Patients admitted to an intensive care unit who do not adopt an antigravity posture have a higher odds of death
DOI:
https://doi.org/10.1590/1809-2950/17027526032019Keywords:
Critical Care, Intensive Care Units, Early Ambulation, Rehabilitation, Exercise TherapyAbstract
Until now, few functional performance markers are able to predict death in Intensive Care Units (ICUs). This study aimed to identify the association between non-adoption of antigravity posture and death in patients admitted to an adult ICU. It is a retrospective and analytical study, performed through the analysis of medical records. Association between non-adoption of antigravity posture and death was tested by multiple logistic regression adjusted for gender, age, disease severity (measured by Acute Physiology and Chronic Health Classification System II [Apache II]), time of invasive mechanical ventilation (IMV), and period of sedation. The odds ratio (OR) with confidence interval (CI=95%) was estimated. A total of 92 sequential patients were included in the study. A strong association between the non-adoption of antigravity posture in the ICU and death (ORadjusted=37.7, CI=4.76-293, p=0.001) was observed. Thus, one can conclude that patients who did not adopt an antigravity posture during ICU admission had a much higher odds of mortality. This simple strategy to classify functional capacity of critical patients can be routinely used by the team as a simple and dichotomous variable for ICU mortality prognosis.
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References
Cameron S, Ball I, Cepinskas G, Choong K, Doherty TJ, Ellis
CG, et al. Early mobilization in the critical care unit: a review of
adult and pediatric literature. J Crit Care. 2015;30(4):664-72.
doi: 10.1016/j.jcrc.2015.03.032
Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L,
et al. Early intensive care unit mobility therapy in the treatment
of acute respiratory failure. Crit Care Med. 2008;36(8):2238-43.
doi: 10.1097/CCM.0b013e318180b90e
Dantas CM, Silva PFS, Siqueira FHT, Pinto RMF, Matias S,
Maciel C, et al. Influência da mobilização precoce na força
muscular periférica e respiratória em pacientes críticos.
Rev Bras Ter Intensiva. 2012;24(2):173-8. doi: 10.1590/
S0103-507X2012000200013
Feliciano V, Albuquerque CG, Andrade FMD, Dantas CM, Lopez
A, Ramos FF, et al. A influência da mobilização precoce no
tempo de internamento na Unidade de Terapia Intensiva.
ASSOBRAFIR Ciênc. 2012;3(2):31-42
Carvalho TG, Silva ALG, Santos ML, Schäfer J, Cunha LS, Santos
LJ. Relação entre saída precoce do leito na unidade de terapia
intensiva e funcionalidade pós-alta: um estudo piloto. Rev
Epidemiol Control Infect. 2013;3(3):82-6
Murakami FM, Yamaguti WP, Onoue MA, Mendes JM, Pedrosa
RS, Maida ALV, et al. Evolução funcional de pacientes graves
submetidos a um protocolo de reabilitação precoce. Rev Bras Ter
Intensiva. 2015;27(2):161-9. doi: 10.5935/0103-507X.20150028
Hodgson C, Bellomo R, Berney S, Bailey M, Buhr H, Denehy
L, et al. Early mobilization and recovery in mechanically
ventilated patients in the ICU: a bi-national, multi-centre,
prospective cohort study. Crit Care. 2015;19(1):81-91. doi: 10.1186/
s13054-015-0765-4
Harrold ME, Salisbury LG, Webb SA, Allison GT. Early
mobilisation in intensive care units in Australia and Scotland: a
prospective, observational cohort study examining mobilisation
practises and barriers. Crit Care. 2015;19(1):336-9. doi: 10.1186/
s13054-015-1033-3
Kasotakis G, Schmidt U, Perry D, Grosse-Sundrup M, Benjamin
J, Ryan C, et al. The surgical intensive care unit optimal mobility
score predicts mortality and length of stay. Crit Care Med.
