%, 40.8-41.2%, 33.0-33.4%, respectively) received physical, occupational, and speech therapy. While on mechanical ventilation, 36.2%, 29.7%, and 29.9% (95% CI = 36.0-36.4%, 29.5-29.9%, 29.7-30.1%) received physical, occupational, and speech therapy. In patients receiving therapy, their first physical therapy session occurred on hospital day 5 [3.0-8.0] and hospital day 6 [4.0-10.0] for occupational and speech therapy. Of all patients, 28.6% (95% CI = 28.4-28.8%) did not receive physical, occupational, or speech therapy during their hospitalization. In a multivariate analysis, patients cared for in the Midwest and at teaching hospitals were more likely to receive physical, occupational, and speech therapy (all P < 0.05). Of patients with identical covariates receiving therapy, there was a median of 61%, 187%, and 70% greater odds of receiving physical, occupational, and speech therapy, respectively, at one randomly selected hospital compared with another (median odds ratio 1.61, 2.87, 1.70, respectively).
Physical, occupational, and speech therapy are not routinely delivered to critically ill patients, particularly while on mechanical ventilation in the USA. The utilization of these therapies varies according to insurance coverage, geography, and hospital teaching status, and at a hospital level.
及时为危重症患者提供身体、职业和言语治疗对于降低发病率和改善预后至关重要。在 5 年的时间间隔内，我们试图确定这些康复治疗在美国的应用情况。
我们进行了一项回顾性队列研究，使用了一个包括 591 家医院 ICU 患者的大型国家行政数据库。纳入年龄大于 18 岁、入院前 2 天内因急性呼吸衰竭需要接受有创机械通气且通气时间至少 48 小时的患者。
共有 264137 名患者接受有创机械通气，中位通气时间为 4.0 [2.0-8.0] 天。总体而言，患者在 ICU 中位停留时间为 5.0 [3.0-10.0] 天，在医院中位停留时间为 10.0 [7.0-16.0] 天。住院期间，分别有 66.5%、41.0%和 33.2%（95%CI=66.3-66.7%、40.8-41.2%、33.0-33.4%）的患者接受了物理、职业和言语治疗。在接受机械通气的患者中，分别有 36.2%、29.7%和 29.9%（95%CI=36.0-36.4%、29.5-29.9%、29.7-30.1%）的患者接受了物理、职业和言语治疗。在接受治疗的患者中，其首次物理治疗时间分别为入院第 5 天[3.0-8.0]和第 6 天[4.0-10.0]，职业治疗和言语治疗的首次治疗时间分别为入院第 6 天[4.0-10.0]和第 7 天[5.0-11.0]。所有患者中，28.6%（95%CI=28.4-28.8%）在住院期间未接受物理、职业或言语治疗。多变量分析显示，在中西部地区和教学医院接受治疗的患者更有可能接受物理、职业和言语治疗（均 P<0.05）。在接受治疗的患者中，与其他医院相比，随机选择的一家医院接受物理、职业和言语治疗的可能性分别增加了 61%、187%和 70%（中位优势比分别为 1.61、2.87、1.70）。
在美国，危重症患者通常不会常规接受物理、职业和言语治疗，尤其是在接受有创机械通气治疗期间。这些治疗的应用情况根据保险覆盖范围、地理位置和医院教学地位而有所不同，并且在医院层面也存在差异。
