Ambulatory Status Is Associated With Successful Discharge Home in Survivors of Critical Illness

Abstract

BACKGROUND: 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. METHODS: 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). RESULTS: The mean age of our cohort was 59.0 6 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 (P < .001). CONCLUSIONS: 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.

A successful case of extracorporeal membrane oxygenation for COVID-19: walking home without oxygen supplementation

“…He recovered successfully and was able to ambulate independently upon discharge, likely as a result of daily aggressive mobility-focused rehabilitation. Our prior study has shown that mobility-based rehabilitation is associated with higher rates of survivors of critical illness being discharged home [ 9 ]. He was discharged home fully independent, without oxygen supplementation, on hospital day 63.…”

Mobilização Precoce De Doentes Na Unidade Cuidados Intensivos: Contributo Para a Enfermagem De Reabilitação. Uma Revisão Sistemática Da Literatura

“…Pelo que, há necessidade de elaborar e implementar programas de treino de atividades de vida diárias visando a adaptação às limitações da mobilidade e à maximização da autonomia e da qualidade de vida e promover a mobilidade, a acessibilidade deambular e a participação social. Tendo-se verificado que é um fator determinante no regresso ao domicílio (Tran, et al 2020) e que é necessário a elaboração de mais programas de reabilitação para reduzir os riscos (Tempera, et al 2013).…”

“…foram para instalações de reabilitação de agudos, 70 tinham enfermagem domiciliária, 139 foram readmitidos na UCI e 13 morreram. Dos 285, 74 deambularam durante a fisioterapia dos quais 24 foram para casa, enquanto que 211 nunca deambularam e apenas 14 foram para casa.No estudo(Tran, et al, 2020) dos 285 participantes, 68% foram transferidos de UCI. A média de permanência nas UCI e em hospitais de cuidados agudos de longa duração foi de 25.5 e de 34 dias, respetivamente.…”