Factors Associated With Receipt of Physical Therapy Consultation in Patients Requiring Prolonged Mechanical Ventilation

Abstract

Background/Introduction Mobilization of critically ill patients in the intensive care unit (ICU) is associated with improved function at hospital discharge and reduced duration of mechanical ventilation (MV). Few studies, however, focus on physical therapy (PT) in patients on prolonged mechanical ventilation (PMV) despite their high risk of immobility and poor outcomes. Objective/Aims To identify factors associated with the receipt of PT consultation among patients requiring PMV. We hypothesized that key factors including age, severity of illness and presence of a tracheostomy are associated with PT consultation. Methods Retrospective cohort study of adults on MV for ≥14 days for acute respiratory failure at an academic medical center. Primary outcome was PT consultation by day 14 of MV. We examined associations between the following key predictors, chosen a priori, and PT consultation: age, tracheostomy, illness severity, oxygenation status, shock, hemodialysis and medical service using multivariable logistic regression. Wilcoxon rank sum testing was used to test relationship between sedation and PT. Results We identified 175 patients requiring PMV at our institution. Most were middle-aged (mean 49.7, SD 18.5) men (65%) with high illness severity (mean APACHE III 86, SD 40). Less than half of all patients requiring PMV (78/175, 45%) received PT consultation in the ICU and most failed to progress with therapy beyond range of motion exercises (86%). Failure to progress was associated with level of sedation (med Ramsay score 4.5 [IQR 3–6] v 3.5 [IQR 3–5], p=0.01). Presence of a tracheostomy and pre-hospital non-ambulatory status were associated with receipt of PT by day 14 of MV (OR 6.94 and 3.42 respectively, p=≤0.05). Conclusions In our study, we found that PT for PMV patients occurs infrequently and is generally of low intensity. Level of sedation, presence of a tracheostomy and pre-hospital non-ambulatory status were associated with receipt of PT consultation by day 14 of MV.

Limiting sedation for patients with acute respiratory distress syndrome – time to wake up

“…22–25 Early mobilization is limited by use of deep sedation and development of delirium, which can be minimized through the use of scale-based targeted light sedation is implemented early on. 26 …”

Existe diferença na mobilização precoce entre os pacientes clínicos e cirúrgicos ventilados mecanicamente em UTI?

“…Physical and functional deficiencies are common sequelae in patients admitted to ICUs 6 due to bed rest, which favors reduction of muscle mass and decrease of muscle efficiency and force 7 . These musculoskeletal changes also involve the vascular system (with decrease of venous return) and the respiratory system (due to respiratory muscle weakness), thus hindering the withdrawal of the MV 3,8 .…”

“…The study by Jolley et al 7 analyzed factors that influenced the performance of physiotherapy in patients on prolonged MV, and found that the septic shock did not interfere in the evolution of physiotherapy. We believe that the same has occurred in our study because, despite clinical patients having presented greater incidence of sepsis, this condition did not change the physiotherapeutic conduct with patients sitting as early than the surgical ones.…”

Does the APACHE II score predict performance of activities of daily living in patients discharged from a weaning center?

“…No more than half of patients in weaning centers receive adequate physical therapy with regard to its frequency and intensity [20–22]. Nevertheless, it was confirmed that appropriate rehabilitation during hospital stay increases the BI approximately twofold and the weaning success by about 50% [21], while early mobilization is a positive independent factor contributing to being discharged home [23].…”