Anna E. Krupp is an assistant professor, College of Nursing, University of Iowa, Iowa City.
Alai Tan is a research professor, Center for Research and Health Analytics, The Ohio State University College of Nursing, Columbus.
Am J Crit Care. 2024 Sep 1;33(5):324-333. doi: 10.4037/ajcc2024939.
Adoption of early mobility interventions into intensive care unit (ICU) practice has been slow and varied.
To examine factors associated with early mobility performance in critically ill adults and evaluate factors' effects on predicting next-day early mobility performance.
A secondary analysis of 66 ICUs' data from patients admitted for at least 24 hours. Mixed-effects logistic regression modeling was done, with area under the receiver operating characteristic curve (AUC) calculated.
In 12 489 patients, factors independently associated with higher odds of next-day mobility included significant pain (adjusted odds ratio [AOR], 1.16; 95% CI, 1.09-1.23), documented sedation target (AOR, 1.09; 95% CI, 1.01-1.18), performance of spontaneous awakening trials (AOR, 1.77; 95% CI, 1.59-1.96), spontaneous breathing trials (AOR, 2.35; 95% CI, 2.14-2.58), mobility safety screening (AOR, 2.26; 95% CI, 2.04-2.49), and prior-day physical/occupational therapy (AOR, 1.44; 95% CI, 1.30-1.59). Factors independently associated with lower odds of next-day mobility included deep sedation (AOR, 0.44; 95% CI, 0.39-0.49), delirium (AOR, 0.63; 95% CI, 0.59-0.69), benzodiazepine administration (AOR, 0.85; 95% CI, 0.79-0.92), physical restraints (AOR, 0.74; 95% CI, 0.68-0.80), and mechanical ventilation (AOR, 0.73; 95% CI, 0.68-0.78). Black and Hispanic patients had lower odds of next-day mobility than other patients. Models incorporating patient, practice, and between-unit variations displayed high discriminant accuracy (AUC, 0.853) in predicting next-day early mobility performance.
Collectively, several modifiable and nonmodifiable factors provide excellent prediction of next-day early mobility performance.
早期活动干预措施在重症监护病房（ICU）实践中的应用一直较为缓慢且各不相同。
探究与危重症成人早期活动表现相关的因素，并评估这些因素对预测次日早期活动表现的作用。
对 66 个 ICU 数据进行二次分析，纳入入住 ICU 至少 24 小时的患者。采用混合效应逻辑回归模型，计算受试者工作特征曲线下面积（AUC）。
在 12489 例患者中，与次日活动能力较高相关的独立因素包括：明显疼痛（校正优势比[OR]，1.16；95%置信区间[CI]，1.09-1.23）、记录镇静目标（OR，1.09；95% CI，1.01-1.18）、实施自主觉醒试验（OR，1.77；95% CI，1.59-1.96）、自主呼吸试验（OR，2.35；95% CI，2.14-2.58）、活动安全性筛查（OR，2.26；95% CI，2.04-2.49）和前一日的物理/职业治疗（OR，1.44；95% CI，1.30-1.59）。与次日活动能力较低相关的独立因素包括：深度镇静（OR，0.44；95% CI，0.39-0.49）、谵妄（OR，0.63；95% CI，0.59-0.69）、苯二氮䓬类药物治疗（OR，0.85；95% CI，0.79-0.92）、身体约束（OR，0.74；95% CI，0.68-0.80）和机械通气（OR，0.73；95% CI，0.68-0.78）。黑人和西班牙裔患者次日活动的可能性低于其他患者。纳入患者、实践和单位间变异的模型在预测次日早期活动表现方面具有较高的判别准确性（AUC，0.853）。
多个可改变和不可改变的因素共同为次日早期活动表现提供了较好的预测。
