Kim Roger Y, Murphy Terrence E, Doyle Margaret, Pulaski Catherine, Singh Maura, Tsang Sui, Wicker Dawn, Pisani Margaret A, Connors Geoffrey R, Ferrante Lauren E
Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.
Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
Crit Care Explor. 2019 Nov 11;1(11):e0060. doi: 10.1097/CCE.0000000000000060. eCollection 2019 Nov.
One goal of early mobilization programs is to facilitate discharge home after an ICU hospitalization, but little is known about which factors are associated with this outcome. Our objective was to evaluate factors associated with discharge home among medical ICU patients in an early mobilization program who were admitted to the hospital from home.
Retrospective cohort study of medical ICU patients in an early mobilization program.
Tertiary care center medical ICU.
Medical ICU patients receiving early mobilization who were community-dwelling prior to admission.
None.
A comprehensive set of baseline, ICU-related, and mobilization-related factors were tested for their association with discharge home using multivariable logistic regression. Among the analytic cohort ( = 183), the mean age was 61.9 years (sd 16.67 yr) and the mean Acute Physiology and Chronic Health Evaluation II score was 23.5 (sd 7.11). Overall, 65.0% of patients were discharged home after their critical illness. In multivariable analysis, each incremental increase in the maximum level of mobility achieved (range, 1-6) during the medical ICU stay was associated with nearly a 50% greater odds of discharge home (odds ratio, 1.46; 95% CI, 1.13-1.88), whereas increased age (odds ratio, 0.95; 95% CI, 0.93-0.98) and greater hospital length of stay (odds ratio, 0.94; 95% CI, 0.90-0.99) were associated with decreased odds of discharge home. Prehospital ambulatory status was not associated with discharge home.
Among medical ICU patients who resided at home prior to their ICU admission, the maximum level of mobility achieved in the medical ICU was the factor most strongly associated with discharge back home. Identification of this factor upon ICU-to-ward transfer may help target mobilization plans on the ward to facilitate a goal of discharge home.
早期活动计划的一个目标是促进重症监护病房（ICU）住院患者出院回家，但对于哪些因素与这一结果相关却知之甚少。我们的目的是评估在早期活动计划中从家中入院的内科ICU患者中与出院回家相关的因素。
对早期活动计划中的内科ICU患者进行回顾性队列研究。
三级医疗中心的内科ICU。
入院前居住在社区且接受早期活动的内科ICU患者。
无。
使用多变量逻辑回归测试了一组全面的基线、ICU相关和活动相关因素与出院回家的关联。在分析队列（n = 183）中，平均年龄为61.9岁（标准差16.67岁），平均急性生理与慢性健康状况评分II为23.5（标准差7.11）。总体而言，65.0%的患者在危重病后出院回家。在多变量分析中，内科ICU住院期间达到的最大活动水平（范围为1 - 6）每增加一级，出院回家的几率就会增加近50%（优势比，1.46；95%置信区间，1.13 - 1.88），而年龄增加（优势比，0.95；95%置信区间，0.93 - 0.98）和住院时间延长（优势比，0.94；95%置信区间，0.90 - 0.99）与出院回家的几率降低相关。院前活动状态与出院回家无关。
在内科ICU入院前居住在家中的患者中，内科ICU达到的最大活动水平是与出院回家最密切相关的因素。在从ICU转至病房时识别这一因素可能有助于在病房制定活动计划，以促进出院回家的目标。
