Tonna Joseph E, Johnson Joshua, Presson Angela, Zhang Chong, Noren Chris, Lohse Bryan, Bento Haley, Barton Richard G, Nirula Raminder, Mone Mary, Marcus Robin
Division of Cardiothoracic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
Crit Care Explor. 2019 Oct 30;1(10):e0055. doi: 10.1097/CCE.0000000000000055. eCollection 2019 Oct.
Studies of mobility during critical illness have mostly examined transitions from immobility (passive activities) or limited mobility to active "early mobility."
Observational analysis of a quality improvement initiative.
Two ICUs (surgical ICU, cardiovascular ICU) at a tertiary academic medical center.
Critically ill surgical and cardiovascular patients.
Doubling available physical therapy.
We examined the outcomes of therapy time/patient/day, ICU and hospital length of stay, disposition location, and change in functional status. We adjusted for age, sex, illness severity, and number of surgeries. Among 1,515 patients (703 baseline, 812 quality improvement), total therapy time increased from 71,994 to 115,389 minutes and from 42,985 to 93,015 minutes, respectively, in each ICU. In the cardiovascular ICU per patient therapy increased 17% (95% CI, -4.9 to 43.9; = 0.13), and in the surgical ICU, 26% (95% CI, -1 to 59.4; = 0.06). In the cardiovascular ICU, there was a 27.4% decrease (95% CI, -52.5 to 10.3; = 0.13) in ICU length of stay, and a 12.4% decrease (95% CI, -37.9 to 23.3; = 0.45) in total length of stay, whereas in the surgical ICU, the adjusted ICU length of stay increased 19.9% (95% CI, -31.6 to 108.6; = 0.52) and total length of stay increased 52.8% (95% CI, 1.0-130.2; = 0.04). The odds of a lower level of care discharge did not change in either ICU (cardiovascular ICU: 2.6 [95% CI, 0.6-12.2; = 0.22]); surgical ICU: 3.6 [95% CI, 0.9-15.4; = 0.08]).
Among diverse cardiothoracic and surgical patients, a quality improvement initiative doubling physical therapy shifts is associated with increased total administered therapy time, but when distributed among a greater number of patients during the quality improvement period, the increase is tempered. This was not associated with consistent changes in ICU length of stay or changes in disposition location.
对危重病期间活动能力的研究大多考察了从不活动（被动活动）或活动受限到积极的“早期活动”的转变。
对一项质量改进举措的观察性分析。
一家三级学术医疗中心的两个重症监护病房（外科重症监护病房、心血管重症监护病房）。
重症外科和心血管疾病患者。
将可用的物理治疗增加一倍。
我们考察了治疗时间/患者/天、重症监护病房和医院住院时间、出院地点以及功能状态变化等结果。我们对年龄、性别、疾病严重程度和手术次数进行了调整。在1515例患者中（703例为基线患者，812例为质量改进患者），每个重症监护病房的总治疗时间分别从71994分钟增加到115389分钟，以及从42985分钟增加到93015分钟。在心血管重症监护病房，每位患者的治疗时间增加了17%（95%置信区间，-4.9至43.9；P = 0.13），在外科重症监护病房增加了26%（95%置信区间，-1至59.4；P = 0.06）。在心血管重症监护病房，重症监护病房住院时间减少了27.4%（95%置信区间，-52.5至10.3；P = 0.13），总住院时间减少了12.4%（95%置信区间，-37.9至23.3；P = 0.45），而在外科重症监护病房，调整后的重症监护病房住院时间增加了19.9%（95%置信区间，-31.6至108.6；P = 0.52），总住院时间增加了52.8%（95%置信区间，1.0 - 130.2；P = 0.04）。两个重症监护病房中低级别护理出院的几率均未改变（心血管重症监护病房：2.6 [95%置信区间，0.6 - 12.2；P = 0.22]；外科重症监护病房：3.6 [95%置信区间，0.9 - 15.4；P = 0.08]）。
在不同的心胸外科和外科患者中，一项将物理治疗班次增加一倍的质量改进举措与总治疗时间增加相关，但在质量改进期间分配给更多患者时，这种增加有所缓和。这与重症监护病房住院时间的一致变化或出院地点的变化无关。
