实施 ICU 早期活动方案后的出院后一年结局。

One Year Post-Discharge Outcomes After Implementation of an ICU Early Mobility Protocol.

出版信息

Dimens Crit Care Nurs. 2022;41(4):209-215. doi: 10.1097/DCC.0000000000000533.

Abstract

BACKGROUND

Early mobility benefits include improved strength, decreased length of stay (LOS), and delirium. The impact of an early mobility protocol on return to activities of daily living (ADL) is less studied.

OBJECTIVE

The aim of this study was to examine 1-year outcomes including ADL performance after the institution of an ICU early mobility protocol.

METHODS

One year after the initiation of an early mobility protocol in 7 intensive care units (ICUs) at an academic medical center, patients with an ICU stay of 7 days or more were enrolled in a 1-year follow-up phone call study. Baseline demographic data included the following: average ICU mobility and highest ICU mobility level achieved (4 levels), highest ICU mobility score (10 levels) at ICU admission, ICU discharge (DC), hospital DC, LOS, and delirium positive days. At 4 time points after DC (1, 3, 6, 12 months), patients were contacted regarding current residence, employment, readmissions, and current level of ADL from the Katz ADL (scored 0-6) and Lawton instrumental ADL scales (scored 0-8).

RESULTS

A convenience sample of 106 patients was enrolled with a mean age of 58 ± 15.4 years, ICU LOS of 18 ± 11.5 days, and hospital LOS of 37.5 ± 31 days; 58 (55%) were male; 4 expired before DC. Mobility results included mean mobility level of 1.6 ± 0.8, mean highest mobility level 3.3 ± 0.9; ICU mobility score was 5.9 ± 2.4 at time of ICU DC and 7.3 ± 2.5 at hospital DC. Katz ADL scores improved from 4.8 at 1 month to 5.6 at 12 months (P = .002), and Lawton IADL scores improved from 4.2 to 6.6 (P < .001). Mobility scores were predictors of 1 month Katz (P = .004) and Lawton (P < .001) scores. None of the mobility levels or scores were predictive for readmissions. Most patients were not working before admission, and not all returned to work. Days positive for delirium were predictive of 1 month Katz and Lawton (P = .014, .002) scores. Impact of delirium was gone by 1 year.

DISCUSSION

In this critically ill patient population followed for 1 year, ICU mobility positively impacted return to ADLs and improved ADLs over time but not readmissions. Delirium positive days decreased ADL scores, but the effect diminished over time.

摘要

背景

早期活动的益处包括增强力量、缩短住院时间（LOS）和减少谵妄。早期活动方案对日常生活活动（ADL）恢复的影响研究较少。

目的

本研究旨在研究实施 ICU 早期活动方案 1 年后 ADL 表现的结果。

方法

在学术医疗中心的 7 个 ICU 实施早期活动方案 1 年后，对 ICU 住院时间为 7 天或以上的患者进行为期 1 年的随访电话研究。基线人口统计学数据包括：平均 ICU 活动度和达到的最高 ICU 活动度水平（4 个水平）、ICU 入院时的最高 ICU 活动度评分（10 个水平）、ICU 出院（DC）、医院出院（DC）、住院时间（LOS）和谵妄阳性天数。在 DC 后 4 个时间点（1、3、6、12 个月），联系患者了解当前居住地、就业情况、再入院情况以及 Katz ADL（评分 0-6）和 Lawton 工具性 ADL 量表（评分 0-8）的当前 ADL 水平。

结果

纳入了 106 名方便样本患者，平均年龄为 58±15.4 岁，ICU LOS 为 18±11.5 天，医院 LOS 为 37.5±31 天；58（55%）名男性；4 名患者在 DC 前死亡。活动结果包括平均活动水平 1.6±0.8，平均最高活动水平 3.3±0.9；ICU 活动评分在 ICU DC 时为 5.9±2.4，在医院 DC 时为 7.3±2.5。Katz ADL 评分从 1 个月时的 4.8 分提高到 12 个月时的 5.6 分（P=0.002），Lawton IADL 评分从 4.2 分提高到 6.6 分（P＜0.001）。活动评分是 1 个月时 Katz（P=0.004）和 Lawton（P＜0.001）评分的预测指标。没有任何活动水平或评分可预测再入院。大多数患者入院前未工作，并非所有人都恢复工作。谵妄阳性天数可预测 1 个月时的 Katz 和 Lawton（P=0.014，P=0.002）评分。谵妄的影响在 1 年内消失。