An Early Tailored Approach Is the Key to Effective Rehabilitation in the Intensive Care Unit.

Autor:	Chiarici A; Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy., Andrenelli E; Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy. Electronic address: elisa.andrenelli@gmail.com., Serpilli O; Neurorehabilitation Clinic, United Hospitals of Ancona, Ancona, Italy., Andreolini M; Neurorehabilitation Clinic, United Hospitals of Ancona, Ancona, Italy., Tedesco S; Department of Clinical and Molecular Science, Internal Medicine, Marche Polytechnic University, Ancona, Italy., Pomponio G; Department of Clinical and Molecular Science, Internal Medicine, Marche Polytechnic University, Ancona, Italy., Gallo MM; Clinical Management Directorate, United Hospitals of Ancona, Ancona, Italy., Martini C; Clinical Management Directorate, United Hospitals of Ancona, Ancona, Italy., Papa R; Clinical Management Directorate, United Hospitals of Ancona, Ancona, Italy., Coccia M; Neurorehabilitation Clinic, United Hospitals of Ancona, Ancona, Italy., Ceravolo MG; Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Marche Polytechnic University, Ancona, Italy.
Jazyk:	angličtina
Zdroj:	Archives of physical medicine and rehabilitation [Arch Phys Med Rehabil] 2019 Aug; Vol. 100 (8), pp. 1506-1514. Date of Electronic Publication: 2019 Feb 21.
DOI:	10.1016/j.apmr.2019.01.015
Abstrakt:	Objective: To investigate the effectiveness, feasibility, and safety of an evidence-based rehabilitation care pathway in the intensive care unit (ICU) in different patient populations. Design: Observational prospective cohort study, with retrospective controls. Setting: ICUs of a university hospital. Participants: Patients admitted between April 1, 2015, and June 30, 2015, were compared to a retrospective cohort admitted to the same ICUs during the same 3-month period in 2014. The number of patients studied (N=285) included 152 in the prospective group and 133 in the retrospective group. Interventions: The prospective cohort benefited of a rehabilitation care pathway based on (1) interdisciplinary teamwork; (2) early customized and goal-oriented rehabilitation; (3) daily functional monitoring and treatment revision; (4) agreed discharge policy; and (5) continuity of care. The retrospective cohort underwent usual care. Main Outcome Measures: Included the following: (1) proportions of patients undergoing rehabilitation team evaluation; (2) latency between patient admission to ICUs and rehabilitation team assessment; (3) proportions of patients undergoing rehabilitation treatment during ICU stay; (4) latency between the patient admission to ICUs and rehabilitation start; (5) ICU stay and total acute hospital stay; and (5) proportion of ventilator-free days out of ICU stay. Results: The novel rehabilitation care pathway led to (1) an increased proportion of patients receiving rehabilitative assessment (P<.0001); (2) a decreased latency from ICU admission to both rehabilitation team assessment and rehabilitation start (P<.0001); (3) an increased proportion of patients undergoing rehabilitation (P<.0001); (4) a shorter length of stay in ICUs (P<.0001) and in hospital (P=.047); and (5) a shorter mechanical ventilation duration (P<.02). A direct relationship between rehabilitation start latency and ICU length of stay was observed. Conclusions: An early, interdisciplinary team approach, providing a customized dynamic planning of physiotherapy programs, increases ventilator-free time and reduces total hospital stay, especially in patients admitted to the ICU after general surgery. This rehabilitation care pathway can be generalized to different geopolitical scenarios, being feasible, safe and cost effective. (Copyright © 2019 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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