Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan.
Critical Care Research Group, the Prince Charles Hospital, Brisbane, Australia.
Nagoya J Med Sci. 2021 Aug;83(3):443-464. doi: 10.18999/nagjms.83.3.443.
This study was undertaken to investigate the rate of mobilization, defined as a rehabilitation level of sitting on the edge of a bed or higher, and its association with changes in barriers in the intensive care unit (ICU). Consecutive patients from January 2016 to March 2019 admitted to the ICU, 18 years old or older, who did not meet exclusion criteria, were eligible. The primary outcome was the rate of mobilization. Barriers, their changes on a daily basis, and clinical outcomes, such as walking independence at hospital discharge, were also investigated. The association between the barriers and mobilization, and walking independence were analyzed by multivariate logistic regression analysis. During the study period, 177 patients were enrolled. Mobilization was achieved by 116 patients (66%) by the 7th ICU day. The barrier to mobilization was circulatory status on days 1 and 2, consciousness level on days 3 to 5, and medical staff factors on days 6 and 7. Multivariate analysis showed that consciousness level (OR: 0.38, p=0.01), and medical staff factors (OR: 0.49, p=0.01) were significantly associated with mobilization. By hospital discharge 125 patients (71%) could walk independently. Consciousness level was associated (OR: 0.52, p=0.04) with walking independence. In this study, over half of patients could achieve mobilization within the first 7 days. Barriers to mobilization in the ICU change over time. Consciousness level is significantly associated with both mobilization and independent walking at discharge.
本研究旨在调查患者在重症监护病房（ICU）中的活动能力（定义为能够坐在床边或更高位置的康复水平）及其与 ICU 中障碍变化的关系。2016 年 1 月至 2019 年 3 月期间，符合以下标准的连续患者可入组本研究：年龄≥18 岁，无排除标准，入住 ICU。主要结局为活动能力的发生率。还调查了障碍及其每日变化，以及临床结局，如出院时的独立行走能力。采用多变量逻辑回归分析来分析障碍与活动能力和独立行走能力之间的关系。在研究期间，共纳入 177 例患者。在第 7 天 ICU 日时，116 例患者（66%）达到了活动能力。活动能力的障碍分别是第 1 天和第 2 天的循环状态、第 3 天至第 5 天的意识水平，以及第 6 天和第 7 天的医护人员因素。多变量分析显示，意识水平（OR：0.38，p=0.01）和医护人员因素（OR：0.49，p=0.01）与活动能力显著相关。出院时，125 例患者（71%）能够独立行走。意识水平与独立行走能力相关（OR：0.52，p=0.04）。在这项研究中，超过一半的患者能够在第 7 天内实现活动能力。ICU 中的活动能力障碍会随时间而变化。意识水平与活动能力和出院时的独立行走能力显著相关。
