Department of Rehabilitation Medicine, National Hospital Organization, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan.
Department of Physical Therapy, Faculty of Rehabilitation, Gifu University of Health Science, Gifu, Gifu, Japan.
Sci Rep. 2023 Mar 14;13(1):4265. doi: 10.1038/s41598-023-31459-1.
Physical dysfunction after discharge from the intensive care unit (ICU) is recognized as a common complication among ICU patients. Early mobilization (EM), defined as the ability to sit on the edge of the bed within 5 days, may help improve physical dysfunction. However, the barriers to, and achievement of, EM and their impact on physical dysfunction have not been fully investigated. This study aimed to investigate the achievement of EM and barriers to it and their impact on patient outcomes in mechanically ventilated ICU patients. We conducted this multicenter retrospective cohort study by collecting data from six ICUs in Japan. Consecutive patients who were admitted to the ICU between April 2019 and March 2020, were aged ≥ 18 years, and received mechanical ventilation for > 48 h were eligible. The primary outcome was the rate of independent activities of daily living (ADL), defined as a score ≥ 70 on the Barthel index at hospital discharge. Daily changes in barriers of mobilization, including consciousness, respiratory, circulatory, medical staff factors, and device factors (catheter, drain, and dialysis), along with the clinical outcomes were investigated. The association among barriers, mobilization, and Barthel index ≥ 70 was analyzed using multivariable logistic regression analysis. During the study period, 206 patients were enrolled. EM was achieved in 116 patients (68%) on the fifth ICU day. The primary outcome revealed that achieving EM was associated with a Barthel index ≥ 70 at hospital discharge [adjusted odds ratio (AOR), 3.44; 95% confidence interval (CI), 1.70-6.96]. Device factors (AOR, 0.31; 95% CI, 0.13-0.75, respectively) were significantly associated with EM achievement. EM was associated with independent ADL at hospital discharge. Time to first mobilization and barriers to achieving mobilization can be important parameters for achieving ADL independence at discharge. Further research is required to determine the most common barriers so that they can be identified and removed.
从重症监护病房（ICU）出院后出现的身体机能障碍被认为是 ICU 患者的常见并发症。早期活动（EM）被定义为在 5 天内能够坐在床边，可能有助于改善身体机能障碍。然而，EM 的障碍、实现以及对身体机能障碍的影响尚未得到充分研究。本研究旨在调查机械通气的 ICU 患者实现 EM 的情况、实现障碍及其对患者结局的影响。我们通过收集日本六家 ICU 的数据，进行了这项多中心回顾性队列研究。符合条件的患者为 2019 年 4 月至 2020 年 3 月期间入住 ICU、年龄≥18 岁且接受机械通气>48 小时的连续患者。主要结局是独立日常生活活动（ADL）的比例，定义为出院时巴氏量表得分≥70。调查了每日移动障碍的变化，包括意识、呼吸、循环、医务人员因素和设备因素（导管、引流管和透析管）以及临床结局。使用多变量逻辑回归分析，分析了障碍、活动能力与巴氏量表≥70 之间的关系。在研究期间，共纳入 206 名患者。在第五天 ICU 时，有 116 名患者（68%）实现了 EM。主要结局显示，实现 EM 与出院时巴氏量表≥70 相关[调整后的优势比（AOR），3.44；95%置信区间（CI），1.70-6.96]。设备因素（AOR，0.31；95%CI，0.13-0.75）与 EM 的实现显著相关。EM 与出院时的独立 ADL 相关。首次活动的时间和实现活动的障碍可能是实现出院时 ADL 独立性的重要参数。需要进一步研究以确定最常见的障碍，以便识别和消除这些障碍。
