Intensive Care Physiotherapy during Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome
| Autor: | Ravi Doobay, Marcelo Cypel, Vincent Lo, Julian DeBacker, Tadahiro Kobayashi, Niall D. Ferguson, Teagan Telesnicki, Laveena Munshi, Nathalie Cote, Shaf Keshavjee, Eddy Fan |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty ARDS Critical Care medicine.medical_treatment Acute respiratory distress law.invention 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine law Intensive care Odds Ratio Extracorporeal membrane oxygenation Humans Medicine Hospital Mortality Intensive care medicine Physical Therapy Modalities Retrospective Studies Ontario Respiratory Distress Syndrome Univariate analysis Rehabilitation business.industry 030208 emergency & critical care medicine Retrospective cohort study Middle Aged medicine.disease Intensive care unit Intensive Care Units Logistic Models 030228 respiratory system Multivariate Analysis Physical therapy Female business |
| Zdroj: | Annals of the American Thoracic Society. 14:246-253 |
| ISSN: | 2325-6621 2329-6933 |
| DOI: | 10.1513/annalsats.201606-484oc |
| Popis: | There are limited data on physiotherapy during extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS).We sought to characterize physiotherapy delivered to patients with ARDS supported with ECMO, as well as to evaluate the association of this therapeutic modality with mortality.We conducted a retrospective cohort study of all adult patients with ARDS supported with ECMO at our institution between 2010 and 2015. The highest level of daily activity while on ECMO was coded using the ICU Mobility Scale. Through multivariable logistic regression, we evaluated the association between intensive care unit (ICU) physiotherapy and ICU mortality. In an exploratory univariate analysis, we also evaluated factors associated with a higher intensity of ICU rehabilitation while on ECMO.Of 107 patients who underwent ECMO, 61 (57%) had ARDS requiring venovenous ECMO. The ICU physiotherapy team was consulted for 82% (n = 50) of patients. Thirty-nine percent (n = 18) of these patients achieved an activity level of 2 or higher (active exercises in bed), and 17% (n = 8) achieved an activity level 4 or higher (actively sitting over the side of the bed). In an exploratory analysis, consultation with the ICU physiotherapy team was associated with decreased ICU mortality (odds ratio, 0.19; 95% confidence interval, 0.04-0.98). In univariate analysis, severity-of-illness factors differentiated higher-intensity and lower-intensity physiotherapy.Physiotherapy during ECMO is feasible and safe when performed by an experienced team and executed in stages. Although our study suggests an association with improved ICU mortality, future research is needed to identify potential barriers, optimal timing, dosage, and safety profile. |
| Databáze: | OpenAIRE |
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