;40(4):1122-8. doi: 10.1097/CCM.0b013e3182376e6d
Sigler M, Nugent K, Alalawi R, Selvan K, Tseng J, Edriss H, et
al. Making of a successful early mobilization program for a
medical intensive care unit. South Med J. 2016;109(6):342-5.
doi: 10.14423/SMJ.0000000000000472
Nydahl P, Ruhl AP, Bartoszek G, Dubb R, Filipovic S, Flohr HJ,
et al. Early mobilization of mechanically ventilated patients:
a 1-day point-prevalence study in Germany. Crit Care Med.
;42(5):1178-86. doi: 10.1097/CCM.0000000000000149
Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados
N, Cooper A, et al. Functional disability 5 years after acute
respiratory distress syndrome. N Engl J Med. 2011;364(14):1293-
doi: 10.1056/NEJMoa1011802
Hermans G, Mechelen HV, Clerckx B, Vanhullebusch T, Mesotten
D, Wilmer A, et al. Acute outcomes and 1-year mortality of ICUacquired weakness: a cohort study and propensity matched
analysis. Am J Respir Crit Care Med. 2014;190(4):410-20. doi:
1164/rccm.201312-2257OC
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE
II: a severity of disease classification system. Crit Care Med.
;13(10):818-29
Berney S, Haines K, Skinner EH, Denehy L. Safety and feasibility
of an exercise prescription approach to rehabilitation across
the continuum of care for survivors of critical illness. Phys Ther.
;92(12):1524-35. doi: 10.2522/ptj.20110406
Kayambu G, Boots R, Paratz J. Physical therapy for the
critically ill in the ICU: a systematic review and metaanalysis. Crit Care Med. 2013;41(6):1543-54. doi: 10.1097/
CCM.0b013e31827ca637
McWilliams D, Weblin J, Atkins G, Bion J, Williams J, Elliott C, et
al. Enhancing rehabilitation of mechanically ventilated patients
in the intensive care unit: a quality improvement project. J Crit
Care. 2015;30(1):13-8. doi: 10.1016/j.jcrc.2014.09.018
Hopkins RO, Mitchell L, Thomsen GE, Schafer M, Link M, Brown
SM. Implementing a mobility program to minimize postintensive care syndrome. AACN Adv Crit Care. 2016;27(2):187-
doi: 10.4037/aacnacc2016244
Hunter A, Johnson L, Coustasse A. Reduction of intensive
care unit length of stay: the case of early mobilization.
Health Care Manag. 2014;33(2):128-35. doi: 10.1097/
HCM.0000000000000006
Stiller K. Physiotherapy in intensive care: an updated systematic
review. Chest. 2013;144(3):825-47. doi: 10.1378/chest.12-2930
Laurent H, Aubreton S, Richard R, Gorce Y, Caron E, Vallat
A, et al. Systematic review of early exercise in intensive
care: a qualitative approach. Anaesth Crit Care Pain Med.
;35(2):133-49. doi: 10.1016/j.accpm.2015.06.014
Dong Z, Yu B, Sun Y, Fang W, Li L. Effects of early rehabilitation
therapy on patients with mechanical ventilation. World
J Emerg Med. 2014;5(1):48-52. doi: 10.5847/wjem.j.is
sn.1920-8642.2014.01.008
Berney SC, Harrold M, Webb SA, Seppelt I, Patman S, Thomas PJ,
et al. Intensive care unit mobility practices in Australia and New
Zealand: a point prevalence study. Crit Care Resusc. 2013;15(4):260-5
Borges RC, Carvalho CR, Colombo AS, Borges MPS, Soriano
FG. Physical activity, muscle strength, and exercise capacity
months after severe sepsis and septic shock. Intensive Care
Med. 2015;41(8):1433-44. doi: 10.1007/s00134-015-3914-y
Iwashyna TJ, Cooke CR, Wunsch H, Kahn JM. Population
burden of long-term survivorship after severe sepsis in
older Americans. J Am Geriatr Soc. 2012;60(6):1070-7. doi:
1111/j.1532-5415.2012.03989.x
Williams PT. Inadequate exercise as a risk factor for sepsis
mortality. PLoS One. 2013;8(12):1-7. doi: 10.1371/journal.
pone.0079344
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