Investigating inpatient rehabilitation outcomes of patients with intensive care unit–acquired weakness, and identifying comorbidities associated with unfavorable outcomes

Abstract

Introduction Data are consistent on the benefits of inpatient rehabilitation for intensive care unit–acquired weaknesses (ICUAW), including critical illness myopathy, critical illness polyneuropathy, critical illness polyneuromyopathy, and disuse atrophy. This study focuses on the effects of inpatient rehabilitation on patients with ICUAW, specifically those with a clinical pattern of proximal muscle weakness and sensory sparing. Objectives To evaluate the impact of inpatient rehabilitation on patients with ICUAW versus other medically complex patients, and to identify comorbidities associated with poor rehabilitation outcomes. Design Retrospective cohort study. Setting Institutional, inpatient rehabilitation hospital. Patients Two hundred seventy adult patients (≥18 years) divided into two groups: diagnosis of ICUAW (N = 55) or otherwise medically complex (N = 215), and admitted under the care of one physiatrist. Interventions Not applicable. Main Outcome Measures For all patients we compared functional independence measure (FIM) gain, FIM efficiency, rehabilitation length of stay (RLOS), discharge disposition, and major medical comorbidities. Results Patients with ICUAW had significantly greater FIM gain (P = .015) and RLOS (P = .02). There was no significant difference in FIM efficiency (P = .15). Patients with ICUAW had a significantly lower odds of acute hospital transfer (odds ratio [OR] = 0.52, with 95% confidence interval [CI] 0.47, 0.58) and skilled nursing facility discharge (OR = 0.19, with 95% CI 0.038, 0.95). However, patients with ICUAW did have a higher percent of acute hospital transfers than other medically complex patients (P = .017). In addition, patients with ICUAW were more medically complex, as evidenced by a significantly higher Charlson Comorbidity Index (P < .001), prevalence of anemia (P < .001), atrial fibrillation (P = .009), obstructive sleep apnea (P = .018), and bacteremia (P = .041). Conclusions Patients with ICUAW with a clinical pattern of proximal muscle weakness and sensory sparing benefit from inpatient rehabilitation as evidenced by FIM gain and high home discharge rate. However, they have multiple medical comorbidities, which require judicious medical management and may contribute to a longer RLOS.

Effect of early progressive mobilization on intensive care unit-acquired weakness in mechanically ventilated patients: An observational study

“…some studies suggested that ICU-AW may occur within several hours after patients receiving mechanical ventilation, the early intervention can reduce incidence of ICU-AW, and the earlier intervention can achieve the better effect. [10–12] So it has an important clinical value to explore an optimum proposal for early progressive mobilization. [13]…”

“…some studies suggested that ICU-AW may occur within several hours after patients receiving mechanical ventilation, the early intervention can reduce incidence of ICU-AW, and the earlier intervention can achieve the better effect. [10][11][12] So it has an important clinical value to explore an optimum proposal for early progressive mobilization. [13] In this study, The MRC score and Barthel index score of the intervention group were significantly higher than those of the control group, suggesting that early progressive mobilization can effectively improve the muscle weakness.…”

Acute Inpatient Rehabilitation Improves Function Independent of Comorbidities in Medically Complex Patients

“…This study excluded patients under RIC-1-8, 10-13, 17-19, or 21 who are CMS's “60 Percent Rule” complaint. However, 55 patients with intensive care unit–acquired weakness 32 equivalent to critical illness myopathy who are considered CMS compliant under RIC-6 were included in this study because they are often coded as having debility (IGC16) under RIC-20.…”

The role of the microcirculation and integrative cardiovascular physiology in the pathogenesis of ICU-acquired weakness

“…The reported incidence of ICU-AW is variable, partially due to inconsistent diagnostic criteria, ranging from 7% to 76% of ICU patients, with an approximate estimate of 40% in the general ICU population ( Appleton et al, 2015 ). Baseline risk factors that increase the likelihood of developing ICU-AW are age ( Moisey et al, 2013 ), and medical comorbidities such as chronic heart failure, anemia, and renal disease ( Rudra et al, 2021 ); risk factors that develop within the ICU are duration of mechanical ventilation, diagnosis of sepsis, severity of critical illness, hyperglycemia, use of glucocorticoids and neuromuscular blockade, and prolonged immobilization ( Yang et al, 2018 ). There are currently no targeted therapies that can prevent or reverse the natural trajectory of ICU-AW, signifying an urgent and unmet need in the treatment of this condition.…”