Early physical rehabilitation dosage in the intensive care unit associates with hospital outcomes after critical COVID-19.

Autor: Mayer KP; Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 Rose Street, Lexington, KY, 40536, USA. Kpmaye2@uky.edu., Haezebrouck E; University of Michigan Hospital, University of Michigan Health, Ann Arbor, MI, USA., Ginoza LM; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA., Martinez C; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA., Jan M; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA., Michener LA; Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA., Fresenko LE; Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 Rose Street, Lexington, KY, 40536, USA., Montgomery-Yates AA; Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA., Kalema AG; Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA., Pastva AM; Division of Physical Therapy, Duke University School of Medicine, Durham, NC, USA., Biehl M; Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA., Mart MF; Division of Allergy, Pulmonary, and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA.; Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Nashville, TN, USA.; Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Veterans Affairs Healthcare System, Nashville, TN, USA., Johnson JK; Division of Physical Therapy, Duke University School of Medicine, Durham, NC, USA.; Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Jul 18; Vol. 28 (1), pp. 248. Date of Electronic Publication: 2024 Jul 18.
DOI: 10.1186/s13054-024-05035-6
Abstrakt: Objective: To examine the relationship between physical rehabilitation parameters including an approach to quantifying dosage with hospital outcomes for patients with critical COVID-19.
Design: Retrospective practice analysis from March 5, 2020, to April 15, 2021.
Setting: Intensive care units (ICU) at four medical institutions.
Patients: n = 3780 adults with ICU admission and diagnosis of COVID-19.
Interventions: We measured the physical rehabilitation treatment delivered in ICU and patient outcomes: (1) mortality; (2) discharge disposition; and (3) physical function at hospital discharge measured by the Activity Measure-Post Acute Care (AM-PAC) "6-Clicks" (6-24, 24 = greater functional independence). Physical rehabilitation dosage was defined as the average mobility level scores in the first three sessions (a surrogate measure of intensity) multiplied by the rehabilitation frequency (PT + OT frequency in hospital).
Measurements and Main Results: The cohort was a mean 64 ± 16 years old, 41% female, mean BMI of 32 ± 9 kg/m 2 and 46% (n = 1739) required mechanical ventilation. For 2191 patients who received rehabilitation, the dosage and AM-PAC at discharge were moderately, positively associated (Spearman's rho [r] = 0.484, p < 0.001). Multivariate linear regression (model adjusted R 2  = 0.68, p < 0.001) demonstrates mechanical ventilation (β = - 0.86, p = 0.001), average mobility score in first three sessions (β = 2.6, p < 0.001) and physical rehabilitation dosage (β = 0.22, p = 0.001) were predictive of AM-PAC scores at discharge when controlling for age, sex, BMI, and ICU LOS.
Conclusions: Greater physical rehabilitation exposure early in the ICU is associated with better physical function at hospital discharge.
(© 2024. The Author(s).)
Databáze: MEDLINE
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