Risk Factors of Patient-Related Safety Events during Active Mobilization for Intubated Patients in Intensive Care Units—A Multi-Center Retrospective Observational Study

Katsukawa, Hajime; Ota, Kohei; Liu, Keibun; Morita, Yoko; Watanabe, Shinichi; Sato, Kazuhiro; Ishii, Kenzo; Yasumura, Daisetsu; Y, Takahashi; Tani, Takafumi; Oosaki, Hitoshi; Nanba, Tomoya; Kozu, Ryo; Kotani, Toru

doi:10.3390/jcm10122607

Cited by 13 publications

(15 citation statements)

References 36 publications

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“…The report noted that there was little impact on medical management or treatment caused by AEs, which could be resolved by sutures for falling, replacement following tube removal, increased oxygenation and end-expiratory positive pressure, and bed rest. SAEs were also not observed in a report investigating AEs when aggressive mobilization was performed in patients with intubated tracheas in the ICU [ 13 ].…”

Section: Discussionmentioning

confidence: 94%

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Investigation of Adverse Events Occurring during Rehabilitation in Acute Care Hospital

Kinoshita

Nishimura

Umemoto

et al. 2022

JCM

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Adverse events (AEs) during intensive care unit (ICU) rehabilitation and serious AEs during acute care hospital stays have been reported previously. However, no AEs have been reported for all patients needing rehabilitation in a non-ICU setting at an acute care hospital. This study aimed to investigate all AEs during acute-phase rehabilitation. Reports of AEs occurring during acute-phase rehabilitation in a university hospital from 1 April 2021 to 31 March 2022 were retrospectively analyzed. Minor and severe AEs were defined as those that did not require new treatment and those that required intensive treatment and/or prolonged hospitalization, respectively. There were 113 incidences of AEs during rehabilitation. The majority of AEs were minor (93.8%) and did not require new treatment. Only one serious AE was documented. The most common AEs were peripheral intravenous tube removal, decreased level of consciousness, poor mood due to low blood pressure, and falling down. There was no significant correlation between years of experience and the frequency of AEs. The neurosurgery department had the highest cases of AEs. Physical, occupational, and speech-language-hearing therapists had different characteristics and experiences of AEs. Risk management strategies should consider exercise load and targeted disorders due to differences in therapists’ specialties.

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Section: Discussionmentioning

confidence: 94%

“…It has been reported that most AEs occurring during rehabilitation in the intensive care unit (ICU) setting did not warrant additional treatment, cost, or prolonged hospitalization [ 11 , 12 , 13 , 14 ]. However, for patients in acute care hospitals, reports on AEs occurring during rehabilitative care are still lacking.…”

Section: Introductionmentioning

confidence: 99%

Investigation of Adverse Events Occurring during Rehabilitation in Acute Care Hospital

Kinoshita

Nishimura

Umemoto

et al. 2022

JCM

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“…In a study regarding the active mobilization of intubated patients, Katsukawa et al found that the highest incidence of adverse events occurred in standing mobilizations [ 38 ]. Adverse events were correlated with highest mobilization levels under logistic regression analysis [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic impact of early mobilization in critical patients receiving vasoactive drugs: A prospective cohort study

et al. 2022

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Background Vasoactive drugs are one of the most common patient-related barriers to early mobilization. Little is known about the hemodynamic effects of early mobilization on patients receiving vasoactive drugs. This study aims to observe and describe the impact of mobilization on the vital signs of critical patients receiving vasoactive drugs as well as the occurrence of adverse events. Methods This is a cohort study performed in an Intensive Care Unit with patients receiving vasoactive drugs. All patients, either mobilized or non-mobilized, had their clinical data such as vital signs [heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and oxygen saturation], type and dosage of the vasoactive drug, and respiratory support collected at rest. For mobilized patients, the vital signs were also collected after mobilization, and so was the highest level of mobility achieved and the occurrence of adverse events. The criteria involved in the decision of mobilizing the patients were registered. Results 53 patients were included in this study and 222 physiotherapy sessions were monitored. In most of the sessions (n = 150, 67.6%), patients were mobilized despite the use of vasoactive drugs. There was a statistically significant increase in heart rate and respiratory rate after mobilization when compared to rest (p<0.05). Only two (1.3%) out of 150 mobilizations presented an adverse event. Most of the time, non-mobilizations were justified by the existence of a clinical contraindication (n = 61, 84.7%). Conclusions The alterations observed in the vital signs of mobilized patients may have reflected physiological adjustments of patients’ cardiovascular and respiratory systems to the increase in physical demand imposed by the early mobilization. The adverse events were rare, not serious, and reversed through actions such as a minimal increase of the vasoactive drug dosage.

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“…Furthermore, we performed a post hoc analysis to investigate the association between the highest intensity level based on the IMS score or the duration from ECMO cannulation to the first mobilization and the occurrence of bleeding complications with the same covariates that were mentioned previously to evaluate the effects of rehabilitation intensity 22 …”

Section: Methodsmentioning

confidence: 99%

Risk factors for bleeding complications during venovenous extracorporeal membrane oxygenation as a bridge to recovery

et al. 2022

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Background Bleeding complications during venovenous extracorporeal membrane oxygenation (V‐V ECMO) can be critical. However, there is limited information on the associated risk factors. This study investigated the risk factors for bleeding complications during V‐V ECMO as a bridge to recovery. Methods This single‐center retrospective study enrolled 59 patients (bleeding and non‐bleeding groups) who received V‐V ECMO from 2012 to 2020, to evaluate whether peak activated partial thromboplastin time (APTT) value, lowest platelet count, and mobilization to sitting on the edge of the bed during V‐V ECMO were risk factors for bleeding complications, defined according to the Extracorporeal Life Support Organization guidelines. Age, sex, body mass index, Sequential Organ Failure Assessment score, and ECMO duration before bleeding complications were covariates in the multivariate logistic regression analysis. Results Thirty‐one (53%) participants experienced 36 bleeding complications; the ECMO cannulation site, gastrointestinal tract, and nasopharyngeal region were the most common bleeding sites. The use of transfusion products and length of ECMO and intensive care unit stay were significantly and medical costs were non‐significantly increased in the bleeding group. Peak APTT (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01–1.05, p < 0.01) was significantly associated whereas the lowest platelet count (OR 0.96, 95% CI 0.82–1.13, p = 0.66) was unassociated with bleeding complications during ECMO. Achieving mobilization (OR 0.14, 95% CI 0.02–1.17, p = 0.07) decreased the trend of risk for bleeding complications. Conclusions Peak APTT might be an independent modifiable factor for bleeding complications during V‐V ECMO. The protective effect of mobilization during V‐V ECMO requires further investigation.

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Risk Factors of Patient-Related Safety Events during Active Mobilization for Intubated Patients in Intensive Care Units—A Multi-Center Retrospective Observational Study

Cited by 13 publications

References 36 publications

Investigation of Adverse Events Occurring during Rehabilitation in Acute Care Hospital

Investigation of Adverse Events Occurring during Rehabilitation in Acute Care Hospital

Hemodynamic impact of early mobilization in critical patients receiving vasoactive drugs: A prospective cohort study

Risk factors for bleeding complications during venovenous extracorporeal membrane oxygenation as a bridge to recovery

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