Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, Maryland.
Respir Care. 2020 Aug;65(8):1168-1173. doi: 10.4187/respcare.07437. Epub 2020 Mar 31.
Survivors of prolonged ICU admissions are bedridden and immobilized for an extended period of time. These patients often are discharged to long-term acute care hospitals (LTACHs) for continued medical care and rehabilitation. Early ambulation has been associated with improved functional outcomes and lower readmission rates in hospitalized patients. The aim of this study was to determine the association between ambulatory status and discharge disposition in survivors of prolonged ICU stays who were admitted to an LTACH.
We performed a retrospective cohort study of 285 survivors of prolonged ICU stays who were admitted to a university-affiliated LTACH facility from 2010 to 2013. Outcomes of interest included comparing the relationship between ambulatory status and disposition status (ie, home vs acute rehabilitation facility, nursing home, readmission to an ICU, or death).
The mean age of our cohort was 59.0 ± 15.3 y, with 129 (45%) males, 148 (52%) African-American, 123 (43%) white, and 14 (5%) of subjects other races. Most of these subjects were transferred from a medical ICU (68%). The median ICU and LTACH lengths of stay were 25.5 (13-38.8) d and 34.0 (14-64) d, respectively. Thirty-eight (13.3%) subjects were discharged home, 25 (8.7%) to an acute rehabilitation facility, 70 (24.6%) to a nursing home, 139 (48.8%) were readmitted to an ICU, and 13 (4.6%) died. Of 285 total subjects, 74 (26%) ambulated during physical therapy, while 211 (74%) subjects never ambulated. Of those who ambulated, 24 (32.4%) went home, whereas 14 of 211 (6.6%) subjects who did not ambulate went home ( < .001).
The ability to ambulate was associated with a greater likelihood of being discharged home in survivors of prolonged ICU stays who were admitted to an LTACH. These results suggest that mobility training for survivors of prolonged ICU stays in LTACH facilities should be strongly emphasized to improve their likelihood of being discharged home.
长时间入住 ICU 的幸存者会卧床不起并长时间无法活动。这些患者通常会被转至长期急性护理医院（LTACH）进行后续医疗和康复治疗。在住院患者中，早期活动与更好的功能结局和更低的再入院率相关。本研究旨在确定在入住 LTACH 的长时间 ICU 幸存者中，活动能力与出院去向之间的关联。
我们对 2010 年至 2013 年期间入住一所大学附属 LTACH 机构的 285 名长时间 ICU 幸存者进行了回顾性队列研究。感兴趣的结局包括比较活动能力与出院去向（即家庭、急性康复设施、疗养院、转至 ICU 或死亡）之间的关系。
我们队列的平均年龄为 59.0 ± 15.3 岁，其中 129 名（45%）为男性，148 名（52%）为非裔美国人，123 名（43%）为白人，14 名（5%）为其他种族。这些患者中大多数是从内科 ICU 转来的（68%）。ICU 和 LTACH 的中位住院时间分别为 25.5（13-38.8）天和 34.0（14-64）天。38 名（13.3%）患者出院回家，25 名（8.7%）转至急性康复设施，70 名（24.6%）转至疗养院，139 名（48.8%）转至 ICU，13 名（4.6%）死亡。在 285 名患者中，有 74 名（26%）在物理治疗期间进行了活动，而 211 名（74%）患者从未进行过活动。在能够活动的患者中，有 24 名（32.4%）出院回家，而在不能活动的 211 名患者中，有 14 名（6.6%）出院回家（<.001）。
在入住 LTACH 的长时间 ICU 幸存者中，活动能力与出院回家的可能性更大相关。这些结果表明，LTACH 设施中应大力强调对长时间 ICU 幸存者进行活动能力训练，以提高其出院回家的可能性。
