Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial
| Autor: | Stephanie D. Grabitz, Manfred Blobner, Daniel Talmor, Nicola Latronico, Matthew J. Meyer, Thomas Peponis, Matthew Anstey, Thomas Edrich, George C. Velmahos, Tobias Kurth, Matthias Eikermann, Stefan J. Schaller, Timothy T. Houle, Karen Waak, Markus Heim, J. Matthias Walz, Ilse Gradwohl-Matis, Jarone Lee, Ross Zafonte |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Research design Pediatrics medicine.medical_specialty Critical Care Medizin Surgical intensive care unit Intensive Care Units Rehabilitation Outcome Patient Care Planning law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Germany Internal medicine medicine Hospital discharge Humans Single-Blind Method 030212 general & internal medicine Adverse effect Early Ambulation Physical Therapy Modalities Aged Sicus biology business.industry Standard treatment Reproducibility of Results Confounding Factors Epidemiologic 030208 emergency & critical care medicine General Medicine Middle Aged biology.organism_classification University hospital United States Treatment Outcome Research Design Austria Surgical Procedures Operative Female business Algorithms |
| Zdroj: | The Lancet. 388:1377-1388 |
| ISSN: | 0140-6736 |
| DOI: | 10.1016/s0140-6736(16)31637-3 |
| Popis: | Immobilisation predicts adverse outcomes in patients in the surgical intensive care unit (SICU). Attempts to mobilise critically ill patients early after surgery are frequently restricted, but we tested whether early mobilisation leads to improved mobility, decreased SICU length of stay, and increased functional independence of patients at hospital discharge.We did a multicentre, international, parallel-group, assessor-blinded, randomised controlled trial in SICUs of five university hospitals in Austria (n=1), Germany (n=1), and the USA (n=3). Eligible patients (aged 18 years or older, who had been mechanically ventilated for48 h, and were expected to require mechanical ventilation for ≥24 h) were randomly assigned (1:1) by use of a stratified block randomisation via restricted web platform to standard of care (control) or early, goal-directed mobilisation using an inter-professional approach of closed-loop communication and the SICU optimal mobilisation score (SOMS) algorithm (intervention), which describes patients' mobilisation capacity on a numerical rating scale ranging from 0 (no mobilisation) to 4 (ambulation). We had three main outcomes hierarchically tested in a prespecified order: the mean SOMS level patients achieved during their SICU stay (primary outcome), and patient's length of stay on SICU and the mini-modified functional independence measure score (mmFIM) at hospital discharge (both secondary outcomes). This trial is registered with ClinicalTrials.gov (NCT01363102).Between July 1, 2011, and Nov 4, 2015, we randomly assigned 200 patients to receive standard treatment (control; n=96) or intervention (n=104). Intention-to-treat analysis showed that the intervention improved the mobilisation level (mean achieved SOMS 2·2 [SD 1·0] in intervention group vs 1·5 [0·8] in control group, p0·0001), decreased SICU length of stay (mean 7 days [SD 5-12] in intervention group vs 10 days [6-15] in control group, p=0·0054), and improved functional mobility at hospital discharge (mmFIM score 8 [4-8] in intervention group vs 5 [2-8] in control group, p=0·0002). More adverse events were reported in the intervention group (25 cases [2·8%]) than in the control group (ten cases [0·8%]); no serious adverse events were observed. Before hospital discharge 25 patients died (17 [16%] in the intervention group, eight [8%] in the control group). 3 months after hospital discharge 36 patients died (21 [22%] in the intervention group, 15 [17%] in the control group).Early, goal-directed mobilisation improved patient mobilisation throughout SICU admission, shortened patient length of stay in the SICU, and improved patients' functional mobility at hospital discharge.Jeffrey and Judy Buzen. |
| Databáze: | OpenAIRE |
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