Determinants of gait independence after mechanical ventilation in the intensive care unit: a Japanese multicenter retrospective exploratory cohort study

Abstract

PurposeGait independence is one of the most important factors related to returning home from the hospital for patients treated in the intensive care unit (ICU), but the factors affecting gait independence have not been clarified. This study aimed to determine the factors affecting gait independence at hospital discharge using a standardized early mobilization protocol that was shared by participating hospitals.Materials and methodsPatients who entered the ICU from January 2017 to March 2018 were screened. The exclusion criteria were mechanical ventilation < 48 hours, age < 18, loss of gait independence before hospitalization, being treated for neurological issues, unrecoverable disease, unavailability of continuous data, and death during ICU stay. Basic attributes, such as age, ICU length of stay, information on early mobilization while in the ICU, Medical Research Council (MRC) sum-score at ICU discharge, incidence of ICU-acquired weakness (ICU-AW) and delirium, and the degree of gait independence at hospital discharge, were collected. Gait independence was determined using a mobility scale of the Barthel Index, and the factors that impaired gait independence at hospital discharge were investigated using a Cox proportional hazard regression analysis.ResultsOne hundred thirty-two patients were analyzed. In the univariate analysis, age, APACHE II score, duration of mechanical ventilation, ICU length of stay, incidence of delirium, and MRC sum-score at ICU discharge were extracted as significant. In the multivariate analysis, age (p = 0.014), MRC sum-score < 48 (p = 0.021), and delirium at discharge from ICU (p < 0.0001) were extracted as significant variables.ConclusionsWe found that age and incidence of ICU-AW and delirium were significantly related to impaired gait independence at hospital discharge.

The Functional Trajectory in Frail Compared With Non-frail Critically Ill Patients During the Hospital Stay

“…As a substitute, the functional status was therefore recorded with the corresponding subdomains of the Barthel Index, which is an ordinal scale incorporating 10 subdomains of the activities in daily life and the most widely used activities of daily living scale ( 24 , 25 ). The points of the subdomains “mobility” and “transfer” of the Barthel Index, each ranging between 0 and 15 (“Mobility-Transfer-Barthel”, MTB) were added and represent the functional capacity and gait independence of the patients with a minimum of 0 points (functionally fully dependent) and a maximum of 30 points (functionally independent) ( 26 ).…”

Mobility and clinical outcome of patients admitted to an intensive care unit

“…Early mobilization is strongly encouraged due to benefits such as improved functional independence and quality of life after ICU discharge [28]. However, a multicenter study in Brazil showed that the prevalence of patient mobilization in the ICU, especially those on mechanical ventilation, is still very low (2%), with weakness, cardiovascular instability and sedation as the main barriers identified [29].…”

The Characteristics of Post-Intensive Care Syndrome to Inform Occupational Therapy Practice During the Post-Intensive Care Period: A Systematic Scoping Review.

“…Gender, the presence of comorbidities, education level, body mass index (BMI), and additional demographic factors were variables commonly considered. The impact of delirium and the acquisition of ICU-aw on recovery during the post-intensive care period were also considered [33]. Taking a biopsychosocial approach, the characteristics of PICS have been characterised into biological, psychological, and social/contextual characteristics.…”