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

Autor:	Fuest KE; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Lorenz M; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.; Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Grunow JJ; Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Weiss B; Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Mörgeli R; Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany., Finkenzeller S; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Bogdanski R; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Heim M; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Kapfer B; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Kriescher S; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Lingg C; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Martin J; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Ulm B; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany., Jungwirth B; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.; Department of Anesthesiology, Universitätsklinikum Ulm, Ulm, Germany., Blobner M; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.; Department of Anesthesiology, Universitätsklinikum Ulm, Ulm, Germany., Schaller SJ; Department of Anesthesiology and Intensive Care, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.; Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Jazyk:	angličtina
Zdroj:	Frontiers in medicine [Front Med (Lausanne)] 2021 Nov 04; Vol. 8, pp. 748812. Date of Electronic Publication: 2021 Nov 04 (Print Publication: 2021).
DOI:	10.3389/fmed.2021.748812
Abstrakt:	Background: Long-term outcome is determined not only by the acute critical illness but increasingly by the reduced functional reserve of pre-existing frailty. The patients with frailty currently account for one-third of the critically ill, resulting in higher mortality. There is evidence of how frailty affects the intrahospital functional trajectory of critically ill patients since prehospital status is often missing. Methods: In this prospective single-center cohort study at two interdisciplinary intensive care units (ICUs) at a university hospital in Germany, the frailty was assessed using the Clinical Frailty Scale (CFS) in the adult patients with critical illness with an ICU stay >24 h. The functional status was assessed using the sum of the subdomains "Mobility" and "Transfer" of the Barthel Index (MTB) at three time points (pre-hospital, ICU discharge, and hospital discharge). Results: We included 1,172 patients with a median age of 75 years, of which 290 patients (25%) were frail. In a propensity score-matched cohort, the probability of MTB deterioration till hospital discharge did not differ in the patients with frailty (odds ratio ( OR ) 1.3 [95% CI 0.8-1.9], p = 0.301), confirmed in several sensitivity analyses in all the patients and survivors only. Conclusion: The patients with frailty have a reduced functional status. Their intrahospital functional trajectory, however, was not worse than those in non-frail patients, suggesting a rehabilitation potential of function in critically ill patients with frailty. Competing Interests: BW reports personal fees from Orion Pharma Ltd and national (DAAD) and international grants (ESICM) outside the submitted work. BJ received honoraria for giving lectures from Pulsion Medical Systems SE (Feldkirchen, Germany). MB received research support from MSD (Haar, Germany) not related to this manuscript, received honoraria for giving lectures from GE Healthcare (Helsinki, Finland) and Grünenthal (Aachen, Germany). SS reports grants and non-financial support from ESICM (Brussels, Belgium), Fresenius (Germany), Liberate Medical LLC (Crestwood, USA), Reactive Robotics GmbH (Munich, Germany), STIMIT AG (Nidau, Switzerland) as well as from Technical University of Munich, Germany, from national (e.g. DGAI) and international (e.g. ESICM) medical societies (or their congress organizers) in the field of anesthesiology and intensive care, personal fees and non-financial support from Bavarian Medical Association, all outside the submitted work; SS holds stocks in small amounts from Alphabeth Inc., Bayer AG, Rhön-Klinikum AG, and Siemens AG. These did not have any influence on this study. The remaining authors declare that they have no competing interests. (Copyright © 2021 Fuest, Lorenz, Grunow, Weiss, Mörgeli, Finkenzeller, Bogdanski, Heim, Kapfer, Kriescher, Lingg, Martin, Ulm, Jungwirth, Blobner and Schaller.)
Databáze:	MEDLINE
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